Sore Nipples

Breastfeeding should not hurt. Blisters, cracking, and bleeding are not normal and are usually related to baby’s latch. Soreness that starts after several weeks of comfortable breastfeeding may be related to yeast overgrowth or eczema.

During the first few days, pay close attention to both positioning and latch. Position yourself comfortably, using pillows as necessary to bring baby to the height of your breasts or to support your arms. Have baby face your breast and support baby’s neck and shoulders. (See our information on Helping Your Baby to Latch Well.)

  • Once baby latches and begins to suckle, you may feel tugging and pulling, but the latch should not feel pinched or sharp.
  • If baby’s latch does not feel as good as the last latch, break your baby’s suction by inserting your index finger into the corner of baby’s mouth and turning your finger to break the suction and start over again to get a good latch.
  • A poor latch can break down your nipple fairly quickly. Be patient. Do not worry if you need to make several attempts to get your baby on in the first few days. It is worth it.
  • When your baby is finished nursing and comes off the breast, look at your nipple. It should look much like it looked before baby started suckling. If your nipple looks pinched, flattened or has a white ridge across it, your baby’s latch may be too shallow. If your nipple is slanted like a tube of lipstick, your baby may be latching too high, or “over-shooting” the nipple. Nipple tissue does not like to be pinched and does not stand up well to the rubbing of a baby’s tongue and will break down easily. Baby’s tongue must be stroking beyond the nipple - on the areola or the breast.
  • If you are unable to obtain a comfortable latch, seek help from a board certified lactation consultant (IBCLC). Breastfeeding should not hurt.

If your nipples are sore or the skin is breaking down:

  • The first step is to correct baby’s latch. It is important to latch baby deeply, with more of the lower breast in baby‘s mouth than the upper breast. Do not leave your baby on the breast if it hurts and your nipple is pinched.
  • If your lactation consultant has recommended the use of a nipple shield, invert it slightly before applying to pull your nipple into the shield. Make sure that baby opens wide, latches deeply so that your nipple is not visible and the shield does not slide in and out of baby’s mouth.
  • You may also use a pump to start your milk flow. Then put baby to breast once your milk is flowing. Breastfeeding should not hurt. Blisters, cracking, and bleeding are not normal and are usually related to baby’s latch. Soreness that starts after several weeks of comfortable breastfeeding may be related to yeast overgrowth or eczema.
  • If your nipples are extremely cracked and sore, limit extended suckling until they heal. Instead, nurse more frequently. Or, nurse for 10 to 15 minutes, take a short break (or switch sides) and then nurse for another 10 to 15 minutes.
  • If your nipples are so sore that you cannot bear to put baby to breast, use a hospital grade rental pump or a high quality personal use breast pump for a few days to allow them to heal. Pump 8 to 12 times a day for 10 to 12 minutes, or until you have collected enough milk to meet your baby’s needs. You may feed your baby this pumped milk via a syringe (finger feeding) or in a bottle with a slow flow nipple. If only one nipple is sore, you may continue to nurse on the other breast and pump the breast with the sore nipple.
  • There is little research on the effectiveness of ointments or creams on sore nipples. After pumping or nursing, air dry your breasts. Allow some breastmilk to remain on your nipples. If your skin is intact, you may apply purified lanolin or coconut oil or calendula cream to your nipples. If using calendula, you may want to wash your nipples lightly with water before nursing.
  • If you have open wounds or scabs on your nipples, your risk of infection is higher. It may be more beneficial to apply an antibacterial ointment to your nipple wounds after every feeding. You may want to wash the nipple wound(s) with warm soapy water (and rinse well) before nursing. Use an antibacterial ointment until wounds are healed and then gradually decrease use of the ointment. We recommend polysporin or bacitracin because mothers may be more allergic to neomycin. Some mothers feel that a steroid ointment helps to decrease inflammation and pain while they are healing. You may choose to use a 1% hydrocortisone cream or ointment around the outside of the wound (on the intact skin) for a few days.
  • Some women find hydrogel dressings soothing. These dressings, which promote moist healing of broken down tissue, may be worn between feedings. After nursing, wash wounds with warm soapy water, rinse well and air dry. Apply a thin layer of antibiotic ointment, and then the hydrogel dressing. Before nursing, rinse your nipples with clean water. The dressings will last one to six days depending on the brand. When they are cloudy or stiff, discard. Medihoney gelpads are another option containing bacteria ¬fighting properties; you do not need to apply an antibiotic ointment with them.
  • You may also wear soft breast shells (with the large opening on the back). They will allow air to circulate and will also keep your nipples from rubbing against, or sticking to, your bra.
  • If your crack is at the base of the nipple, you may want to wear a shell for inverted nipples (with a smaller opening on the back), to keep the edges of the wound apart for faster healing.
  • Continue to work with your lactation consultant to obtain a correct latch for your baby. This will prevent further breakdown of your nipples. As your nipples heal, the skin tissue may look white. Nipples generally heal quite quickly if baby is latching correctly.