Small Beginnings Perinatal Clinic

RSV Is More Contagious Than You Think While most cases of RSV disease are mild, all babies are at risk of lung infections such as bronchiolitis or pneumonia if they catch RSV.2,3

🥛 Milk Blebs: Tiny Spot, BIG Pain

If you’ve ever noticed a small white, yellow, or clear spot on your ni**le that feels like you’re nursing through a shard of glass, you may have experienced a milk bleb (sometimes called a ni**le bleb or milk blister).

For years, many of us were taught that milk blebs were simply “clogged pores” filled with trapped milk. But the updated Academy of Breastfeeding Medicine (ABM) Protocol #36 gives us a different understanding. Milk blebs are now thought to be primarily an inflammatory condition, not just a milk blockage. (PubMed)

💡 What exactly is a milk bleb?

According to ABM Protocol #36, a milk bleb occurs when inflammatory cells from inside the milk duct extend to the ni**le surface and become lodged at or near the ni**le pore. In other words, the white spot you see is often the result of inflammation, not simply milk “stuck” behind the skin.

Symptoms can include:
• A white, yellow, or clear spot on the ni**le
• Sharp, burning, or stabbing ni**le pain
• Pain during feeding or pumping
• Localized breast fullness or tenderness behind the bleb
• Recurrent areas of breast inflammation or mastitis symptoms

🤔 What causes milk blebs?

Milk blebs are often associated with inflammation within the breast and ducts. Factors that may contribute include:

• Hyperlactation (oversupply)
• Recurrent breast inflammation
• Excessive pumping
• Trying to constantly “empty” the breast
• Aggressive breast massage
• Ongoing ductal narrowing and swelling within the breast tissue
•Shallow latch or tongue tie

This is why many parents find themselves stuck in a frustrating cycle:
Inflammation → bleb → pain → more pumping/massage → more inflammation.

🛑 What NOT to do

This is the part that surprises many parents.

ABM specifically recommends NOT unroofing, popping, picking, scraping, or opening the bleb. While it may seem logical to remove the white spot, this creates additional ni**le trauma and can worsen inflammation and ductal narrowing.

Also avoid:
• Digging at the bleb with needles or fingernails
• Aggressive massage
• Excessive pumping to “clear it”
• Repeated attempts to empty the breast completely

✅ What does ABM recommend? The goal is to reduce inflammation.

Strategies may include:

• Continue feeding your baby normally
• Feed on demand rather than trying to empty the breast
• Reduce unnecessary pumping
• Use ice for comfort and inflammation
• Consider anti-inflammatory medications when medically appropriate
• Address any oversupply issues
• Work with an IBCLC to identify the root of the inflammation

For the bleb itself, the ABM recommends:

• Find and address the root cause of inflammation
•Topical steroid cream (triamcinolone cream typically prescribed by your healthcare provider) to reduce inflammation at the ni**le surface

While not in the ABM protocol, La Leche League and other breastfeeding sources have recommended
• Coconut or olive oil on the tip of the ni**le between feedings
•Some found Epsom salt soaks of the ni**le helpful which were based on older recommendations prior to the ABM protocol. Epsom salts should be avoided in the presence of mastitis or other inflammation

⏳ How long do they last?

Unfortunately, milk blebs can be stubborn. Some resolve within days, while others may persist for weeks if the underlying inflammation isn’t addressed. Treating the root cause is usually more effective than focusing solely on the white spot itself.

A milk bleb is usually not a sign that you need to pump harder, massage more aggressively, or start digging at your ni**le. In many cases, it’s your body waving a little inflammatory flag that says, “Hey, things are irritated in here.”

The solution is often less force and more inflammation management.

This is not medical advice. If you are struggling with a bleb please consult a local knowledgeable IBCLC to help you figure out the root and any specific testaments based on your unique situation.