Every breastfeeding experience is unique. While some moms may not feel any discomfort while nursing, there are still many mothers who feel that their nipples are quite sensitive during their first few days of breastfeeding. Whether you’re a newbie or an experienced mom, it is not unusual for you to encounter sore nipples while breastfeeding your baby. But how do you know when it can be considered normal and when to call for help? I will discuss what I have discovered and what research I came across in relation to sore nipples when breastfeeding.
So what are some experts’ opinions with regards to sore nipples while breastfeeding? According to the CDC, during the first few days of nursing, your nipples may be sore or sensitive because they need to adjust to your baby feeding. The AAP also suggests that it is not unusual for your baby to encounter difficulty in latching during the first few days and suck only on the nipple, which can cause pain while breastfeeding, as well as sore or cracked nipples.
So, it turns out that sore nipples can be considered as a part of the adjustment period between the breastfeeding mother and her baby when learning this new skill. If you’re a breastfeeding mom who had or is currently experiencing sore nipples while breastfeeding, you’ll understand how it affects your breastfeeding relationship with your baby. Sore nipples are even one of the common reasons why moms discontinue breastfeeding their baby, which shouldn’t be the case. So if you are also a mom who dreads each time your baby tries to latch onto your nipple, read a little further and learn more about what you can do to help heal your sore nipples.
Are sore nipples common during breastfeeding?
Though not all breastfeeding moms experience nipple pain, several studies in the United States and other Western countries showed that the majority of breastfeeding women experience some nipple soreness at the beginning. In fact, the American Pregnancy Association says that almost 90 percent of new mothers may experience nipple pain while breastfeeding.
Sore nipples are common but should only be temporary. Most moms may feel that their nipples become more sensitive during the early days of breastfeeding. In addition, your baby is still learning how to latch and suck effectively. The friction created by his mouth and tongue movements may be another contributing factor.
Common Causes of Sore Nipples
Poor latch and sucking
The La Leche League suggests that if you feel more than a slight tenderness to your nipple while breastfeeding, the most probable cause is your baby’s poor latch and sucking.
When nursing, your baby’s mouth should fully grasp not only the nipple but also the breast tissue behind your areola. While sucking, your baby also needs to be able to compress your breast tissue, while your nipple is positioned deep into the soft palate of his mouth. If not properly latched, your baby will only suck on the nipple without getting enough milk. Because the nipple will press under the baby’s hard palate, it will cause nipple pain on the part of the mother. A poor latch may also trigger vasospasm due to the irritation of the blood vessels beneath the nipple.
In addition, some babies will have the correct latch at first but then lose this latch while they are nursing. If this happens, your nipple will continuously rub against your baby’s mouth, which may damage the skin of the nipple resulting in pain and uncomfortable breastfeeding experience.
Sometimes, what causes the pain is your baby’s poor positioning while nursing. A good breastfeeding position promotes ease in latching and sucking. You need to be comfortable and your baby should be not reaching out for your breast. Though there are various positions recommended, both you and your baby need time to find the breastfeeding position that will work best for you and your baby.
Cracked or damaged nipple skin
Any break that appears on your nipple can cause significant tenderness while nursing. The skin may be damaged due to constant friction when your baby isn’t correctly latched or positioned. Another reason it may occur is if you pull your nipple without breaking the suction from your baby’s mouth. In some cases, a cracked nipple may cause a secondary condition such as thrush which can also result in pain to the nipple and breast.
Breast and nipple edema
Mothers who have received intravenous fluids for several hours during labor may also experience swelling or edema on their breast or nipples after they have given birth. This swelling can make it harder for the baby to grasp the nipple and lead to soreness and sometimes resulting in your baby refusing the breast.
Unusual infant anatomy
Babies who are suffering from tongue tie, lip tie or have some palate malformations may find it hard to get a good latch because of their condition. This can lead to painful breastfeeding and soreness of the nipples. A clicking sound can also be heard. This is due to the tongue losing contact with the nipple during the suck-swallow sequence.
Flat, inverted or large nipples
Similarly, mothers who have unusual nipple anatomy can experience painful nursing as their babies will find it harder to latch and suck effectively. There are different degrees of nipple inversion. Some nipples may only be slightly inverted. In this case, your baby will most likely bring out the nipple while nursing. Severely inverted nipples may retract deeply on a level with or behind the areola. This makes it difficult and painful for mom when baby goes to latch on for a feed.
