One of the most widespread myths about breastfeeding is that nipple pain is inevitable in the first weeks of breastfeeding. It is not only false but can be harmful: sore nipples are one of the key causes of early weaning. Many moms quit either because sore nipples hurt or because its underlying reasons eventually lead to poor weight gain.
In the first week, nipple tenderness may be acceptable, especially for first-time moms. If it is more a feeling of discomfort than a pain. It does not last long and goes away during and in-between feedings. Nipples are not cracked. Usually, this transient soreness is gone by the end of the second week. However, intense nipple pain that persists during the feeding and in-between them, with cracked or bleeding nipples, is something you need to worry about.
There are seven key causes of sore nipples – poor or swallow latch of the baby, incorrect use of breast pump, tongue tie or another unusual anatomy of the child, nipple thrush, milk bleb, nipple blister (often caused by poor latch), or vasospasm. Most of these causes can be eliminated or mitigated.
How to Prevent Sore Nipples
- Become sure that your baby latches on correctly. In the majority of cases, nipple pain means shallow latch. If the baby does not take the areola around the nipple into her mouth in a right position, she puts the pressure of her tongue and gums on the nipple instead of the areola.
- Avoid early use of bottles and pacifiers that may cause nipple confusion. Woman breasts and artificial nipples have different shapes and imply different suckling methods. Breastfeeding babies that use pacifiers may start latching on breasts as they would do on artificial nipples. Nipple confusion leads to poor latch. Read our article on cons and pros of pacifiers and other artificial nipples.
- Ensure 8-12 feeds in 24 hours. When babies are too hungry, they start sucking too vigorously. On the other hand, full and engorged breasts are difficult to latch. Try catching early hunger cues of the baby such as licking lips, sucking on fingers, opening and closing the mouth, sticking out the tongue, or the rooting reflex – moving mouth and head towards a touch to his cheeks.
- Keep your breast pads and bras dry, expose your nipple to air frequently. Breast pads are a good moist and warm environment for different bacteria to breed and may cause thrush and infections. Change pads and wash bras whenever they get wet to avoid moisture being kept directly on your nipples. Consider using breast shells that hold fabric off and allow air circulation.
- Check baby’s mouth for abnormal anatomy. Remember that improper latch and infections are not the only causes of sore nipples. Tongue tie is a common but often overlooked reason of cracked nipples. An informed and qualified pediatrician can diagnose and assess it immediately after the birth of the baby.
How to Treat Sore Nipples
- Fix the cause. Become sure that the baby latches on the breast properly, i.e. (a) takes the breast with a wide-open mouth, (b) has more breast tissue in her mouth, especially of the lower portion of the areola, (c) is tummy-to-tummy with you, and his ear, shoulder, and hip are in alignment, (d) both lips are turned out when suckling, and (e) her nose indents the lower part of your breast and nose is free.
- Try different breastfeeding positions to find the one that helps your baby latch properly. “Biological nurturing” (laid back position) is the breastfeeding position recommended by most lactation consultants and midwives to help with the shallow latch. It follows your baby’s natural reflexes and makes it easier for babies to take the breast deeply.
- Sooth your cracked nipples with lanolin ointment and avoid using creams that are not safe for the baby and you would need to wash them off before breastfeeding. Avoid using soap. Instead, clean your nipples by expressing a few drops of your own milk and applying on nipples and areolas.
- If nothing is working, seek professional help from a certified lactation consultant. Since nipple shields and bottle feeding with pumped milk may worsen the situation, seek lactation consultant’s advice before using them.
- Contact a dermatologist, if you suspect nipple thrush, or a pediatrician if you think your baby has a tongue tie.
Breastfeeding is not meant to hurt you. Breastfeeding is about enjoying the comfort you pass to your baby together with your milk. Sore nipples indicate an issue in your breastfeeding relationship that you need to fix. The sooner, the better.
Did you experience sore nipples when breastfeeding your child? How did you cope with nipple pain? Any (safe) tips to share with other moms?