Sore Nipples– Normal, or Sign of a Problem?

A mom having sore nipples is one of the reasons given most frequently for ending her breastfeeding journey sooner than she had planned. Some women tough it out, but breastfeeding is not a pleasant experience for them, and they may even come to dread feedings. Sore nipples are not uncommon during the first couple of weeks of breastfeeding. For a lot of women, this discomfort can be within normal limits. However, it should go away at a certain point.

Some women are also given misinformation about sore nipples. A nurse I work with once told me that she tells mom that if it hurts, then they know they are doing it right. I responded, “Noooo!” Then we had a quick conversation, and now she knows, that is a terrible thing to say to a mom.

I want you to know what is normal and what you can do about this challenge, and when to call for a lactation consult. If you have sore nipples, the quicker you get professional help, then the easier it will be to fix the problem. The longer you wait can result in a much longer time until the pain, and possibly, trauma goes away.

Reasons for Sore Nipple

There are many reasons why sore nipples can happen. It can occur throughout your breastfeeding journey, for different reasons.

There was a time when women were told that sore nipples came from poor positioning. End of story. Fix your positioning and all would be right with the world and your nipples. Your breastfeeding world, anyway. Among the many things I learned when I became a lactation consultant was that promise is a lie. It was also another one of those things that blame moms when things go wrong. If it is all about positioning, and you still have pain, then you obviously must be positioning your baby wrong. It’s your fault.

So, as I list the reasons for sore nipples, let’s get that one out of the way, right away.

  • Poor positioning – Poor positioning of your baby can definitely result in sore nipples. This is true of how your baby’s body is positioned against your body, and where your baby’s mouth is relative to your nipple
  • Within Normal Limits (WNL)– this is sore nipples that will happen to the majority of moms in the beginning (more on this one later)
  • Poor latch
  • Poor latch technique
  • Poor suck
  • Dysfunctional suck
  • Tongue variations
  • High palate
  • Vasospasm or Raynaud’s Syndrome
  • Nipple yeast (mom and baby don’t always have it together either)

Sore Nipples in the First Few Days

WNL – There is nipple soreness that is considered to be “within normal limits.” If you want to sound like you know the medical lingo, when you write about it on Facebook, call this nipple soreness that is WNL.

  • This usually starts after you have had several breastfeeding sessions. It occurs when your baby first latches, and then eases within about 10-20 sucks.
  • After the initial period of discomfort (or even downright pain), it should feel like a firm tug, but should not feel pinchy (that’s a medical term–kidding!).
  • When your baby comes off your breast, your nipple should be round, and might be a little longer than it usually is.
  • It should not be creased.
  • It should not look like a lipstick, or be wedge-shaped, which is when one part of the nipple is pulled out more than the rest. At least as long as your nipple is round to begin with. If your nipple has always had one part pulled out then breastfeeding is not going to make it round.
  • Sore nipples that are WNL will be at its worst by 2-4 days
  • Your nipples should feel much better by the end of the first week
  • Any discomfort should be entirely gone by the end of the second week.
  • Nipple trauma, cracks, bleeding, bruises or blisters are never normal.  You should always get professional help if you are experiencing pain from nipple trauma.
  • You should get help if your pain is not improving within the time frame that I gave.

Poor Positioning – This is an important one. Proper positioning can quickly improve any nipple soreness you are having.

  • Your baby should completely be facing your body. In the cross-cradle, cradle, laid-back and side-lying positions this will be “tummy to tummy.” In the football hold, it will be his tummy against your side.
  • Hold your baby in close to you.
  • His nose should be across from your nipple. This will result in him reaching up when he opens up to take your breast into his mouth.
  • Any position that makes him have to reach down, so his chin  gets closer to his chest, makes it uncomfortable to swallow, and he will pull up on the nipple

Poor Latch Technique – This is another important thing that can make a huge difference when you do it right.

  • Keep your hands OFF your baby’s head. Having your hands on the back of your baby’s head will result in his head being pushed down when you bring him into the breast. This result in his chin being pushed down towards his chest, and remember, he won’t like that. Also, if having his head pushed on doesn’t feel good to your baby, he will probably push back against your hand, instead of starting to suck. He may cry as well. I always demonstrate to moms what this would do and feel like to them. Some moms misinterpret this pushing back and crying as a sign that their baby doesn’t want to breastfeed when, really, he just doesn’t want his head shoved on and pushed down towards his chest.
  • Put your hands on his neck and shoulders, firmly, so you have good control of him as you pull him in.
  • Pull him into your breast. This is the common “baby to breast, not breast to baby” advice. It really will result in a more comfortable latch.
  • A good latch is not only more comfortable for you but results in your baby getting more milk. It’s a win-win

Poor or Dysfunctional Suck – You need a professional to assess this. Sometimes parents will tell me that their baby has a very strong suck, when in fact he is biting or clamping down. This is the kind of thing where a lactation consultant is usually the best person to assess if this is the cause of your nipple soreness.

