What are two suggestions to offer a breastfeeding woman if her nipples are painful?

Sore nipples are very common for breastfeeding women. Prevention is possible and treatment depends on what the cause is. The most common causes include:

• a baby not latching well
• chafing
• thrush
• adapting to this new skill

You might even have more than one cause of sore nipples.

Read on to learn more about the possible causes and how to treat and prevent sore nipples from breastfeeding.

Breastfeeding often takes time to learn. Many babies and mothers need to practice to get the right latch. A healthy nursing latch, deep on the breast, will get baby the most milk and prevent pain for you.

A baby might have trouble latching in any number of ways. A common problem is a latch that’s too shallow. Remember that it’s called breastfeeding, not nipple feeding. Your baby’s lips should be around most or all of your areola when nursing.

A shallow latch puts too much suction right on the nipples and becomes painful. A bad latch can even bruise nipples.

How to get a good latch

To encourage a good latch:

• Gently hold baby’s chin down and open as they approach the breast to feed.
• Tickle baby’s upper lip with your nipple and wait until their mouth is wide open (like a yawn) before you gently guide them to the breast.
• Pull them off and start over again if they don’t latch well at first.
• If you deliver at the hospital, ask nurses to check your baby’s latch throughout your hospital stay. If you delivered at home, ask your midwife or doula for guidance.
• Only use a nipple guard temporarily and under the guidance of a lactation consultant.

If you continue to have trouble, have pain, or your baby seems frustrated while nursing, contact a lactation consultant. A licensed consultant can give personalized help. Many accept health insurance. Some hospitals have a consultant on staff with whom you can speak during your stay.

Also ask if your hospital hosts breastfeeding support classes.

If you need to unlatch your baby, it’s important to break the suction before pulling them off to prevent sore nipple.

To help baby to unlatch, gently stick your finger between your breast and their gums to break the suction, and then guide baby’s head away from your chest.

Persistently sore nipples can occur if your baby has a tongue tie. Only a doctor or licensed lactation consultant can diagnose and treat a tongue tie. The treatment may be surgical, or they may be able to help you work around it and learn how to still get a good latch.

How you sit and hold your baby during breastfeeding can affect how comfortable it is for you and baby. There are a number of breastfeeding positions. You can find books and online resources to try all of them, or ask a lactation consultant for recommendation.

A healthy hold will keep your baby’s face parallel to your breast (horizontally or vertically), and will keep their tummy in contact with your body.

To have a good hold:

• Keep baby’s hips and face turned towards you while nursing.
• Try multiple positions and change positions to avoid getting sore.
• Try accessories like a nursing pillow or footstool if they help.
• Hold baby up close to your breast instead of crouching over them.

Engorgement happens when the breasts get too full of milk. This occurs if you go too long between nursing, or if you’re still in the early stages and your supply is adjusting to baby’s needs.

Engorged breasts may hurt. They can also make it more difficult for your baby to latch onto the breast. You may need to release a little bit of milk before nursing if this happens.

Try one of these methods to release milk:

• Lean over a sink and use a warm, wet towel compress on one breast at a time.
• Use a breast pump to express a little bit of milk (you can store it if you want).
• Gently massage breasts while you’re in the shower and let milk drip out.

Your nipples get wet with milk each time you nurse. That can lead to thrush, which is a yeast infection of the nipples. Thrush can pass between mother and baby during breastfeeding. It must be treated by a doctor.

Nipples with thrush may be bright pink and hurt a lot.

To prevent thrush, dry between feedings. You can blow on or pat your nipple with a baby towel to dry, or you can walk around topless to air dry. When you bathe, use a mild soap on your nipples and rinse thoroughly.

If you tend to regularly leak milk, use breast pads and change them often to prevent trapped moisture. Moist bras and nipples are a breeding ground for yeast.

While you want to keep your nipples clean and dry, you may also need to moisturize them. Nipples are sensitive and can crack and bleed during breastfeeding if they become too dry.

You can find a variety of nipple creams at the drugstore. It’s important that you only use nipple products that are safe for babies, since they put their mouth directly on your nipple. Read product labels and ask your doctor which creams they recommend.

To use a nipple cream, clean the area with water then apply the cream right after you feed your baby so your skin has enough time to absorb it before the next feeding.

If you use a breast pump, using the wrong sized breast shield can cause your nipples to become irritated and sore. It can also affect the amount of milk you express when pumping.

If you see a lot of your areola inside the shield while pumping, you probably need a smaller shield. And if your nipples rub against the inside of the shield, you probably need a bigger shield.

Follow your breast pump brand’s guides to pick the right shield. You can find new shields online and at major retailers. You can also call the pump brand directly to find out where to get different sized shields.

You may need to change sizes as your breasts change over time, too. Also, be sure to use a vacuum strength and speed that feels comfortable to you while pumping. Making the pump too strong will not result in more milk, but may hurt you.

Cool compresses can help soothe sore nipples after breastfeeding by reducing swelling. You can use a cool compress on your breast and nipple as well as under your arm.

Use a piece of fabric between your skin and something cold such as an ice pack. Never apply an ice pack directly to your skin. Apply the compress a few minutes at a time. You can do this on and off for a few hours until swelling is reduced.

A milk bleb is a blocked nipple pore. It appears as a small white or yellow blister on the nipple. A milk blister may go away on its own or it may recur.

You can try massaging it with olive oil (a folk remedy) but do not pick at it as this may cause bleeding and infection. You can also try applying a warm compress and then hand expressing some milk to see if that releases the block.

Talk with your doctor if you have a painful, recurring blister.

Choose a bra that’s breathable to prevent chafing. If it’s hard to find a bra that fits consistently while you adjust to milk supply and breast size, look for nursing camisole tops that tend to have more stretch.

Some doctors don’t recommend underwire bras while breastfeeding so ask your doctor what’s best for you.

Whatever is causing sore nipples, hydrogel pads can help soothe pain. Brands like Lansinoh and Medela make hydrogel pads. You can use them at room temperature or put them in the refrigerator for more cooling.

Gel pads also prevent your nipples from sticking and chafing on bra fabric. This is especially helpful if your nipples are already cracked or bleeding.

If your baby is a few months old and you suddenly get sore nipples, pay attention to see if your baby is playing around or gumming on your nipples when they should be eating. This new behavior sometimes starts as babies begin teething.

Offer a teething ring and don’t let baby gum your nipple during or between feedings, even if they don’t have teeth yet. If your baby does bite you and won’t let go, use the tips above to unlatch your baby.

Most women experience nipple pain when they first begin breastfeeding, but don’t wait too long to get help. The first few days and weeks are important for both mother and baby to learn healthy breastfeeding.

Contact your pediatrician right away if you’re worried that your baby isn’t getting enough milk. A sign your baby might not be getting enough is if they don’t have enough wet diapers each day.

Contact your own doctor right away if your pain is severe or you have any signs of mastitis. Mastitis is inflammation of breast tissue that sometimes includes infection.

Signs of mastitis include:

• fever
• breasts warm to the touch
• swollen or sore breasts
• redness
• pus
• pain or burning while nursing

Sore nipples are common in breastfeeding women, but there are ways to manage and reduce this symptom. Ask experienced mothers for advice, and work with your doctor to prevent and treat sore nipples.

If you want to breastfeed, take care of yourself so that it’s a mutually beneficial experience for you and your baby.

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