Expert: Sally Wendkos Olds - 11/30/2006

Question
Hello

I am writing this for my sister and her 2 month old baby. My sister has inverted nipples and she had a sore nipple when she was brestfeeding the baby initially. So she used an artifcial niple so that the baby can latch on easily. She used it continusly for 1 month and then the baby stopped latching.
Now my sister is not able to breast feed the baby from one side of her breasts because she has developed severe infection and swelling. She has already taken 2 set of antibiotics and still no improvement. It seems she cannot even stand properly because of the pain and is on bed rest now.

Can you advice on how to ease her pain, swelling and the infecion. Also, how can she make the baby latch on properly (she has invereted nipples).

Thanks.


Answer
Dear SG,

I am so sorry to hear of your sister's problems. Usually inverted nipples begin to protrude once a baby starts nursing, but apparently that has not happened for your sister. As far as the infection is concerned, it sounds as if she is under a doctor's care and that the doctor is prescribing antibiotics, which is the recommended treatment for breast infection (mastitis). I am attaching an excerpt from my book (see below) -- perhaps one of these suggestions will also help.

Meanwhile, for both of your sister's problems, I would suggest that she consult a lactation consultant as soon as possible. To find someone in her area, she can contact the International Lactation Consultant Association (ILCA) at info@ilca.org or by phone at 919-861-5577.

Good luck!

Sally

Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters.
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  BREAST INFECTION
  (MASTITIS)
When breast infections occur, they usually show up between two and six weeks after birth, but they may appear earlier or much later. A breast infection may be a complication of a clogged duct or the result of an infection carried from the baby to the mother or picked up elsewhere. Symptoms tend to appear suddenly, and may include some of the following: headache, an intense localized pain, engorgement with the breast hot and tender to the touch, redness, fever, a cracked nipple that looks infected, red streaks on the breast, and a generally sick, ache-y, flu-like feeling. If you see any of these symptoms, begin treatment right away. If you still have fever after 24 hours of treatment, call your doctor.
  Mothers with breast infections used to be told to stop nursing immediately. We now know that breast infections clear up more quickly and with fewer complications when the mother continues to nurse, and nurses frequently, from the affected breast. There is no danger from the baby's becoming ill from nursing at an infected breast; he probably harbors the same germs in his mouth and nose that may have caused the problem in his mother's breast. Occasionally a baby may not nurse well at an infected breast because the milk tastes salty. If this happens, express or pump from the infected breast and nurse from the unaffected one.
  It is important to treat a breast infection right away, as suggested in Box 15-5. With treatment, the fever should drop within 36 to 48 hours, and the soreness and hardness will go away soon afterward. If symptoms do not disappear within three days of treatment, call your doctor.
  
  BOX 15-5  TREATING A BREAST INFECTION
  * Go to bed immediately and stay there as much as you can. If you can't stay in bed, rest as much as possible.
  * Apply moist heat to the infected breast, with one or more of the following: moist-heating pad, hot water bottle, hot wet towel, soaking in basin of warm water, warm shower, or warm bath. Nurse soon after application of heat.
  * Do not apply an ice pack.
  * Nurse frequently, as often as every two hours around the clock. This will keep your milk flowing and will avoid engorgement. Be sure your baby is well positioned, and change positions so your baby is not always putting pressure at the same spot on your breast.
  * Offer the sore breast first at each nursing so that it can be drained more completely.
  * Be sure your bra is not too tight. You may want to get one in the next larger size. Or try going without one, at least while you're nursing. Also check other items that may be putting too much pressure on your breasts, like a baby carrier or a shoulder bag.
  * Drink plenty of fluids.
  * Do not wean suddenly if you can help it, since this can contribute to an abscess, a serious and painful infection that may require surgery and temporary cessation of nursing from the affected breast.
  * Call your doctor immediately upon development of symptoms of mastitis. The usual treatment for mastitis is the administration of an antibiotic for a course of from 10 to 14 days, in addition to other treatment, as indicated above. This will be safe to take while you continue to nurse. Once prescribed, the antibiotic should be taken for its full course, even if your symptoms have gone away before then.
  * If you suffer repeatedly from breast infection, see your family physician, your obstetrician, or a breast surgeon, especially if a lump is not reduced in size after three days of treatment, if the mastitis keeps reappearing at the same place on your breast, and/or if you have dimpling on the breast. Breast cancer is extremely rare in lactating women, but it does occasionally occur and must be ruled out.
  * If you have been checked out for repeated breast infection and reassured that it is not caused by a malignancy, check for other factors that may be causing the mastitis -- allowing your breasts to become too full, not alternating them, improper positioning of your baby, inadequate washing of your hands before nursing, using an unclean breast pump, or not getting enough rest. Change what you can and seek help at the first sign of infection.