It is possible to avoid pain during the early days of breastfeeding. Sore nipples are a sign that something is not right and you need to make a change.

You can expect some tenderness in your nipples when you first start to breastfeed. As your baby latches onto the nipple and stretches the breast tissue, you may feel a pulling sensation that is uncomfortable. However as baby begins to suck and you have a let down, it should become more comfortable. This initial soreness should improve within two to four days after birth, if your baby is positioned well at the breast and is properly attached.

If baby is having difficulty learning to latch-on, you can expect that your nipples will be sore. Pain that lasts throughout the breastfeed or soreness that is still there after the first week tells you that something needs to be changed about your baby’s attachment.

It’s important to do something about nipple soreness before it gets worse and your nipples develop painful cracks. If you are dreading the next feed because your nipples hurt, you may benefit from some time with a lactation consultant.

Sore nipples in the first days and weeks postpartum are usually the result of poor attachment or the inexperienced baby’s sucking technique. If you experience sore nipples past the first few weeks or if you suddenly develop the problem after weeks or months of pain-free breastfeeding, there is probably another cause, such as nipple thrush. Again, my advice is too see a lactation consultant.

If your nipples are very sore, your baby is probably not getting enough breast tissue in the mouth. A horizontal red stripe across the tip of your nipple or a temporary indentation at the base of your nipple are signs that the nipple is not far enough back in the baby’s mouth while sucking. The baby’s tongue may be rubbing against the tip of the nipple or the baby’s gums might be chomping at the base of the nipple instead of on the areola over the milk sinuses. This kind of sucking is painful for mothers and inefficient for babies. Your Baby will not be able to empty the breast properly if sucking only on the tip of the nipple. Of course this not only means pain for Mum but passably a hungry frustrated baby and supply problems.

How you can prevent sore nipples

Paying careful attention to how your baby takes the breast will prevent, or at least reduce the problems associated with sore nipples.

See Tips for proper attachment and Tips for Happy Breastfeeding to teach your baby to breastfeed correctly. If you have problems with attachment, you may need hands-on help from a lactation consultant before your nipples get terribly sore and your baby develops bad habits.

What to do..

  • Again, ensure your baby is attached properly.
  • Always break the suction before taking baby off the breast.
  • Pulling the baby off the breast hurts and can leave your nipples hurting for a long time. Slip a clean finger into the corner of baby’s mouth to release the suction before taking baby off the breast. Or, try pressing down gently on the breast near baby’s mouth.
  • Avoid bottles and dummies or pacifiers during the time that your baby is learning to breastfeed. Getting milk from bottles requires a different technique than breastfeeding. Using the bottle technique at the breast leads to attachment and sucking problems. Babies who get both the bottle and breast in the early days are likely to have problems learning good sucking technique.
  • In the early days of breastfeeding, you’ll have to keep working at getting your baby attached properly, even if it means taking the baby off the breast and starting over several times at the beginning of a breastfeed. If you do this, you’ll soon be rewarded with pain-free breastfeeding. If you are struggling with attachment or your nipples are painfully cracked or bleeding get help. The sooner you get help, the easier it will be to fix the problem. Call a lactation consultant or a breastfeeding counsellor.
  • Experiment with different breastfeeding positions; find what works for you and your baby. It can be very helpful to change positions from one feeding to the next so as to change the distribution of pressure on your areola and nipple during sucking.
  • Feed your baby on the side that is least sore first and change to the more painful side after you have had a let down. The pain from sore nipples is usually less intense after the milk is flowing and your baby will be more calm and patient if it is not so hungry.
  • Feed your baby before it becomes impatiently hungry. This way the sucking will be less vigorous and baby is likely to be more co-operative with re-positioning and re-attaching.
  • Try shorter more frequent breastfeeds, these are easier on your nipples than longer feeds spaced farther apart.
  • Pad your nipple. As you’re putting baby to the breast, use your thumb and fore finger to slide the skin of the areola forward with gentle compression. This forms a wrinkle at the base of the nipple, which adds extra padding to protect the sore nipple.
  • If your baby needs to suck for comfort and your nipples are too painful to allow it, give your baby a finger to suck on. This will avoid having to use a dummy or pacifier. Long periods of comfort sucking at the end of a breastfeed are great for building a good supply but they can be feeding hard to endure when you have recovering traumatised nipples. Mum or Dad can use a clean finger instead of a dummy so as to avoid allowing baby to learn a poor sucking technique.
  • Avoid engorgement. It is more difficult for a baby to latch on to a breast that is swollen and engorged. Feeding often will help to prevent this. While you may want to limit the amount of comfort sucking your baby does when your nipples are very sore, make sure that you breastfeed often enough and long enough for your baby to get the milk out of your breasts. Engorgement can make problems with attachment and sore nipples worse.
  • Numb your nipples. If your nipples are really tender, try numbing your nipples before breastfeeding by applying ice wrapped in a damp cloth.