Women with larger nipples can often experience nipple pain particularly when their baby is small. A newborn baby can find it difficult to accommodate the larger nipple into their small mouth resulting in an inadequate latch. They can often gag after latching on and then slide back toward the nipple tip. Subsequently, mom will feel pain and possibly damage to the nipple as it is unable to reach the area between the hard and soft palate of the baby’s mouth. Nipple shields can help baby to latch on in certain situations. This guide discusses when it’s appropriate to use a nipple shield.
How Long Do Nipples Hurt When Breastfeeding?
The characteristic of nipple soreness depends upon the root of the problem itself. According to experts, the typical nipple pain that may be experienced by new mothers should be temporary, usually peaks around the 3rd day after giving birth and gone after about 2 weeks of nursing. Though pain can differ from one mother to another, latch- on pain should only last for about 30 seconds on the onset of breastfeeding and should not continue throughout the feed or in between feedings. In addition, your nipple’s appearance should remain the same- no cracks, blisters or bleeding and it is not flattened, creased, blanched or pinched.
So what if you experience nipple soreness that is far beyond these conditions? The experts suggest that you need to seek help from a lactation consultant or health professional once you feel some intense or unbearable pain that extends all throughout the feeding and in between feedings, or if you have some cracks, blisters, bleeding on your nipple skin. Also seek consultation if your nipple soreness goes beyond 2 weeks of nursing. This is to let them assist you in getting a good latch and correct positioning while nursing, as well as ensure that if there is an underlying medical condition involved like thrush or a bacterial infection, it could be properly treated and resolved.
Is it OK to Breastfeed With Sore and Cracked Nipples?
Cracked nipples may differ in appearance. The crack can be visible and seen on the nipple itself or on the area where it joins the areola. It can also be very fine and hardly noticed until it causes pain while breastfeeding. Sometimes, cracked nipples may also bleed while nursing.
In most cases, sore and cracked nipples are caused by the baby’s poor latch and attachment and it is generally safe to continue breastfeeding your baby. There may be times where you may see traces of blood in your milk. This is usually harmless and you can continue on breastfeeding. Continuous breastfeeding is essential to maintain your milk supply and to prevent other complications from occurring such as engorgement and mastitis.
However, it is important to seek a medical consultation if you feel you can’t tolerate the pain or the soreness doesn’t get better after the first few weeks of nursing. A medical professional can help you determine the cause of your sore or cracked nipples and can help provide measures to relieve them. In a short period of time cracked nipples can become infected with bacteria and/or yeast which would result in more pain and longer healing time. Early detection and treatment of anatomical anomalies such as tongue tie will enable a more comfortable breastfeeding experience for you and your baby. Resolving these problems will enable you to continue nursing your baby without undue pain.
Can I Pump If My Nipples Are Bleeding?
Nipples can bleed if the skin is damaged or due to improper usage of breast pumps. Generally, you can continue pumping and give your baby your expressed breast milk even if you notice some traces of blood in your nipple or in your milk. Sometimes, you may also notice small blood traces on your baby’s vomit or stool which may appear scary at first but are typically harmless for your baby.
If bleeding is caused by a crack in your nipple, it will usually go away within a few days as your nipple heals. You can continue pumping and nursing as you normally would. Excessive suction while pumping can also break the small capillaries within your nipples and result in bleeding. Mothers who experience nipple bleeding may also feel pain, especially while pumping. Here are some things you can do to minimize trauma and pain to your nipples:
- Use a breast pump with a size that perfectly fits your breasts and just the right amount of suction to prevent undue trauma on the small blood vessels in your nipples. You can seek assistance from a lactation consultant with regards to choosing the appropriate size and proper usage of a breast pump.
- Try giving your injured nipple a break from nursing to allow some time to heal. However, you need to pump milk on that side to maintain your supply and prevent engorgement.
- If pumping is too painful, try hand expressing your milk.
The presence of a small amount of blood in your milk usually won’t make a significant change to its taste. However, there are some babies who might be extra sensitive and start to refuse the breast milk due to its altered taste.
How To Heal Sore Nipples
Healing takes time and the rate at which your sore nipples will improve differ from one person to another. As mentioned earlier, there are many causative factors which can lead to nipple soreness. Determining the cause of the pain will give you a better idea of the healing time.
Pain related to poor latch and sucking
A poor latch at the beginning of breastfeeding usually gets resolved in due time with advice from a trained professional. A poor latch can also be associated with some anatomical problems on the part of the baby, such as tongue or lip tie and palate malformations, or on the part of the mother’s breast. If this is the case, the problem must be addressed individually with the help of your doctor or a lactation consultant.
