Breastfeeding

Breast conditions like blocked/plugged ducts, mastitis, and milk blebs are all characterized by inflammation. They may involve any of the following symptoms:

• Redness
• Localized warmth
• Swelling
• Pain
• Loss of function

According to the World Health Organization (2000) and the Academy of Breastfeeding Medicine (2014), mastitis does not necessarily mean that there is an infection. Conservative measures are recommended as the first line treatment:

• Continue feeding the infant or pumping to remove milk
• Therapeutic breast massage
• Cold or ice (not on the nipple)
• Rest as able
• Address any latch issues

Milk blebs look like a blister on the nipple and can indicate an underlying blocked duct or inflammation. They can be removed with a sterile instrument by a trained health professional.

Cracked & painful nipples

Nipples can be painful for many reasons and should be examined by a health professional to rule out infections, rashes, and other treatable conditions.

If the symptoms are mechanical in nature – either compression or friction – then a physiotherapist can help to alleviate the pain.

Compression of the nipple typically happens because of the way that it is manipulated inside an infant’s mouth.

• Biting or gumming during feeds
• Tight jaw and/or neck muscles
• Uncoordinated suck in premature infants
• Tongue and/or lip tie

Pain from friction often comes from an ill-fitting pump flange, nipple shield, or other external device.

Torticollis – Neck & Jaw Muscles

Torticollis is a tight or short sternocleidomastoid muscle, which runs from under the ear down to the breast bone (sternum).

It’s often accompanied by other tight muscles on one side of the body. Torticollis is more common in babies that are:

• Breech position
• Long at birth (more than 51cm)
• First born
• Born with vacuum or forceps

If your infant has torticollis or other tight muscles, you may see:

• A preference to turn the head to one side
• Flat spot on the back of the head
• Difficulty opening the mouth wide
• Biting at the breast, bottle, or soother
• Preference for one breast over the other

Therapeutic Breast Massage

When the breast has inflammation and swelling, therapeutic breast massage can help to relieve symptoms. This can be done by the mother, a trained health professional, or someone else.

Swelling in the breast sits outside of the milk ducts and milk-producing areas (called the alveoli). Because of this, massaging or pushing toward the nipple is ineffective and can make the inflammation worse.

Therapeutic breast massage:

• Gentle, broad strokes
• Toward the armpit or collar bone
• 2-3 minutes
• Alternate between massage and milk removal
  • Hand expression
  • Pumping
  • Infant feeding