Sore or cracked nipples are a common complaint particularly in the first few weeks of establishing breastfeeding. The most common cause of sore nipples is poor attachment. Some other causes are listed below but early intervention can
help tremendously especially when first establishing breastfeeding so seek advice from a Lactation Consultant sooner rather than later if you are experiencing nipple pain.

Causes

  • Poor position and attachment (most common cause) <liDermatitis
  • Candida infection
  • Baby’s anatomy (high palate, tongue tie)
  • Using an incorrect sized flange when using breast pump
  • Raynaud’s phenomenon

Treatment

  • Consider baby-led attachment (place baby skin-to-skin on your chest and allow the baby time to bob his/her way to your nipple- often baby’s will latch perfectly when allowed time to latch on their own)
  • Ensure optimal positioning (see Resources section for a link to a video demonstrating optimal positioning and attachment)
  • Never force or push the baby onto the breast
  • Consider using warm flannels or lukewarm heat packs on nipples immediately prior to breastfeed to encourage milk flow
  • Ensure the baby is taking a large mouth of both the areola and the nipple,not just the nipple. The further back your nipple is in the baby’s mouth the less pain
  • Sometimes after correcting the positioning and attachment you may still experience pain when the baby initially attaches to the breast. In this case count to 10 once the baby initially latches. If the baby has latched correctly the pain will soon subside however if the pain continues unlatch the baby, check the positioning of the baby and try again
  • If breastfeeding is till too painful despite correcting the positioning
  • If engorged consider hand expressing a small amount off to soften the areola to allow baby to take a wide enough mouth full of the breast
  • If there is still pain once the baby has latched unlatch the baby by placing a clean finger into the baby’s mouth to break the seal and reposition the baby (tummy-to-tummy, nose to nipple) and try again
  • Express a small amount of breastmilk post each feed and gently rub onto nipple- allow to air dry. Then use 100% Lanolin after each feed- do not wash off prior to breastfeeding.
  • If the damaged nipples are caused by candida DO NOT use Lanolin and instead seek advice from your doctor- consider using Dr Jack Newman’s All Purpose Nipple Ointment- see link in resource section

What if my nipples are too painful to breastfeed despite correcting the position and attachment?

  • If nipples are already damaged you can continue to breastfeed in most cases once the position and attachment of the baby has been improved (see Resources section for a link to a video demonstrating optimal positioning and attachment)
  • If breastfeeding is till too painful despite correcting the positioning and attachment consider resting and expressing the damaged breast for 24 hours.
  • If both nipples are damaged you can choose to rest and express both breasts- giving the baby the expressed milk or if one nipple feels ok then you can continue breastfeeding from the less damaged breast and express from the more damaged breast
  • If you choose to rest and express one breast then offer the intact breast at each feed, then offer the baby a top up of the expressed milk (that has been expressed from the damaged breast). Ensure you have a good quality breast pump and that the flanges fit correctly (your nipple should not rub on the side of the flange)