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Sore Nipples: 7 Causes and the Solutions You Need to Know

Monday, February 15, 2021

Most women will experience some nipple tenderness when they are learning to breastfeed. It can be uncomfortable at the beginning of each feed; this discomfort typically eases off within the first 10 seconds after latching.

If you are experiencing pain that makes you “curl your toes”, or if your nipples have cracking or damage, your body is sending a signal that something is not right. Although it can be frustrating and sometimes difficult to determine the cause of the pain, please do not give up. Most causes of sore nipples can be treated and you will be able to breastfeed, pain free.

Possible causes

  • Baby is latching incorrectly

In the first couple of weeks, an incorrect latch is often the cause sore nipples. Mom and baby are still learning. A few simple adjustments may be all you need to breastfeed more comfortably.

Read more about how to get a good latch in this post.

Some mothers find they get their best ever latch when baby ‘self-attaches’. You can see a description and video of self attachment in this post.

It can take a bit of time to figure out the position that will work best for you and your baby. Feel free to experiment and do not hesitate to ask for help if needed.

P.S. If you’d like more help, we have an online class that goes step by step through what you need to know about breastfeeding. Check it out here. (Scroll to the bottom of the page for a free preview.)

  • Tongue-tie

The movement of baby’s tongue is very important to the mechanics of breastfeeding. A baby uses his tongue to draw the breast into his mouth, to keep it in his mouth and to transfer milk. With a tongue-tie, a stretchy band of tissue under the tongue (called a frenulum) is tighter than it should be. This restricts the tongue’s movement and can lead to sore nipples.

If you suspect that your baby may have a tongue-tie, it is important to have it assessed by someone experienced in working with tongue-ties. Talk to your doctor or an International Board Certified Lactation Consultant.

  • Candida (yeast infection)

Candida is a yeast infection that can be transferred back and forth between mom and baby. Women with yeast-infected nipples typically have a sudden onset of pain. Some women describe this pain as burning or like having “ground glass” in their nipples. Infected nipples may be pink or fiery red and there may be cracks at the base of the nipple. The areola (brown area around the nipples) may appear shiny or be itchy. A baby with a yeast infection will have white patches in the mouth on the gums or cheeks (called thrush) or may have a bright red diaper rash that does not respond to regular diaper creams. See your doctor for treatment if you or your baby are having any of these symptoms.

  • Milk bleb or blister

A milk bleb or blister occurs when a thin layer of skin grows over the opening of a nipple pore, blocking the flow of milk from that pore. You may see a small white dot on the end of the nipple. The pressure from the backup of milk behind the pore can cause intense nipple pain. Treatment is available; talk to your doctor or an International Board Certified Lactation Consultant.

  • Incorrect use of a breast pump
Breastpump-partsCompressed

The flange is the part of the breast pump that covers your nipple. Flanges come in different sizes; it is important to get the size that fits you best. Most pumps come with the standard flange size, 24mm (the distance across the opening of the flange). If the flange is too small, your nipple will rub on the sides of the flange. If the flange is too large, too much breast tissue is drawn in as you pump. Pumping with a flange that does not fit well can cause soreness.

Another cause of sore nipples while pumping can be the level of suction. It is not usually necessary to pump at the highest suction setting. If your nipples are sore, try lowering the suction to see if that helps.

  • Vasospasm

Some women have sharp, burning nipple pain after a feed and notice the end of their nipple turning white (blanching). This is caused by a spasm of the blood vessels in the nipple. Women who have had a yeast infection or have had cracked or damaged nipples are at risk for this. Cover the breast immediately after feeding or try holding a warm rice bag or hot water bottle against your chest. If the pain persists despite these measures, please discuss other treatment options with your healthcare provider.

  • Pregnancy

In the early days of pregnancy, you may have tender nipples while breastfeeding. If you cannot come up with any other reason, this may be the one!

Treatments for sore nipples

The best way to treat sore nipples is to identify and fix the source of the problem. Start by having the latch assessed, as often this is the cause.

The following may help sore or damaged nipples to heal:

  • Breastfeed on the least sore breast first. Baby will nurse more gently on the second side. If both nipples are sore, hand express some milk before a feeding to help your milk letdown.
milk-supply-home-pageCompressed
  • There are healing properties in breast milk; rub a few drops on your nipples after feeds. (Note: If your nipples are cracked, abraded, or wounded or if you have a yeast infection, use plain water to rinse your nipples after feeds instead.)
  • Recent research show that nipple creams are not helpful. This study found that in most cases of sore nipples, the pain will be reduced to a mild level by 7 to 10 days. (Dennis, Jackson and Watson, 2014)
  • You could try wearing breast shells if the pressure from your bra or clothing is painful.

There are many reasons for sore nipples. It may not be possible to determine the source of your discomfort on your own. The good news is that most causes of sore nipples respond quite quickly to treatment. Find an International Board Certified Lactation Consultant (breastfeeding specialist) near you if you need assistance.

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References:

  1. BellyBelly. “Tongue Tie- 9 Facts You Need To Know” bellybelly.com 2015.https://www.bellybelly.com.au/breastfeeding/tongue-tie-9-facts-you-need-to-know/
  2. Bonata, Kelly. “Sore Nipples or Breasts? Here’s Help…” kellymom.com 2018. https://kellymom.com/hot-topics/sore-nipples-breasts/
  3. Breastfeeding Medicine. “Persistent Pain with Breastfeeding” Academy of Breastfeeding Medicine. 2016. “https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/26-persistent-pain-protocol-english.pdf
  4. Dennis, CL., et al. “Interventions for Treating Painful Nipples among Breastfeeding Women”. www.ncbi.nlm.nih.gov. 2014. https://www.ncbi.nlm.nih.gov/pubmed/25506813
  5. La Leche League. “Breastfeeding with Sore Nipples” llli.org 2019. https://www.llli.org/breastfeeding-info/breastfeeding-sore-nipples/
  6. Walker, M., “Breastfeeding Management for the Clinician. Using the Evidence.” Jones & Bartlett, 4th Edition 2017, pp589-91.

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