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First aid for sore nipples

Breastfeeding shouldn’t hurt. 

 

Fixing baby’s attachment is the first step to manage nipple pain but what else can I do? 

mother holding breast

In the early days, most sore nipples are caused by incorrect attaching to the breast. Your baby may not be taking a large enough mouthful of breast and/or not drawing your nipple far enough back into their mouth.  

The first thing to do is to check your baby’s positioning and attachment.

Helping your nipples to heal

While you’re getting help to fix the problem that’s caused your sore nipples, here are some things you can do to help them heal.  

  • Lightly press a warm water compress (eg using a soft washer) onto your nipples after a feed.

  • Gently smear a little breastmilk onto your nipples and let it dry. 

  • Keep nipples dry between feeds. Change breast pads regularly if you’re using them. Avoid those that hold moisture against the skin. 

  • Speak to your midwife, lactation consultant or doctor before using creams or ointments on your nipples to check if this is the right choice for you. 

  • Seek medical advice if you need pain relief, or if healing seems particularly slow. 

Taking care of your nipples

  • Try to avoid anything that might be drying or damaging (eg alcohol based products, rough towels).  

  • It’s alright to let soapy water run over your nipples during a shower but be careful that soap products aren’t drying the skin of your areola or nipples. 

  • Wear a well-fitting bra. 

Breastfeeding with sore nipples

Yes, it can be painful but it’s important to keep feeding your baby frequently if you can. Some ideas that might help: 

Help your baby to attach  
  • Offer a feed before your baby starts crying, when they are 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 and to lubricate the nipple. 

  • If your breasts are engorged, your baby might have extra trouble attaching. Expressing to soften or using Reverse Pressure Softening may help.

Adjust as needed 
  • Offer the less sore side first. 

  • If it doesn't feel quite right, you can try pulling your baby in closer to your body, making sure they are well positioned so their body is straight. 

  • Try different feeding positions and see what works for you. 

  • If it’s not working, gently break suction with a clean finger in the corner of your baby’s mouth. Take baby off and try again. 

Commonly asked questions about sore nipples

How long will it take to heal?  

The healing process will depend on the cause of the problem, and how quickly you can get help to fix it.  

Once your baby’s attachment is improved, you may notice that the feeds quickly become more comfortable. If your nipples are damaged, then you may still feel pain just at the start of the feed, as baby draws your nipple into their mouth. However, if they are latching well, this pain should ease after 20-30 seconds.  

Once the attachment is improved, your nipples will be able to heal. 

What if my nipples are cracked or bleeding?

Sometimes a damaged nipple gets a crack. You might see this on the nipple itself or where the nipple joins the areola. Sometimes the crack is very small and hard to see. Breastfeeding with a crack can be very painful and the cracked nipple may bleed during breastfeeds. 

If your nipples are cracked or bleeding, it's quite safe to continue breastfeeding. The bleeding looks scary and blood may sometimes show up in your baby's poos or vomit but it's not harmful to them. 

Should I use a nipple shield?

Someone may have suggested that you try a nipple shield. In some cases, shields can be helpful, but it’s still important that your baby latches well at the breast. This is to make sure that you are comfortable. And also to be sure that your baby feeds well and gets enough milk.  

Before using a shield, seek face-to-face assistance from an ABA Breastfeeding Counsellor, a lactation consultant or a doctor who is a lactation expert.   

Should I pump instead of breastfeeding?

If the pain is very bad, you might like to rest your nipple for 12 to 24 hours to allow healing to begin. In this case, you can express to maintain your supply and continue feeding your baby. You can feed your baby expressed breastmilk using a cup. Cup feeding rather than bottle feeding helps babies as they're learning how to attach to the breast well. 

Take care when using a breast pump to make sure that the fit is right and the suction is not too strong, or this may also hurt your nipples. You may find that hand expressing is a gentler option that can still work very well.  

References

Huml S 1999. Sore nipples. A new look at an old problem through the eyes of a dermatologist. The Practising Midwife 2(2): 28-31. 

Winter GD 1962. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature 193:293-294. 

Cable B, Stewart M, Davis J 1997. Nipple Wound Care: A New Approach to an Old Problem. Journal of Human Lactation 13(4): 313–318. 

Brodribb W (ed) 2019, Breastfeeding Management in Australia. 5th ed. Australian Breastfeeding Association, Victoria 

Walker M 2013. Are there any cures for sore nipples? Clinical Lactation 4(3), http://dx.doi.org/10.1891/2158-0782.4.3.106 

© Australian Breastfeeding Association April 2022

Read more about sore nipples

Breastfeeding: breast and nipple care 

For evidence-let info and practical tips

Breast and nipple care booklet