Breastfeeding Problems: Sore Nipples

Soreness in the first few days

Your nipples may be tender for the first few days of breastfeeding. This is normal for many women.

You may also experience tenderness more in the first few minutes of breastfeeding. This tenderness should decrease as the feeding continues. Most women find this tenderness decreases during the first week.

It is not normal for the pain to last the whole feeding or to have strong pain. If this is the case, it is important to get help from a breastfeeding expert right away.

Soreness caused by poor position and latch

Latch is how your baby attaches to your breast. Latching and holding your baby properly at the breast prevents sore nipples. Soreness often lasts the whole feeding if there is a poor latch or position at the breast. This may cause your nipples to be red, bruised, or cracked. A crack is a break in the skin.

Holding your baby properly at the breast

To breastfeed your baby, hold your baby close to you so that the baby's chest, stomach, and thighs are against your stomach. Support the baby's back and neck with your hand or with the baby's head supported on your arm. Your baby needs to be able to easily reach your breast.

You can also hold your baby tucked under your arm at your side. Support your baby's back and neck with your hand. You may want to support the baby on some pillows. Your baby can easily be more upright in this position.

You can also lie on your side to breastfeed. Your baby lies close to you on his side with his head tilted back a little. Pillows placed behind you and under your head can make you more comfortable. You can place a pillow behind the baby's back too.

In all positions

  • Make sure that the baby's nose is opposite your nipple as you start to latch your baby.
  • Make sure the baby comes to the breast with the head tilted slightly back, in a sniffing position.
  • Your baby's head should not be twisted or turned toward his shoulder.

Some babies latch well without the breast being supported. You may feel you need to support the breast to help your baby latch. Hold your breast by putting your thumb on one side of the breast and your fingers on the other side of the breast. Your fingers need to be well away from the areola. The areola is the darker area around the nipple. Your baby needs to take the nipple deeply into his mouth.

Correct latching

Let your baby guide you to latch correctly. You can start by holding your baby between your breasts with his skin next to your skin. When he starts to look for the breast, gently move him toward your breast with your hand supporting his neck and shoulders. Let your baby search for the nipple and reach up and latch to your breast.

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Bring your baby to the breast with the head tilted slightly back.

If your baby is not opening his mouth, lightly stroke your baby's lip from corner to corner with your nipple. Remember to break the contact between your baby's mouth and your nipple at the end of each stroke.

Try to get your baby to latch on when his mouth is open as wide as a yawn. Be patient. Wait for a wide, open mouth.

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Bring your baby's chin to the breast first, then the lower lip.

When he opens wide, bring him quickly but gently towards your breast. Do not push your breast towards your baby. Your baby's chin comes to your breast first, then the lower lip covering as much of the areola as possible, then the upper lip to the breast last. The tip of the nose is near or just touching the breast. If your baby is latched properly, the lower lip will cover more of the areola than the upper lip.

If you still feel pain when your baby latches onto your breast, press your baby's chin down with your finger.

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Make sure your baby’s lower lip covers more of the areola than the upper lip.

Soreness caused by improper sucking

Your baby may be positioned and latched correctly but you still have nipple soreness.Your baby may not be sucking properly. The nipple pain usually lasts throughout the feeding.

Ask a breastfeeding specialist to check how your baby is sucking. Sometimes suck training and finger feeding are used to train your baby to suck properly.

Soreness caused by infection

Sore, cracked nipples that do not heal after correcting the position and latch may be due to an infection caused by bacteria.

Nipples can also be infected with yeast. A yeast infection can easily be passed between a mother and her baby, so it is important to have your doctor treat both of you. Yeast infection causes pain that often starts suddenly after days or weeks of breastfeeding with no pain. Mothers experience burning pain during the whole feeding and between feedings. You may notice flaky, shiny, pinkish-red skin on the nipple.

Mothers or babies who have been on medicine to treat infections may get yeast infections more easily.

It is important to have your doctor check for infection. Your doctor will prescribe an antibiotic ointment to apply to your nipples for a bacterial infection. Antifungal medication is prescribed for both mother and baby for yeast infections. Sometimes cortisone, a medication to reduce inflammation, is added to an ointment as well.

