Sore & cracked nipples
Some tenderness of the nipples (without broken skin) during the first week or two of breastfeeding is perfectly normal. However, burning, throbbing or shooting pain in your nipple when your baby latches on is not normal and probably means a crack has developed.
A grazed, fissured, blistered or cracked nipple is extremely painful. Occasionally a damaged nipple can become infected, resulting in inflammation, redness, swelling and oozing pus. A cracked nipple increases the risk of mastitis (breast infection) developing.
Bleeding commonly occurs when nipples are cracked. Sometimes blood can be seen in the baby's mouth or in milk when it is brought back up. Babies often vomit back milk with blood in it.
Approximately 80% of new mothers experience sensitive or tender nipples within the first few days of breastfeeding. This discomfort, which is due to hormonal changes and your nipples adjusting to breastfeeding, usually peaks on the 4th or 5th day and then lessens each day after that. Any soreness will generally have disappeared by the time your baby is 2 weeks old and breastfeeding should then be pain free.
Nipple soreness that extends beyond 2 weeks post delivery is not normal; nor is grazed, cracked, blistered or bleeding nipples. These problems are usually due to one or more of the following causes...
1. Positioning and latch-on
The number 1 cause of damaged nipples is a poor latch-on. Incorrect positioning of your baby or yourself can contribute to a poor latch-on.
A poor latch-on may result in your baby not taking your nipple into her mouth deeply enough, so your nipple becomes abraded as it is rubbed against the edge of her hard palate. (With a deep latch-on this cannot occur.)
OR your baby's jaws may clamp down hard on your nipple. The clampdown bite reflex causes pain as the bite cuts off the blood supply to the nipple. After feeding you can see a white stripe on your nipple temporarily until blood flow returns. In some cases the nipple may become bruised. Changing your baby's position and the way you sit can sometimes help.
2. Prolonged moisture
If your nipples remain moist for long periods of time this causes softening of the skin which increases the risk of damage. Moisture can be retained by not drying your nipple after each feed; by wearing soggy breast pads; or by using plastic breast shields or plastic-lined nursing pads that hold in the moisture.
3. Removing natural oils
Your nipples produce their own natural lubricants that protect them from the effects of moisture and provide anti-bacterial properties. Over-washing or the use of chemicals can strip away your nipples natural protection, making them more vulnerable to cracking (in a similar way to chaffed lips).
Soaps and shampoos can strip away natural oils. Nipple creams and lotions that need to be removed before breastfeeding can make the problem worse. Many products that were once recommended to treat cracked nipples, such as Tinc benz co. and methylated spirits are no longer recommended due to their drying effects.
Sore, itchy or cracked nipples may mean you have thrush. Thrush is due to a overgrowth of a yeast-like fungus called Candida albicans. A nursing mother's nipple can become infected when her baby has oral thrush.
Thrush may affect one of both nipples; it can also enter the breast. The pain from a thrush breast infection has been described as a burning hot knife or shooting pain through the breast during or after feeding is over. Whereas the pain associated with a poor latch-on hurts most when a baby first latches on but improves as the baby nurses.
6. Dermatitis, eczema or psoriasis
If you have a history of these conditions, they can also be a reason for sore or cracked nipples.
1. Before breastfeeding
- If the pain is severe, you can take a mild painkiller such as acetaminophen (paracetamol) or ibuprofen about 30 minutes before feeding.
- If nursing pads are stuck to your nipple, moisten them with water before trying to remove them.
- Try rubbing your nipples with ice before feeding to slightly numb them.
- Hand express or pump for a few minutes before feeding; this will bring on a let-down so that your baby does not nurse so aggressively in the first minute or so of feeding. If your breasts are engorged, this will also make it easier for your baby to latch-on.
2. During breastfeeding
- Correct positioning and deep latch-on are the MOST important steps you take do to prevent further damage and help your nipples heal. (See Breastfeeding basics for tips.)
- Offer the least sore breast first.
- Try a change in feeding position. This will focus the pressure on a less tender area of your nipple.