Tongue Variations – Some babies have a tongue or lip tie. I just wrote about this-http://breastfeedinganswersandsolutions.com/answering-questions-tongue-tie-lip-ties-can-affect-breastfeeding

Some babies just have a short tongue. This is not an abnormality. It’s more of a variation in anatomy.

High Palate – This is another variation in anatomy. It is one that can result in sore nipples for a period of time, but, usually, will eventually get better with time.

Vasospasm or Raynaud’s Syndrome – these are conditions that are very similar. Although you can consult Dr. Google, a lactation consultant is usually in a better position to help you determine if this is why you have sore nipples.

Nipple Yeast – We all have yeast in our bodies. Sometimes it overgrows and creates itching and burning. Yeast in the nipples is sometimes apparent visually because the nipples are bright pink and may have flaky skin around them. This is not always the case though. The nipples may not be itchy. The pain associated with yeast is typically described as a shooting or burning type of pain. Both treatment and precautions are essential and are a blog post all in themselves. Stay tuned! If you think you might have a yeast infection in your nipples, you should see a lactation consultant.

Photo credit: treehouse1977 via VisualHunt / CC BY-SA

Poor Fit of Breastpump Shields – a breastpump shield that is too small or too large can cause sore nipples. The nipple itself should not rub against the sides of the shield. A little bit of your areola should be pulled in, but not too much. When in doubt, ask a lactation consultant. And remember. Breast size can be very different from nipple size and nipple size can be different than areola size.

Skin Disorders – Such as psoriasis or eczema. See a dermatologist to determine the best course of treatment.

Biting – This can happen in the first few days and will usually resolve on its own. Continued biting past a couple of weeks in a newborn should be evaluated by a speech therapist.

  • Once your baby starts teething, or gets teeth, he may start biting. That can cause cuts on your nipple.
  • If your baby is sucking actively, he will have his tongue extended and won’t be able to bite.
  • If he’s biting due to teething or just experimenting with his new teeth, he can be taught not to do that in the vast majority of cases. Tell him, firmly, “no..” Tell him that biting hurts mommy and that is not allowed. Try to let him go back, but if he doesn’t stop, then you should end the feeding. Usually, he will do this at the end of the feeding when he is full.

Reaction to solids – This is rare. However, sometimes when a baby starts solids and breastfeeds soon after eating them, the residue in his mouth can cause irritation to your nipples.

Allergy to the plastic of breast pump shield – This is very rare, but can happen.

Hormones – Some Moms will have sore nipples that linger for about six weeks until their hormone levels get back to some of their pre-pregnancy levels. The discomfort won’t be severe and there will be no trauma associated with it.

Pregnancy – If you become pregnant while breastfeeding, the effect on your hormones can cause sore nipples. Remember, you can get pregnant without ever resuming your periods.

Photo credit: nina.jsc via Visual hunt / CC BY

Things That Can Help Sore Nipples

  • First and foremost is to fix the cause, if possible
  • For sore nipples that are WNL, lanolin for breastfeeding, and breastfeeding gel pads for your nipples can help
  • Peppermint tea water blotted on with a cotton ball. I don’t recommend applying the actual wet tea bag or soaked cotton ball directly to your nipples
  • I’m not a fan of butters or creams that have a lot of different ingredients
  • Sometimes, for more painful sore nipples, using a prescription ointment can help things significantly. (It’s called “All Purpose Nipple Ointment” where I practice. APNO for short.
    • It requires a health care provider to write an Rx and a pharmacy that will compound it. The recipe can be found here https://www.breastfeedinginc.ca/informations/all-purpose-nipple-ointment-apno/
    • It is a combination of an antibiotic, antifungal, and cortisone.
    • This type of ointment should not be used for longer than 2-3 weeks.
    • It does not need to be wiped off before breastfeeding, according to the pediatrician who developed the recipe

One Last Thought

Many things can cause sore nipples. It is always a good idea to check in with a lactation consultant if you are experiencing sore nipples.

Next Time

Baby Friendly hospitals. What does that mean, and where they are