Soreness at the end of feeding

Some mothers have burning, throbbing pain after breastfeeding. The nipples turn white after feeding and then red and sometimes blue before turning pink again. This is caused in some mothers by a difference in temperature between the colder air and baby's warm mouth. It can also be caused by the baby clenching on the nipple, or a poor latch which decreases the flow of blood to the nipple.

Place warm towels on your breasts after feeding. This allows the nipples to cool gradually. Check that your baby is positioned and latched well. Ask your doctor for more help if this pain does not go away.

Soreness from breastfeeding on an engorged breast

Engorgement means your breast is very hard. The area around the nipple may also be very hard. The nipple cannot easily go deeply into your baby's mouth. The nipple then rubs against the top of the baby's mouth and becomes sore.

Use warm or cold compresses on your breast before you feed and use your hand to gently get some of the milk from your breast. The area around the nipple should be soft before latching your baby. Cold compresses after and between feedings help. Ask for help from a breastfeeding specialist if you cannot get your breast soft.

Soreness from a blocked nipple pore

Some mothers may notice a white dot on their nipple and experience pain throughout the feeding. One of the milk ducts has become blocked as it opens onto the nipple. Warm compresses before feeding and frequent feeding can help. If there is no improvement in a few days, your doctor can open the nipple pore with a sterile needle.

Nipple soreness when your baby is tongue-tied

Some babies cannot easily move their tongue because it is held too closely to the floor of the mouth. If the baby's tongue cannot come over the gumline, it may cause a problem with latching and sucking and cause sore nipples. Your doctor and a breastfeeding specialist need to check your baby.

Other measures to help prevent and treat sore nipples

Breast care

  • Wash your nipples with warm water only once a day without soap. Soap removes the natural oils needed to keep the skin on the nipple moist. Gently apply some breastmilk on your nipples after each feeding.
  • Let your nipples air dry or use a hair dryer on the lowest setting.
  • Use cotton nursing pads that you can wash instead of nursing pads that you throw out. Do not use nursing pads with plastic linings. They keep the skin too wet. Soak the nursing pad off if it sticks to your nipple. This prevents pulling the skin off the nipple.
  • Wear plastic shells on your areola inside your nursing bra. Breast shells will protect your nipples from rubbing against your nursing bra. Breast shells are available at some pharmacies and at the Specialty Food Shop on the Main floor at SickKids.

Lactation supplies can be ordered in person, on the phone, or on line from the Specialty Food Shop at SickKids in Toronto. For details, go to http://www.specialtyfoodshop.ca/specialtyfoodshop/ or call 1-800-737-7976. The Specialty Food Shop may be able to ship these supplies to your home.

When feeding

  • Remember to put your finger in the corner of the baby's mouth through the lips and gums to break the suction to take the baby off the breast.
  • Try feeding on the least sore breast first.
  • Feeding in different positions may ease the soreness.
  • Feeding more often but not as long may make you more comfortable.
  • When your baby is learning to breastfeed, try not to use soothers or bottle nipples. Most babies suck differently at the breast then with bottle nipples or soothers. This may make it difficult for your baby to breastfeed and may cause sore nipples.
  • Let one or both nipples heal if you are too sore to breastfeed. You must express your breast milk on the same schedule as your baby feeds to maintain your milk supply. Expressed breast milk is milk that you take from your breast by hand or with a breast pump. It is best to finger feed your baby for the day(s) while your nipple heals.

If you are experiencing pain when pumping your breasts, please refer to the brochure on "Breast Milk: Expressing It for Your Hospitalized Baby." For more information on finger feeding, see "Finger Feeding."

Key points

  • Nipple tenderness is common in the first week of breastfeeding.
  • Prevent soreness with proper position and latch.
  • Sore nipples are one of the leading reasons mothers stop breastfeeding.
  • Early assessment and treatment of nipple soreness is very important.

Debbie Stone, RN, IBCLC, RLC

Joyce Touw, BScN, PNC(C), RN, IBCLC, RLC

11/6/2009

At SickKids:

If you are experiencing nipple pain that is not getting better or when using a breast pump, please call the breastfeeding program at 416-813-5757, option 2.

Breastfeeding supplies, such as breast shells, are available at the Specialty Food Shop located on the main floor of the hospital.  

 




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