During the first few days of breastfeeding, it's common to experience mild nipple soreness or tenderness when your baby first latches on. This tenderness should not last through the entire feeding, and it shouldn't persist for more than a few days. Very painful, cracked or bleeding nipples are not normal, and indicate that something isn't right.
What Causes Sore Nipples?
An Incorrect Latch: If your baby isn't latched on properly, sore nipples are often the result.
Breast Engorgement: Hard, swollen breasts can be very tender, especially during latch on.
Mastitis: Soreness can result from inflammation or infection of the breast.
Blebs: Blebs are small, white spots on the nipple that can cause extreme nipple pain for some women.
Nipple Blisters: Blisters can form on the nipple, damaging the skin and causing pain.
Vasopsasms: Vasospasms occur when blood vessels in the nipples squeeze together and cut off the blood flow, causing painful nipple blanching.
Breast Pumps: Using a breast pump incorrectly can cause damage to your nipples and breasts.
A Baby With a Powerful Suck: A strong, aggressive suck can hurt sensitive nipples.
Thrush: A fungal infection can cause pain, burning, redness and itching.
Dry Air: The air in certain climates or during the winter months can cause dry, irritated, cracked skin on the breast and nipples.
Eczema, Psoriasis and Dermatitis: These skin conditions can cause dry patches that crack and bleed.
A New Pregnancy: Tender nipples are common in pregnancy, especially in the first trimester. If you're breastfeeding during pregnancy, you may have to deal with sore nipples for a little while.
Things You Can Do If You Have Sore Nipples
- Do not stop breastfeeding. It's safe to breastfeed even if your nipples are cracked and bleeding: your baby will not be harmed if he swallows blood while he's nursing. Continuing to breastfeed also helps build and maintain your milk supply while preventing engorgement, plugged ducts, blebs and mastitis.
- Make sure your baby is latching on to your breast correctly. An incorrect latch is often the main reason that sore nipples occur.
- Begin nursing on the breast with the nipple that is less sore or not sore. After the feeding has started, let-down has occurred, and the baby is not as aggressively hungry, switch to the breast with the sore nipple. Once your nipples are no longer painful, go back to alternating the breast you start each feeding with.
- Rub your nipple and areola with your breast milk after each feeding to moisturize and soothe sore nipples. If possible, keep your nipples exposed and allow them to air dry.
- Ask your doctor or lactation consult if you could try a purified medical grade lanolin product or Dr. Jack Newman's All Purpose Nipple Ointment after nursing to moisturize and protect your nipples between feedings. Don't use any other lotions, creams or ointments without first discussing them with your doctor or lactation consultant, as not all products are safe for your baby, and some can cause even more irritation to your skin.
- Do not use numbing creams or sprays to help with pain, as they can cause numbness in your baby's mouth and interfere with let-down.
- Talk to your doctor about taking an over the counter pain reliever to help lessen the pain while you're nursing.
- Hydrogel pads can be chilled in the refrigerator or freezer and then placed on your breasts after feedings to help heal and soothe your nipples.
- See your doctor or a dermatologist if you have a rash or scaly patches on your skin. Skin conditions such as eczema, psoriasis and dermatitis may need to be treated with a steroid, while thrush needs to be treated with an antifungal medication.
- If you are having another baby, you can continue to breastfeed while you are pregnant, as long as you're not high risk and your doctor has not advised against it. Your nipples may remain sore throughout your first trimester or even longer.
- If you need to stop breastfeeding from one side to allow the nipple to heal, you should continue to breastfeed from the other side. Express or pump the milk from the breast that is sore to prevent engorgement, blebs, plugged ducts and a decrease in your milk supply.
- If you have to stop breastfeeding from both breasts, express or pump your breast milk very frequently to maintain your milk supply. You may also want to use an alternative feeding method, such as finger feeding or cup feeding, during the time you're not breastfeeding.
- Watch for signs of infection, which include fever, redness, swelling, yellow or green drainage and/or a warm area on the breast.
Complications of Sore Nipples
Early Weaning: Sore, cracked, or bleeding nipples might make it so painful to nurse that you no longer want to continue to breastfeed.
A Low Milk Supply: If you are breastfeeding less due to the pain, this could result in a decrease in your milk supply.
Breast Problems: Engorgement, blebs, and plugged ducts can result from not breastfeeding often enough.
Mastitis: Cracked, broken skin on the nipples can allow bacteria to enter the breast and cause an infection.
Things That May Help Prevent Sore Nipples
- Check your baby's latch and positioning. If you cannot tell whether your baby is latching on and breastfeeding properly, talk to your doctor, a lactation consultant or local La Leche group for assistance.
- Use a nursing pillow and a nursing footstool to help you get into a comfortable position that will encourage a proper latch and more effective breastfeeding.
- Alternate breastfeeding positions regularly to prevent one area of the nipple from getting sore.
- If your breasts are full and hard, express some milk before each feeding to soften them. A baby can latch on much easier to a softer breast.
- Feed your baby more frequently, and before she is very hungry. Your breasts will be softer, and the baby may have a less aggressive suck.
- Wash your breasts with warm water, and don't use soap, which can dry out, irritate and crack the skin.
- If you use nursing pads for leaking, avoid pads with plastic liners, and change them very often. Wet nursing pads left in place for a long period of time could cause the breakdown of the skin and lead to pain or infected breasts.
- When a feeding is complete, do not pull the baby off your breast. Place your finger into the side of the baby's mouth to break the suction between her mouth and your breast.
American Academy of Pediatrics. New Mother’s Guide To Breastfeeding. Bantam Books. New York. 2011.
Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Sixth Edition. Mosby. Philadelphia. 2005.