Breastfeeding: Sore and Cracked Nipples

Preventing sore nipples

• Latch your baby deep onto your areola, not just your nipple.
• Support your breast with your hand; be sure your fingers are placed back away from your nipple. This allows your baby to latch onto your areola (dark area around nipple), NOT the nipple.
• Nursing often or for a long time does NOT cause sore nipples, if baby is latched properly.
• If your breasts are hard (engorged) when your milk increases, hand express some milk to soften them before latching your baby.
• The first week after delivery, you may experience some slight discomfort or stretching sensation, which last for 20 – 30 seconds when the baby latches to breast. After 30 seconds, the feeding should be comfortable and your nipple should be round after the feeding. This discomfort is temporary and will improve. Nipple pain that increases or remains throughout a feeding is not normal. Both mother and baby need to be evaluated to determine the cause of discomfort.
• Gently massage your breast to encourage your milk to come down before bringing baby to the breast.
• If one breast is more sore or sensitive, start feeding on the least sore breast first.

Treatment for nipple pain

In the first week, nipple discomfort is often caused by the baby latching incorrectly. Try different positions. If breastfeeding remains uncomfortable after repositioning your baby, and get help! Call your healthcare provider or talk with a lactation consultant to learn how to position the baby correctly on your breast. Sudden nipple pain after a period of comfortable breastfeeding may indicate an infection. See your healthcare provider and follow recommended treatment.

If the nipple skin is cracked or wounded

• Rinse nipple skin with clean warm water after every feeding or use warm moist compresses with a soft cloth.
• Wash hands before touching your breast to help prevent infection.
• You may want to consider wearing breast shells, gel pads, or silver nursing cups to protect nipples while they heal.
• Moisten your bra or breast pads before removing to reduce sticking to sore nipples.
• A clean nipple shield may be used over the nipple to protect nipple. Do NOT use a nipple shield without first correcting baby’s latch. Consult with a healthcare provider or lactation consultant for proper fit and discussion of possible risks when using a nipple shield.
• Avoid nipple ointments and creams unless recommended by your healthcare provider.

If breastfeeding is too painful

• Hand express or pump to maintain your milk supply while your nipples heal.
• If the baby is not latching, pump 8 – 12 times daily until your milk stops flowing, generally around 15 – 20 minutes per breast or a total of 15 – 20 minutes if double pumping. Pumping should be comfortable. Do not increase vacuum beyond comfort to try to obtain more milk.
• Check to be sure the breast flanges are the right size for your nipples. If you feel rubbing or pinching sensation while pumping, try a different flange size.
• Obtain a high quality pump and use pump according to pump instructions.
• Consult your healthcare provider or lactation consultant on methods to supplement your baby with expressed breast milk while your nipples heal.
• Feed your baby from the breast as soon as possible. After 24 hours, you may be able to latch your baby again.

Other possible causes for sore nipples

• Pulling your nipple out of your baby’s mouth without first breaking the baby’s suction.
• Using the wrong size nipple shield for your nipples.
• Older babies may turn their heads and pull on the nipple if distracted by other activities. Use a nursing cover or feed your baby in a calm, private area.
• Older babies who are teething may bite nipples. Offer your baby a teething toy prior to feeding. Watch for signs that the baby has finished nursing and quickly removed your baby from breast. Immediately remove your baby from breast if baby bites. Some mothers may quickly pull the baby into the breast, causing baby to release the breast. Teething babies QUICKLY learn not to bite during feeding..

If you have sore or cracked nipples, do not get discouraged. Nipples heal quickly even when mothers are nursing frequently.

Works Cited

Lawrence, Ruth A. & Lawrence, Robert M. “Breastfeeding, A Guide for the Medical Professional”, Ninth edition, ELSEVIER, 2022.

Wambach, Karen and Spencer, Becky “Breastfeeding and Human Lactation”, Sixth edition, Jones & Bartlett, 2021.