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Sore Nipple Management

By Barbara Wilson Clay, BSed, IBCLC

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Breastfeeding is meant to be a comfortable and pleasant experience. During the first week or two, however, many mothers notice nipple tenderness. This may be related to normal postpartum skin changes or to inexperience with latching on. Tenderness of this kind soon disappears. In the meantime, USP modified lanolin such as Medela’s Tender Care™ Lanolin and Hydrogel pads are safe and soothing.

Nipple pain that occurs between feedings or that continues during the entire feeding is not a normal part of the breastfeeding experience. Tell your lactation consultant, La Leche League or Nursing Mothers’ Council helper, or your health care provider if your nipples become cracked or blistered. Breastfeeding assistance from a knowledgeable breastfeeding professional can often correct these problems.

Most nipple injury results from a poor latch. Effective latch on insures that the most sensitive part of the nipple tissue is pulled deeply into the baby’s mouth. The tongue is forward over the lower gum to help cushion the compression.

When a baby is incorrectly latched, the baby grasps just the nipple shaft rather than locating the gum compressions on the breast itself. Mothers can identify a shallow, improper latch by removing the baby and checking the shape of the nipple. If the nipple looks creased, or drawn into a point (like a new lipstick), this is a sign that the baby is compressing the nipple shaft. Cuts can form across the crease line, as well as at the base or junction of the nipple and areola.

If the milk flow is pinched off due to a nipple latch, if the milk supply is low, or the breast is hard to draw in because of engorgement, the baby will suck harder to get milk. This extra strong suction applied to such a small surface area can cause blistering.

Solutions:

Seek help to correct the latch-on and positioning problems that cause sore nipples. Often, simple positioning changes can fix the problem.

Manage engorgement or low milk supply problems.

Gentle cleansing is good first aid for any cut in the skin surface. Wash your nipples with a mild, non-antibacterial soap during your daily shower. Rinse well.

Your own milk feels soothing to sore nipples.

If the nipples become too painful to allow breastfeeding, hand expression or a gentle, effective breast pump will protect your milk supply and provide milk for your baby until healing takes place.

Broken skin can become infected. Your health care provider may recommend a safe, topical medication to resolve the problem. If mastitis (breast infection) occurs, oral antibiotics can be prescribed that are safe for use by breastfeeding moms.

Other suggestions for preventing sore nipples:

Avoid early use of bottles and pacifiers.

Frequent breastfeeding (8-12 feeds per 24 hours) will prevent the baby from sucking too vigorously due to hunger.

Soften engorged breasts with hand expression or pumping to help baby latch on. A brief warm shower before expression might be soothing to some moms.

Express a little milk first to stimulate the let down reflex before latching.

Use relaxation techniques before and during feedings.

Check the baby for conditions such as tongue-tie that can contribute to sore nipples.

Breastfeed on the least sore side first. Limit feeding time on the sore nipple if necessary. (Finish emptying the breast with hand expression or a breast pump).

To remove the baby from the breast, place a clean finger between the baby’s gums. This will prevent the baby from clamping down on the nipple.

Avoid synthetic bras and plastic-lined pads.

Use care when applying herbal preparations. Some can be toxic to the baby, or have strong odors that lead to breast refusal, or can trigger allergic reactions.
-Avoid the use of Vitamin E on the nipples. This can be toxic to the baby.
-Many ointments or creams can cause allergic reaction when applied to broken skin. Consult your health care provider or lactation consultant.

Keep pads and bras dry. Drop bra flaps and allow air to circulate.

Multiple-hole breast shells hold fabric off of sore nipples and allow air circulation.

References:

Centuori S, Burmaz T, Ronfani L, Fragiacomo M, et al: Nipple Care, Sore Nipples, and Breastfeeding: A Randomized Trial, J Human Lact 1999; 15(2):125-130.

Fetherston C: Mastitis in lactating women: physiology or pathology? Breastfeeding Review 2001, 9(1):5-12.

Lawrence R and Lawrence R: Breastfeeding: A guide for the medical profession, Fifth Ed. Mosby, St. Louis.1999. Pg. 259-261.

Livingston V and Stringer J: The Treatment of Staphyloccocus Aureus Infected Sore Nipples: A Randomized Comparative Study, J Human Lact 1999, 15(3):241-246.

Riordan J: The effectiveness of topical agents in reducing nipple soreness of breastfeeding mothers, J Human Lact 1985;1(3):36-41.

Spangler A and Hildebrandt E: The effect of modified lanolin on nipple pain/damage during the first ten days of breastfeeding, Int J Childbirth Ed 1993; 8(3):15-19.

Woolridge M: Aetiology of sore nipples, Midwifery 1986; 2:172-176.

Wilson-Clay B and Hoover K: The Breastfeeding Atlas 1999, Lactnews Press, Austin, Tx. Pg. 10-12, 17-21.

Zeimer M, Paone J, Schupay J, and Cole E: Methods to Prevent and Manage Nipple Pain in Breastfeeding Women, West J Nurs Research 1990; 12(6):732-744.

Zeimer M and Pigeon J: Skin Changes and Pain in the Nipple During the 1st Week of Lactation, JOGNN 1993; 22(3):247-256.

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