Helping the nipples to heal faster

  • After each breastfeed, manually express a few drops of colostrum or milk and gently rub this into your nipples. This stimulates circulation and promotes healing. Colostrum is the best nipple cream.
  • Keep your nipples dry when you are not breastfeeding. Pat your nipples dry with a soft cotton cloth after feedings. If it hurts to this, just let your nipples air-dry. Leave your bra flaps down and your shirt open until the nipple is no longer moist. Or, go without a bra, especially at night. You can sleep on a towel to absorb any leaking milk. Use fresh, dry breast pads after feedings, avoid disposable breast pads as these have plastic backs on them which hold the moisture against the skin.
  • Don’t use quick drying methods, such as a hair dryer (even on a low setting) to dry your nipples. While some nipples tolerate this technique, it can cause more delicate nipples to crack because it dries the skin itself, not just the surface of the skin.
  • Try exposing your nipples to a few minutes of sunshine during the day. This will help to heal damaged nipples, stop the growth of bacteria or thrush and can help to toughen them up. You only need to do this for a few minutes at a time. Don’t get sunburnt nipples, OOCH!
  • Avoid using soap on your nipples. The little bumps on the areola around your nipples are the Montgomery glands that secrete a natural antibacterial and lubricating oil. Soaps remove these natural oils, causing dryness and cracking.
  • Wear a properly fitting bra. Be sure your bra is not so tight that it compresses your nipples or so rough that it irritates them. Your nipples may feel better if you go without a bra and wear a soft t-shirt or cotton crop top instead.

When nothing is working

If your nipples are still very sore after using the above measures, you may need to take more drastic action. If you haven’t seen a lactation consultant yet, now is the time. You may need expert help in fixing the cause of the pain. A lactation consultant can show you how to teach your baby to suck more effectively so as not to traumatise your nipples. If your nipples really need a rest, try the following suggestions:

Try a nipple shield. This is a soft, flexible silicon artificial nipple that fits over your nipple and areola. The baby sucks on the shield to get milk out of the breast. Nipple shields can ease the pain during vigorous sucking and can also provide a temporary solution to some attachment difficulties.

Nipple shields should be used with caution because your nipples will receive less stimulation and the baby will require a different sucking action to the milk out. This is not so much a concern with the very thin silicone shields but it is still something to keep in mind. Ensure your baby’s lips are turned out and positioned high on the part of the shield that covers the areola – and not just on the nipple. Try to use the nipple shield only temporarily, since some babies develop problems with attachment if they are used for too long.

To wean your baby from the shield, try using it only at the beginning of feedings. Once the baby is attached and feeding, quickly slip the shield off and get baby directly onto the breast. Eventually, your baby will take the breast without the shield at the start of the breastfeed.

You can obtain a nipple shield from a lactation consultant, who will also help you resolve the problems that have made the use of a nipple shield necessary. They can also be bought from a pharmacy, but be sure to follow the directions in the packet and ask for help if you are having trouble using them. They can be a little tricky until you get used to using them and following the instructions really does help- I learnt the hard way.

Rest the breast with a pump. Let baby suck on the nipple that is less sore while you express the milk from the sore side for a day or so. But be careful. Pumping can irritate the nipples if you use too much suction pump for too long, or if the nipple rubs against the pump. Offer the milk that you pump to your baby using a cup, a feeding syringe, or a spoon. Avoid giving your breast milk to your baby in a bottle. Feeding expressed milk with a bottle will often make it more difficult to solve the attachment problems that caused the sore nipples in the first place.

Consider other causes. If you have tried everything and you still have exquisitely tender and painful nipples, you could have thrush of the nipples. Sore nipples that appear after weeks or months of comfortable breastfeeding are almost always caused by this. Other causes of persistent sore nipples include eczema or Reynaud’s syndrome. These problems will need to properly diagnosed and the best person to this is a lactation consultant.