- Nurse frequently (at least every 2 hours) this will ensure your baby is not too hungry, causing her to feed ravenously.
- Watch your baby's sucking pattern (described in Breastfeeding basics). Don't leave your baby comfort sucking on the sore side for more than a couple of minutes once she has ceased actively feeding.
- Don't pull your baby off the nipple until she has released her grip. Release her suction by placing your finger in her mouth between her gums.
3. When it's just too painful to feed
- Rest one or both breasts for 24 to 48 hours.
- Hand express or pump from the worst breast to maintain adequate drainage and to minimize the risk of mastitis. If possible use a hospital grade electric breast pump to maintain lactation. (A double pump if both sides are affected).
- Feed your baby your milk using an alternative feeding device such as an eyedropper, medicine dropper, syringe, medicine cup or spoon. Avoid bottles (especially if your baby is younger than 4 weeks) because of the risk of nipple confusion. If your baby is not latching on correctly bottle feeding may further complicate the situation.
4. After breastfeeding
- Gently pat your nipple dry. If you can, leave your breasts exposed to the air. Otherwise use a hair dryer on a low settling.
- For mildly cracked or tender nipples (i.e. not bleeding) rub a little breast milk over your nipple and let it dry. Your milk contains anti-microbial properties that will help to protect your nipple against infection.
- For severely cracked and bleeding nipples, try medical-grade modified lanolin such as Lansinoh® or Purelan®, made specifically for breastfeeding mothers. This doesn't need to be washed off prior to nursing as it is safe for your baby to ingest. OR use hydrogel dressings or glycerin gel pads (available from wound care specialists).
5. Between breastfeeds
- Expose your breasts to the air as often as you can by going topless whenever possible. Exposing your nipples to 5 minutes of sunlight each day may also help.
- When it's time to cover up, you could use multiple holed nipple shells (not to be confused with nipple shields). Nipple shells remove the need for nursing pads. These allow the air to circulate and are worn over your nipple inside your bra. Tea strainers (with handles removed) will also work in a similar fashion; however make sure there's not to much pressure from your bra. You could wear a nursing pad over this if your breasts leak a lot.
- If you use nursing pads, change them immediately once they become even slightly damp. Moisture up against your nipples can prolong healing. Avoid nursing pads with plastic linings.
- Don't use soap, alcohol, creams or lotions on your nipples. Bathing your nipples with clear water once a day is all that is necessary.
Don't give up!
It usually takes only a day or so for your nipples to heal once you have your baby latching on and sucking effectively. If a cracked nipple persists longer than 2 days without signs of improvement see a breastfeeding counselor observe your latch-on technique and your baby's sucking pattern.
See a doctor if you experience any of the following...
- Shooting pains through your breast during or following feeding.
- All or part of your breast becomes painful, red, hot and swollen.
- A fever with a temperature of 1001 F (38 C) or higher.
1. How will I know if my baby swallows blood from my nipple?
You may see blood in your baby's mouth or it may be seen in milk if he spits up. This will not harm your baby.
2. Will my nipples heal faster if I temporarily stop breastfeeding?
Studies have shown no difference in healing time for mothers who continue to breastfeed with cracked nipples compared to those who "rest" their nipples. However, as continued breastfeeding will reduce the risk of other complications, such as engorgement, mastitis, and low milk supply, it should be continued where possible.
3. Will a nipple shield help?
Many women who have tried nipple shields find that they don't help with soreness. As nipple soreness is nearly always due to incorrect latch-on, using a nipple shield will do little to correct the problem, and in some situations may make the problem worse. Once your baby gets used to a nipple shield, it may be difficult to get her back onto the breast.
Because nipple shields can affect milk supply they should be used only as a last resort.
4. Will nipple creams help?
Some creams and ointments commonly sold for the treatment of sore nipples may actually impede healing by preventing air circulation or by drying out of the skin. Avoid the use of any creams and ointments that need to be washed off prior to nursing.
Studies have shown that Lanisoh® and Purelan® aid healing by a process called 'moist wound healing', which works by preventing scab formation.
Added Aug 2004. Reviewed Aug 2008; Sept 2013.