Nipple Pain Associated With Improper Positioning
Several breastfeeding positions can be tried that promote a good latch and make breastfeeding a more comfortable experience. Positions such as the laidback, football hold, cradle, and cross-cradle positions can be successful. It often helps to put the baby skin to skin on the mothers’ chest and with guidance from the mother, moving her breast and nipple towards the baby’s mouth. This will allow the baby to self attach. Stick with the breastfeeding position that is most comfortable for you and your baby.
Breast And Nipple Swelling
Application of cold packs, gentle massage, and anti-inflammatory medications are some methods used to firstly reduce swelling. If your baby is then unable to attach, hand expression can be used to remove milk from the breast to further reduce engorgement. A technique called the reverse pressure softening is also used as a way to create a softer nipple and areola for your baby to latch on with less pain. This technique makes use of gentle finger pressure over the base of the nipple to temporarily remove the excess fluids in the area and push them backward.
Inverted, Flat or Large Nipples
Sore nipples can occur as baby will struggle to latch on correctly. For flat nipples, massage can help followed by a cold cloth to help the nipple evert outward. For inverted nipples, the mother can shape her nipple by placing her thumb about 2 inches behind the nipple and pulling back into her chest. Any pump can also be used prior to a nursing session to draw the nipple out. Temporarily using breast shields to also draw out the nipple can help baby get a good latch. While drawing out flat or inverted nipples, ensure the milk let-down reflex has been stimulated to facilitate breastfeeding with less pain.
How To Treat Cracked, Sore Nipples While Breastfeeding?
Sore and cracked nipples that are not related to any underlying infection should heal within the first 2 weeks of continuously breastfeeding your baby. Breast milk applied to the affected areas can help healing as it is known to have antibacterial and moisturizing properties that can relieve sore and cracked nipples naturally. Air blocking products that create a moisture barrier can also help with healing. Purified lanolin is commonly used with good effect. Hydrogel products also create a moisture barrier to help with healing. These are designed to be placed over the nipple between feeds to prevent drying.
However, if cracks or damage to the nipple skin tissue are not showing any signs of healing alternative treatment from your doctor is necessary. This may indicate that an infection (bacterial or fungal) may be present and will need to be treated with antibacterial or antifungal medication.
Home Remedies For Sore Cracked Nipples From Breastfeeding
Sore and cracked nipples can ruin your current breastfeeding routine and become a stressful experience for you and your baby. There are various home remedies may help soothe and promote healing to your sore nipples. However, it is important to consider that the effectiveness of these measures can differ from one person to another. If you have certain food allergies, you’ll need to consult with your health care provider prior to application. Nevertheless, here is a compilation of the home remedies to help heal your sore and cracked nipples.
Breast milk is well-known for its antibacterial and soothing properties, making it the most readily available emollient for sore and cracked nipples. To use your own milk as a natural soother, here’s what you can do:
- Wash your hands thoroughly.
- Hand express a few drops of your milk.
- Gently pat the milk around your nipples and areola.
- Allow to air dry before you cover up.
It is important to note that breast milk would be ineffective as a nipple moisturizer if your cracked nipples are due to a yeast infection called thrush. Breast milk can feed the yeast and help it thrive. Contact your doctor to treat thrush immediately
The initial latch-on is the most painful part of breastfeeding with sore and cracked nipples. To use ice for numbing sore cracked nipples, apply ice for a brief period right before you breastfeed your baby. For soothing a specific area of injury, such as a bite, you can use ice packs or ice wrapped in a damp washcloth used as a cold compress. Leave it on the affected area for 20 minutes on and 20 minutes off in between feedings.
A warm compress can help soothe your sore cracked nipples. Warm, moist heat is found to help relieve nipple soreness and increases blood circulation in the area to promote healing. To prepare a warm compress:
- Get a clean basin and fill with warm water (not hot).
- Dip a clean wash cloth and wring out excess water.
- Gently pat around your nipples and areola.
- Allow to air-dry before covering.
Salt has natural anti-microbial and healing properties which makes it an ideal additive component to water that will be used for rinsing your nipples. Commercially prepared normal saline solution can be bought in your nearest drugstore or you can make your own saline solution at home. Salt water can be used as a rinse or for a warm compress. To prepare a salt water rinse:
- Mix ½ teaspoon of salt into 8 ounces of warm water.
- Get a clean small bowl and fill it with your salt water. Make sure that the amount would cover the area around your nipples and areola.
