Sore Nipples 101
Ouch! Breathe. It’s not that painful… but when the baby starts to latch, OUCH! Many mummies, including myself, have had the experience of having sore nipples while breastfeeding. It is a frequent complaint from mummies, and some assume it’s an inevitable part of the nursing experience. But lactation experts agree that pain is a sign that something isn’t right.
It is common to feel some discomfort when the baby first latches on, especially in the first days after birth before the milk has come in. This type of soreness will usually ease up after the first few sucks, especially after the milk lets down and flows freely.
Babies are born with a strong sucking reflex, but they have to learn the mechanics of breastfeeding. At the same time, you are learning the mechanics of positioning, supporting the breast, etc. While some babies seem to come into the world knowing just how to breastfeed correctly, more often it is a learning process for both of you.
Nipple soreness will usually begin during the first few days of nursing, will peak on the fourth or fifth day, and then ease off each day after that. Soreness should lessen greatly on days 7-10, and by the time the baby is 2 weeks old, nursing should be pain-free.
What are the causes of sore nipples?
Difficulty latching on
This is by far the most common cause of sore nipples. A good latch should feel like tugging and pulling but not painful. A poor latch from a baby is when the baby has to pull or suck your nipple hard into her mouth. Your nipple is then too far forward in the baby’s mouth and it pinches your nipple against her hard palate, causing pain.
For breastfeeding to be comfortable, your baby needs to have the entire nipple and part of the breast in his mouth. The nipple needs to be near the back of her mouth where the palate is soft. This good latch is more likely to happen if the baby latches on with his head tipped back so that her chin is pressed into the mother’s breast and her nose is away from the breast. Of course, every baby and every breast is a little different, so you may need to adjust the positioning to find what works best for both of you. If your baby doesn’t gape to take in your breast, don’t pull your nipple out. Instead, break the suction by gently inserting your finger into the corner of her mouth and above her tongue. Take her from your breast and start again.
Here’s a video from NHSChoices
If your baby has a tongue-tie, her tongue will be attached to the bottom of her mouth. If she can’t move her tongue much, she may not be able to draw full feeds from your breast. The signs will be that she can’t latch on well to your breast and keeps slipping off. She will be feeding often, but not putting on enough weight. See a doctor to check for treatment recommendations.
Adjust without unlatching
If your baby latches on, and it hurts, you’ll know something is wrong. Sometimes mothers are advised to stick a finger in the baby’s mouth, unlatch him, and start over. The problem with this approach is that it’s very frustrating for the baby: every time he starts nursing, he’s taken off the breast. Some get so frustrated they refuse to nurse or begin clamping down on the nipple. It also puts you at the risk of more nipple damage if the baby latches on incorrectly repeatedly.
What you can do is to adjust when the baby is latching,
- Wait for the baby to open its mouth by tickling the baby nose with your nipple.
- Count to 10 for the baby to readjust.
- If you still feel tight and the position is wrong, flange the baby’s upper and lower lips out and hold the baby’s jaw for about 10 sec.
- Holding down the jaw for about 10 seconds is to make sure the baby’s jaw is in the position and doesn’t go back up.
Feed as soon as you spot a hungry cue
A very hungry baby isn’t going to have much patience and may try to grab at your nipple, causing more pain. Feeding the baby as soon as he seems hungry will make it easier to work on getting a good latch every time.
Use your milk to heal cracked, bleeding or blistered nipples
Express a little milk onto the nipple and let it air-dry there. Apply an ice pack just before you feed the baby to temporarily numb the nipple as you latch the baby on. One piece of good news: breastfeeding nipples generally heal very quickly once the cause of the damage (such as a latch problem) is resolved.
If your nipples are sore after a spell of pain-free feeding, and you feel burning, shooting or stabbing pains in your breasts, you may have thrush on your nipples. Thrush is a fungal infection that sets in when organisms that naturally exist in your body spread out of control.
Your doctor can prescribe an antifungal treatment for you and your baby. If you have thrush on your nipples, it will also be in your baby’s mouth, whether or not you can see it. You’ll both need to be treated at the same time, so you don’t keep passing the infection between you.
Dermatitis or eczema
If your nipples are inflamed and itchy it may be a sign of dermatitis or eczema. This can be caused by creams, lotions or soaps that irritate your skin. Swimming in chlorinated swimming pool water can also sometimes cause sore, itchy nipples. Wash your breasts with plain water alone, and see your doctor if your symptoms don’t improve.
If your baby has tender gums due to teething, she may change the way she feeds. If her tongue isn’t down and forward enough to take in a big mouthful of breast, she may end up biting your nipple. Help your baby to gape and keep her tongue forward by touching her lips to your nipple and then moving her quickly onto your breast as she responds. Older babies sometimes keep their mouths open but pull their tongues back after they have gaped, so you’ll have to move fast.
Breastfeeding during pregnancy
Your nipples may be tender if you are breastfeeding and pregnant again. Your nipples may only feel tender in the early days of your pregnancy, or they may only feel sore towards the end of your third trimester. If your nipples get really sore, you can try using a purified lanolin ointment or cream to soothe them.
Soreness from your bra or breast pads
If your nursing bra is too tight, it will put pressure on your already sore nipples. Some breast pad traps air and often will cause your nipple’s condition to worsen. Choose breast pads from natural materials which will help your skin breathe.
How to make yourself feel better
Have a towel on standby
Once the baby is done nursing you will want to gently dry your breast of any leftover milk. Gently clean the nipple and dry it. Breast milk is a great healer but it’s best to keep it dry to keep any form of bacterial away.
Air your nipple
Bring down your bra flap, use a nipple shell or even using a hairdryer on a low setting after each feed.
Apply modified anhydrous lanolin
After nursing, apply lanolin cream to help ease off some of the soreness. Surface dampness can contribute to soreness and cracking if the nipple remains moist after nursing, the same way your chapped lips get worse if you lick them. Applying lanolin can help keep the skin soft and pliable, which helps breaks in the skin heal without forming a hard scab which will break open each time the baby-nurses. Don’t use soap on your nipples as it can dry the skin. Bathing with clear water is all you need to keep your nipples clean.
Use Nipple Butter
Nipple butter helps keep your nipples soft and supple. It also helps to moisturise and heal your sore nipples. It’s completely safe for the baby, so keep it with you at all times.
Some breast pads and plastic linings in bras don’t let your skin breathe and they trap the moisture. Choose pads made from natural materials. I like to use disposable ones as I feel that they are cleaner and I can just change and feel fresh at any time of the day. Be sure to put a couple of sets of breast pads in your diaper bag and you can change your breast pads on the go!
Getting a comfortable bra will help you improve your breastfeeding experience. If your nursing bra is too tight, it will put pressure on your nipples and cause pain. Try wearing a bigger bra.
Have one set in the fridge! So that after an intensive feeding, you can put them on for some cooling relief it brings!
Don’t Give Up
I promise it will get better! It’s about learning together with your baby. Before you know it, you will be feeding like a pro! It always makes me sad when mothers quit nursing because of soreness. The long-term benefits of breastfeeding far outweigh the short-term pain. It really is worth hanging in there – ask any nursing mother, and she’ll tell you she’s glad she didn’t give up when the going got rough.
Teresa Pitman Jul 8, 2011
BabyCentre Sore Nipples, February 2013
Breastfeeding Basics, Anne Smith, IBCLC September 2013