SORE NIPPLES

Up to 90% of nursing parents experience nipple tenderness, but nipple pain that increases or lasts beyond the first couple weeks should be interpreted as a warning that something may be wrong. 

Typical nipple pain (sometimes called transient soreness) includes:

• Latch-on pain that lasts no more than 30 seconds into the feeding. It is often described as mild pain or discomfort, but, since the pain sensation is very subjective, every parent experiences pain differently–some parents feel more severe pain. It is often described as similar to a bad sunburn.
• The pain should not continue through the entire feeding, and there should not be pain between feedings.
• Pain usually peaks around the third day after birth and is gone within two weeks.
• There is no skin damage – no cracks, blisters, or bleeding.
• Your nipple should look the same before and immediately after the feeding – not flattened, creased, or pinched.

Get help from a La Leche League Leader or IBCLC if you have:

• Intense, excruciating pain
• Pain that continues through the entire feeding
• Pain between feedings
• Pain that continues past the first couple of weeks
• Skin damage including cracks, blisters, or bleeding
• A nipple that looks misshapen after a nursing session (including being compressed or lip-stick shaped)

Nipple pain can occur when baby does not grasp enough breast tissue or the tongue is positioned improperly. Baby must be able to compress your breast tissue with your nipple positioned deep in the mouth. First, check baby’s body position. Be sure their body is turned towards yours and their mouth opens very wide, like a yawn, before you offer your breast. If you gently pull down the corner of the baby’s mouth while nursing, you should see the underside of the tongue, which should extend over the lower gum line, cupping the breast. Find more info on positioning and latching on our Positioning and Latching page. 

Sometimes babies latch deeply, but slide down the nipple during the feed—watch for more distance between your baby’s nose and your breast. If this happens, break the suction and re-latch your baby.

Tongue-tie can also cause sore nipples. When baby cries, can you see if the tongue is able to reach past the lower lip? If baby’s tongue appears heart-shaped, it could be a short or restricted frenulum (tongue-tie) that prevents a good latch. Contact a La Leche League Leader if your baby does not seem to be latching on well.

Flat or inverted nipples can make it difficult for baby to grasp your breast and properly latch on. With proper latch-on, your baby’s sucking can effectively draw out flat or inverted nipples. Gentle pumping or special exercises are sometimes recommended to draw the nipple out.

If you received IV fluids for several hours during the birth process, this can be a cause of edema (swelling) in the breast and nipple. Reverse Pressure Softening can help create a softer nipple/areola that baby can grasp. Reverse Pressure Softening involves using gentle finger pressure around the base of the nipple. This temporarily moves some of the swelling slightly backward and upward into the breast. This technique is also helpful in preventing sore nipples if your breasts become engorged (swollen and uncomfortable) when your milk supply comes in several days after birth, making it difficult for baby to latch on comfortably.

Be aware that more than one cause can be contributing to nipple soreness at the same time. Avoid limiting the length of nursing sessions, a practice that is mistakenly thought of as a way to avoid sore nipples. Instead, try to concentrate on correct positioning and latching while reaching out to a Leader for help.

TREATMENT OF SORE NIPPLES

It’s important to continue nursing while you work to correct the cause of sore nipples. You may want to try one or more of these comfort measures while the cause of your sore nipples is being corrected.

• Vary nursing positions—laid-back nursing, cradle hold, cross cradle hold, football hold, and side lying—in order to vary the position of baby’s mouth on your breast. (For information on various nursing positions, contact an LLL Leader for assistance.)
• Begin to nurse on the least sore side until the letdown occurs, then gently switch baby to the other breast, paying careful attention to good positioning and latch-on. Some people use relaxation breathing until their milk lets down.
• Express a little milk onto your nipples after nursing. Your milk has healing properties to relieve soreness.
• There are a variety of creams and ointments that can be used for help healing. For example, place a small pea-sized portion of ultrapure modified lanolin or coconut oil between clean fingertips and apply to the nipple and areola. Gently pat it on: do not rub it in. It does not need to be removed before feedings. This provides a moisture barrier that will slow down the loss of internal moisture, which is vital to healthy, supple skin; eases discomfort; and promotes healing without scab formation. This process is known as “moist wound healing.”
• Gel pads may provide relief from soreness and promote healing. Note: Lanolin or gel pads are not recommended if you have thrush.
• Be aware that your bra or clothing may cause further discomfort while healing. If that is the case, breast shells with large openings may help. 

In most cases, sore or cracked nipples are no longer painful once good positioning and latch are achieved. It is rarely necessary to discontinue breastfeeding.

It is not typically recommended that you dry sore nipples with a hair dryer or use a sun lamp. These practices have been shown to dehydrate skin further and cause additional damage to tender nipple tissue.

Find more info on positioning and latching on our Positioning and Latching page. 

RESOURCES 

Positioning and Latching, LLL USA

Attaching Your Baby at the Breast VIDEO, Global Health Media

Laid Back Breastfeeding (PDF), LLL Canada

Laid Back Breastfeeding Video, Biological Nurturing

Breastfeeding Pain, LLLI

Helping to Get Breastfeeding Off to a Good Start: Latch, LLL USA

Helping to Get Breastfeeding Off to a Good Start: Skin-to-Skin Contact, LLL USA

Helping to Get Breastfeeding Off to a Good Start: Frequent Access, LLL USA

Lie Back and Relax! A Look at Laid-Back Breastfeeding, LLL USA

Breastfeeding and Motor Development: Mutually Beneficial!, LLL USA

Reverse Pressure Softening, KellyMom

Sore Nipples, KellyMom

Nipple Pain, LLL Great Britain

Positioning, LLLI

PERSONAL STORIES 

Our Latching Story, LLL USA blog

Breastfeeding and Motor Development: Mutually Beneficial!, LLL USA blog

Katelyn’s Story: Overcoming mastitis and tongue-tie, LLL USA blog

Success! Latching On Luna, LLL USA blog

Annika’s Story: Overcoming Obstacles and Breastfeeding Advocacy, LLL USA blog

IS YOUR CONCERN OR QUESTION NOT COVERED HERE?

Please contact a local LLL Leader with your specific questions.

Medical questions and legal questions should be directed to appropriate health care and legal professionals.

Page updated January 2020

Resource adapted from LLLI materials.