- After breastfeeding your baby, submerge your nipples and areola for 1 to 2 minutes, but not more than 5 to 10 minutes because it would cause more cracking.
- Alternately, you can use a squeeze bottle and fill it with saline solution.
- Squirt the solution around the affected area, making sure it covers all area of the damaged skin.
- Gently pat the area using a soft paper towel.
- If your baby refuses the breast due to the taste of the salt residue, you can dip your nipples in a bowl of clean water right before nursing.
- Make sure to prepare a fresh saline solution every day to prevent contamination.
To prepare a salt warm compress:
- Mix ¼ to ½ teaspoon of salt to a liter or 35 ounces of warm water.
- Dip a clean washcloth in the solution and squeeze out excess fluid.
- Place the salt warm compress over the affected area for around 10 minutes.
Virgin coconut oil
Coconut oil is recognized as for its anti-inflammatory, anti-bacterial, anti-fungal and analgesic properties, making it a good natural soother for sore and cracked nipples. Moreover, it is a pure oil which has long been used and found safe for babies even if ingested. To use, have a few drops of high grade pure coconut oil on your clean finger. Gently pat and massage around your nipples and areola.
Another natural oil that you can use for moisturizing your sore and cracked nipples is virgin olive oil. Before taking a bath, gently massage a small amount over your nipples and areola.
This herbal remedy has been credited for its antibacterial, anti-inflammatory and wound healing properties. Studies found that both peppermint water and peppermint gel are effective for sore and cracked nipples. However, if you’re going to use these peppermint preparations as nipple soothers, experts advice that nipples should be washed prior to breastfeeding.
This herbal plant is well-known for its soothing effects on the wound, making it a good natural moisturizer for cracked and sore nipples. Gently apply some aloe vera gel over the affected area and allow it to air dry. Make sure to rinse your nipples or pat them with a warm, wet wash cloth prior to nursing your baby. This is done to prevent your baby from ingesting aloe vera which is found to cause diarrhea among young infants.
Apple cider vinegar
If cracked nipples are related to some fungal or bacterial infection, you may benefit from the natural disinfecting properties of apple cider vinegar. To prepare an apple cider vinegar mixture:
- Add 1 teaspoon of apple cider vinegar to 1 cup of water.
- Dip a cotton ball and use it to pat the mixture over the affected area.
- Do this right after breastfeeding your baby.
How do I take care of my nipples while breastfeeding
Prevention is the best cure! The most important thing to prevent sore and cracked nipples in the future is to take good care of your nipples while breastfeeding. Here are some important reminders:
Wash them gently
Normally, your nipples need only clean water for rinsing when you take a bath. You do not need to wash them every time you breastfeed. You do not need to use soap. The little bumps that you can find on your areola secrete some natural lubricant and cleansing oil. Soaps can remove these natural oils and leave your nipples dry and more prone to cracking. If you notice some broken skin over the nipple, you can use an antimicrobial, non-perfumed soap once a day to prevent further infection.
Allow to air dry
Allow your nipples to breathe in some fresh air. Air drying prevents unnecessary moisture that can attract fungi or bacteria. This can be done quickly by removing the front part of your nursing bra, or you can take off your bra, especially at night. Place an absorbent towel to catch any leaking milk. Avoid using rough towels to rub or hair dryer to dry your nipples more quickly.
Wear comfortable bra
Invest in a high-quality and comfortable nursing bra made of cotton fabric. Do not wear a tight-fitting bra or those made with poor quality fabric that may irritate your nipple skin.
Change your breast pads
Use breast pads that are free from plastic linings. Make sure to remove used pads and replace them with a fresh, dry pad every time you nurse to prevent bacteria or fungi from thriving.
Watch out for your personal care products
Perfumes, deodorant, hair sprays, and alcohol-based products can harm your nipples delicate skin. Avoid using these products near your nipples or make sure your nipples are covered prior to usage.
Check your breast pump
Poorly fitting breast pumps and those with strong suction can create further damage to your nipples. If you do not know how to select the breast pump that is right for you, consult a lactation specialist or your nearest health care provider.
Sore nipples might make your breastfeeding journey a little harder, but with the right advice and assistance, this can be overcome. Most often, this is a part of the adjustment period and once you and your baby have mastered the art of breastfeeding, you’ll end up remembering it as a tough but meaningful experience that you conquered for your little one.
Wambach, K, Riordan, J. (2016) Breastfeeding and Human Lactation – enhanced fifth edition