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Sore Nipples

Breastfeeding should not hurt. Blisters, nipple cracks, and bleeding are not normal and are usually related to a 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, use pillows as necessary to bring baby to the height of your breasts, or to support your arms. Another option is to lean back and position baby skin to skin on your chest. Support baby’s neck and shoulders and keep baby’s tummy against your tummy. Once baby latches and begins to suckle, you may feel tugging and pulling, but the latch should not feel pinched or sharp. See our information on Helping Your Baby to Latch Well for more guidance.

If baby’s latch does not feel as good as the last latch, break your baby’s suction, and remove baby from your nipple. Insert your index finger into the corner of baby’s mouth, turn your finger to break the suction, and start over again. A poor latch can cause your nipple to become sore 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 feeding 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, flat, 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. 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. Most nipple pain heals quite quickly once the cause is identified. However, some nipple pain can take a bit longer to resolve. Work with your lactation consultant so that you can figure out how to continue to feed your baby as you find a solution to your soreness.

If your nipples are sore or you have an open wound on your nipple:

The first step is to correct your 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.

If your nipples are sore, or you have deep wounds, and you feel you cannot put baby to breast, use a high quality Medical Need (aka hospital grade) rental pump or a high quality Personal Use Pump for a few days to allow your nipple(s) to heal. Pump 8 to 12 times a day for about 10 minutes, or until you have collected enough milk to meet your baby’s needs. You may feed your baby this milk via a finger feeding with a syringe, or from a bottle with a slow flow nipple. If only one nipple is sore, you may pump the breast that is sore and continue to nurse on the other breast. See our information on Using a Double Electric Breast Pump.

There is little research on the effectiveness of hydrogel dressings, ointments or creams on sore nipples. After pumping or nursing, air dry your breasts. Allow some breastmilk to remain on your nipples. If you do not have cracks or open wounds on your nipples, you may apply purified lanolin, coconut oil or calendula cream to your nipples. If using calendula, you may want to wash your nipples lightly with water before nursing.

Some mothers find that hydrogel dressings can be soothing, but they should not be used with any cream or oil. If using a hydrogel, rinse your nipples with clean water before nursing. The dressings will last one to six days, depending on the brand. When they are cloudy or stiff, discard.

If you have open wounds or scabs on your nipples, your risk of infection increases. It may be beneficial to apply an antibacterial ointment to your nipple wounds after every feeding. You may also want to wash the nipple wound(s) with warm soapy water (and rinse well) once or twice a day. Use an antibacterial ointment until wounds are healed. We recommend polysporin or bacitracin because some mothers react to neomycin.

Medihoney gel pads are another option to help protect and heal nipple wounds. They contain bacteria-fighting and healing properties found in honey. (Do NOT apply your own honey to your nipples--the medihoney is irradiated to eliminate the possibility of exposing your baby to botulism.) Some mothers report a slight stinging sensation with the medihoney pads.

If you find that your nipples are rubbing against, or sticking to your beast pad or bra, you may want to wear soft breast shells designed for sore nipples. They have a large opening on the back which allows air to circulate as your nipples heal.

If your nipple crack or wound is at the base of the nipple (versus on the tip of your nipple), you may want to wear a breast shell designed for inverted nipples. This shell has a smaller opening on the back, to keep the edges of the wound apart between feedings for faster healing. Use an antibiotic ointment to keep the wound moist and help protect it from infection.

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 a baby is latching correctly.

If you have been nursing pain-free for days or weeks, and suddenly both nipples and/or areola are red and sore, you may have a yeast overgrowth. See our information on Yeast Overgrowth for treatment suggestions.

If your nipples were damaged and have healed, or the pain feels like it shoots deep into your breast after nursing or pumping, vasospasm may be the cause or your nipple pain. See our information on Vasospasms of the Nipple to learn more.

If you have eczema or psoriasis elsewhere on your skin, and your sore nipples are not healing, consider seeing your dermatologist for suggestions.

August 2017