Sore/cracked nipples

Breastfeeding should not hurt. The most common reason for sore and damaged nipples is the baby’s poor attachment to the breast.

It can take a little while to get used to the strong sucking of a healthy baby. When you begin breastfeeding, your nipples may be sensitive and you can expect some early nipple tenderness. For most mothers, sore nipples cease to be a problem after the early weeks. Allowing your baby to self-attach as often as possible while you both learn gives you the best chance of avoiding damaged nipples.

Taking care in getting your baby on and off your breast, some simple first-aid treatment and a little time and patience are usually all that is needed to solve the problem. You will find that sore nipples improve quickly once your baby learns how to attach correctly.

Sore nipples

Although it is tempting to put off feeds, this can make things worse. Feeding your baby frequently for shorter periods is better than having fewer but longer feeds. Your baby will be calmer if less hungry and will be gentler on your nipples.

Before feeds:

  • Offer a feed before your baby starts crying, when your baby is showing early feeding cues.
  • Make yourself comfortable and relax as much as you can.
  • Massage your breasts gently and apply warmth to help get your milk flowing.
  • Express some milk to soften the areola to lubricate the nipple.

During feeds:

  • Offer the less sore side first.
  • Make sure baby is properly positioned at and attached to the breast. For help with this, please call our Breastfeeding Helpline.
  • Try different feeding positions.

If you wish, restrict comfort sucking while nipples are tender. Gently break suction with clean finger inserted in the corner of baby’s mouth before removing baby from the breast.

After feeds:

  • Check your nipples for signs of stress, such as red stripes or a squashed look.
  • Express a few drops of milk and smear on the nipple.
  • Leave your bra open for a few minutes until nipples are dry.
  • Keep nipples dry. Change nursing pads frequently. Consider washable nursing pads if disposable ones are chafing.
  • Use breast shells or nipple protector over tender nipples to stop clothes rubbing and allow air to circulate.

Avoid:

  • Using anything on your nipples that is drying or may damage your nipple skin (eg soap, shampoo, rough towels).
  • Wearing poorly-fitted bras and plastic-backed nursing pads.
  • Using breast pumps that have strong suction and hurt your nipples.

Contact your medical adviser, a lactation consultant, child health nurse or an ABA breastfeeding counsellor for further help.

Cracked nipples

Painful, sore or cracked nipples are NOT normal. There can be a few causes of sore or cracked nipples. Please contact one of our trained breastfeeding counsellors either by phone. Members can also contact a breastfeeding counsellor via email. They can help you work out what the cause may be. Working out the cause is important, as this helps to find the right solution in your case.

In most cases, sore or cracked nipples are the result of incorrect positioning or attachment.

If the cause of sore nipples is found and fixed, they usually improve quickly. However, if this doesn’t happen, they can develop cracks. Sometimes the crack in the nipple skin can be seen on the nipple itself or where the nipple joins the areola, or the crack can be very fine and hard to see. Breastfeeding with a cracked nipple is often painful and cracked nipples may bleed during breastfeeds.

Please note: Although bleeding looks scary and blood may sometimes show up in your baby’s bowel motions or vomit, it is not harmful to your baby. It is quite safe for her to keep breastfeeding.

Things to do to help a cracked nipple:

  • Find the cause — poor positioning or attachment, medical problems such as infection or dermatitis on your nipples, or anatomical problems such as tongue-tie in your baby, or damage from incorrect use of breast pumps.
  • Follow the ideas for sore nipples.
  • You may need to take your baby off the sore breast for 12–24 hours to rest the nipple and allow healing to begin. In such a situation, you can express to maintain your supply, keep your breasts feeling comfortable and feed your baby your expressed breastmilk.
  • Start breastfeeding on the sore nipple again gradually, with short feeds. Feed your baby from the less-sore side first. Take special care with positioning and attachment.
  • See your medical adviser if you need pain relief or you suspect a medical cause.
  • Use a nipple shield only after seeking face-to-face expert help.
  • Contact an Australian Breastfeeding Association counsellor, your child health nurse, midwife or lactation consultant for further help.

Please see your medical adviser if healing is slow.

The information on this website does not replace the advice of your health care provider.

© Australian Breastfeeding Association February 2014