• many causes;

  • normal tenderness in intiial days to weeks

    • expect tenderness at beginnning of feed until about d7-10 post birth

    • peak tenderness between d3-6

    • after 10d not normal

  • poor positioning and attachment

  • infection of nipple

  • vasospasm

    • blanched nipple - Raynaud’s-type phenomenon

      • avoid caffeine/nicotine as may exacerbate

      • latch/positioning

      • try nifedipine

  • milk blisters -> blocked nipple pore

  • BF should not hurt

    • pain = problem

Management

Normal tendnernss

• reassure

• make sure positioning and attachment are correct

Nipple infection

• fluclox for bacterial infection

• candida

  • oral antifungal liquid - nystatin for baby

  • topical antifungal for mother - effective

    • excess cream should be removed from the nipple before BF

    • Oral fluconazole may be required in more severfe/painful cases

      • Use is unlicensed

        • 400mg as loading

        • 200mg/day for 10d

MoH breastfeeding