Breastfeeding shouldn’t hurt.
In the early days, most sore nipples are caused by your baby not attaching well 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.
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Lightly press a warm water compress (e.g. using a soft washcloth) onto your nipples after a feed.
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Gently smear a little breastmilk onto your nipples and let it dry.
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Keep nipples dry between feeds. Change breast pads regularly if you’re using them. Avoid those that hold moisture against the skin.
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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.
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Seek medical advice if you need pain relief, or if healing seems very slow.
Taking care of your nipples
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Try to avoid anything that might be drying or damaging (eg alcohol based products, rough towels).
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It’s alright to let soapy water run over your nipples during a shower but be careful that harsh soap products aren’t drying the skin of your areola or nipples.
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Wear a well-fitting bra. Take care that the fabric doesn't rub or stick to your nipples.
Breastfeeding with sore nipples
Yes, it can be painful but it’s important to keep feeding your baby as often as they need if you can. Some ideas that might help:
Help your baby to attach
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Offer a feed before your baby starts crying, when they are showing early feeding cues.
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Make yourself comfortable and relax as much as you can.
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Gently stroke your breasts or apply warmth just before a feed to help get your milk flowing.
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Hand express some milk to soften the areola and lubricate the nipple.
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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
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Offer the less sore side first. You can switch to the sore side after the milk begins to flow.
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If it doesn't feel quite right, pulling your baby's lower half in closer to your body can help them to attach more deeply. Make sure they are well positioned and their body is straight.
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Try different feeding positions and see what works for you. Baby-led attachment can be helpful.
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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
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. If healing is very slow, see your doctor to rule out infection.
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. You may see traces of blood in your baby's poos or vomit but it's not harmful to them.
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 attaches well at the breast. This is to make sure that you are comfortable. It also helps your baby to feed well so they can get enough milk.
Before using a shield, seek face-to-face help from an ABA Breastfeeding Counsellor, a lactation consultant or a doctor who has extra training in 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 feed your baby your 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.
Berens, P., Eglash, A., Malloy, M., & Steube, A. M. (2016). ABM clinical protocol #26: Persistent pain with breastfeeding. Breastfeeding Medicine, 11(2), 46–53.
Brodribb, W. (ed). (2019). Nipple pain. In Breastfeeding Management in Australia (5th ed., pp. 137-147). Australian Breastfeeding Association.
Cotterman, K. J. (2004). Reverse pressure softening: A simple tool to prepare the areola for easier latching during engorgement. Journal of Human Lactation, 20(2), 227–237.
Dennis, C. L., Jackson, K., & Watson, J. (2014). Interventions for treating painful nipples among breastfeeding women. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858. CD007366.pub2
Joanna Briggs Institute. (2009). The management of nipple pain and/or trauma associated with breastfeeding. Australian Nursing Journal, 17(2), 32–35.
Walker, M. (2013). Are there any cures for sore nipples? Clinical Lactation 4(3).
Wang, Z., Liu, Q., Min, L., & Mao, X. (2021). The effectiveness of the laid-back position on lactation-related nipple problems and comfort: A meta-analysis. BMC Pregnancy and Childbirth, 21(1), 248.
© Australian Breastfeeding Association February 2023
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Breastfeeding: breast and nipple care
