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Nipple infections

Sore nipple still isn’t healing but baby latches well?

An infection can be the cause of nipple pain.

Woman checking breast

What is the difference between sore nipples and a nipple infection?  

Sore nipples usually happen because of poor attachment. Once you find the cause and manage it, the soreness goes away. Occasionally nipple pain persists because the nipple has an infection.    

You may have a nipple infection if:  

  • Your baby is attaching and feeding well but you are still experiencing nipple pain beyond the first week.  

  • The nipple pain starts after you've been feeding comfortably for a while. 

  • Other causes of nipple pain have been ruled out, for example tongue-tie. 

About 10% of breastfeeding mothers experience nipple or breast pain that's not associated with breast redness or fever. They often described the pain as 'burning', ‘stabbing’, ‘knife-like’, ‘shooting’ or ’sharp’. 

Common infections 

Sometimes it can be difficult to find out what germ is causing the nipple pain as different germs can cause similar signs and symptoms.   

  • Thrush (Candida albicans) is a yeast-like germ that is present in the gut of healthy people.  
  • ‘Staph’ (Staphylococcus aureus) is a bacterial germ also often found on healthy human bodies.  

Both of these can cause infection under the right conditions, leading to breast and nipple pain in breastfeeding mothers. Staph is sometimes present in mastitis. All mouths, including those of babies, contain germs that can cause thrush or a bacterial infection if the nipple skin is broken. This will delay healing of the damage already there. In some cases, these infections may occur even when your nipples don't look damaged.1

How do I tell if I have a nipple infection?  

Signs of infection on the nipples may include:

  • cracks 

  • redness 

  • shiny areas 

  • pus-like fluid or clear fluid coming from the nipple. 

Or there may be no outward signs but you may have

  • sore nipples that are extremely sensitive (especially to light touch) 

  • an itchy breast or nipple 

  • knife-like or burning pain 

  • deep pain or throbbing inside the breast 

  • pain sometimes extending to the arm or back 

  • pain starting during a feed and staying for some time afterwards. 

What to do about a nipple infection?

  • See your doctor for diagnosis and treatment.  Treatment will depend on what is causing the infection. One common treatment is a combined antifungal/antibacterial cream. In severe cases, you may have to take tablets. Your doctor will also check for other conditions, such as dermatitis, which may have similar symptoms. 

  • Keep breastfeeding or feeding expressed breastmilk to your baby. It is safe to feed while you have a nipple or breast infection.  

  • You don’t need to throw out any stored expressed breastmilk if you have a breast or nipple infection.2

If you or your baby have thrush

Thrush spreads easily. If you are being treated for thrush, your baby’s mouth is usually treated at the same time. This will stop you and your baby passing the infection back and forth between you through breastfeeding.3

Thrush shows in your baby’s mouth as white, curd-like patches or coating that cannot be wiped off easily. Even if no white can be seen in the baby’s mouth, it is usually still treated if you have symptoms of thrush on your nipples. 

If you also have vaginal thrush or your baby has nappy rash, these can be treated too. Getting rid of thrush requires very strict attention to hygiene:  

  • Washing hands before and after feeds and nappy changes.  

  • Washing towels, face washers, bras and cloth breast pads frequently in hot water and drying them in the sun. Wash bras and breast pads in a laundry product designed for sensitive skin and rinse well. 

  • Boil dummies as well as any toy that goes into your baby’s mouth. Put away any item that cannot cope with this treatment. 

 

Access the Royal Women's Hospital, Victoria fact sheet on Breast and nipple thrush 

 

© Australian Breastfeeding Association May 2022

References
  1. Amir LH, Cullinane M, Garland SM, Tabrizi SN, Donat SM, Bennett CM et al, 2011, The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol, Biomedical Central Pregnancy and Childbirth, 11(54): 1–10.
  2. Academy of Breastfeeding Medicine 2017 Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants. Retrieved from https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/8-human-milk-st….
  3. Royal Women’s Hospital. (2020). Breast and nipple thrush clinical guideline. https:// thewomens.r.worldssl.net/images/uploads/downloadable-records/clinicalguidelines/breast-and-nipple-thrush_280720.pdf