sore nipples

Sore nipples can be a problem in the early days of breastfeeding and beyond. This article discusses causes of sore nipples and suggests methods to ease the pain.

The nipple is a structure located at the top of breast, surrounded by a darkened area of skin called the areola. The areola contains small glands called Montgomery’s glands, which lubricate the nipple during breastfeeding (MedicineNet, 2018). Some women get sore, cracked or painful nipples in the early days of breastfeeding.

Sore nipples are the most common breastfeeding complication and the most common reason women give up breastfeeding (NHS, 2016a). With a little breastfeeding support this can often easily be rectified.

What are sore nipples and what causes it?

Some women find their nipples get very sore a few days after they begin breastfeeding their baby. This usually happens if your baby isn’t positioned or attached well at the breast. If a baby only sucks the nipple rather than the whole areola, then their tongue or roof of the mouth may rub on the nipple. This causes nipples to get sore quickly and might cause nipple cracking (NHS, 2017).

What should I do if I have sore nipples?

Breastfeeding shouldn’t be painful, so it’s important to get breastfeeding support right from the start (NHS, 2016a). You should be offered breastfeeding support by a midwife or breastfeeding counsellor before you leave the hospital or birth centre. They can show you how to position and attach your baby to your breast and explain the signs that your baby is feeding well (NHS, 2017).

If your nipples are getting sore but you’re already home, make sure you get breastfeeding support from a midwife, health visitor or breastfeeding counsellor promptly. They can watch you while you feed your baby and check your baby is positioned well and feeding effectively.

You might also be able to feel when your baby is well attached. Your nipple should rest comfortably against the soft palate at the back of their mouth. If the nipple is nearer to the front of their mouth, your baby might be poorly attached. This can cause pinching of your nipple against the hard palate, which can cause pain.

You can check with your local NCT group what local breastfeeding support might be available. You may be able to drop in to a breastfeeding support group for advice or you might be able to have an NCT breastfeeding support worker visit you at home. You can call the NCT support line for practical and emotional support on 0300 330 0700.

Your midwife, health visitor or breastfeeding counsellor might also be able to help identify any other underlying issues (NHS, 2016a). Read on to find out more…

What other less common causes of sore nipple are there?

Engorgement

When your breasts become full of milk, your nipples might become sore (Breastfeeding Basics, 2015). This can happen when your breastmilk first comes in. Feed your baby as often as they would like and for as long as they like. You can also try using a warm heat pack or a warm shower before feeding or expressing milk or use cold packs after feeding for pain relief (NICE, 2017).

Flat or inverted nipples

Nipples come in all sorts of sizes and shapes. While most protrude, some are flat or inverted.

These differences don’t usually affect your ability to breastfeed. Yet if one or both nipples are flat or inverted, you might find it takes you a bit longer to get breastfeeding established. You might also be able to take steps when you’re pregnant or just after your baby’s born to help your nipples stick out (Breastfeeding Basics, 2015; La Leche League, 2016).

Tongue tie

Tongue-tie is when the skin joining the underside of the baby’s tongue to the floor of their mouth (frenulum) restricts how they can move their tongue. This causes difficulty in sucking milk and gives you sore nipples because they don’t latch properly.

If you’re experiencing breastfeeding difficulties and you think your baby might have tongue-tie, do visit your GP. They may suggest division of your baby’s frenulum, which is a straightforward procedure (NICE, 2017).

Thrush (candida) infection

Breast or nipple pain can sometimes be caused by a thrush infection (NICE, 2017). Sometimes, candida can infect your nipples if they become cracked or damaged. Babies who are breastfed can also develop thrush in their mouth. This is likely to be the cause if you have severe pain in both breasts for up to an hour after breastfeeding, despite weeks of pain-free breastfeeding. See your GP who can prescribe cream to treat you and your baby (NHS, 2018).

Mastitis

Mastitis is an infection that often causes a woman’s breast to become red and inflamed. See our article on mastitis for more information on symptoms and treatment. Continue to feed your baby and make sure they are attached well to the breast.

It’s important to see your GP quickly if you think you might have mastitis. That’s because it can lead to a breast abscess (collection of pus) if left, which may need draining (NHS, 2016b).

Nipple vasospasm

Sometimes painful and sore nipples can be caused by nipple vasospasm. This can be triggered if a baby’s latch is shallow and can also be connected to Raynaud’s phenomenon (a condition affecting blood supply) (Breastfeeding Support, 2018).

Some mums’ nipples look white (blanched) after a feed and they may experience a deep pain or burning sensation. If this is the case avoid exposing your nipples to the cold, wear warm clothing and breastfeed in a warm environment (NICE, 2017).

Should I limit my baby’s time at the breast to avoid sore nipples?

You should not try to limit your baby’s time at the breast, this is unlikely to relieve your pain. Continue breastfeeding if you can and get breastfeeding support to help you solve any issues like a poor latch or attachment (NICE, 2017).

What are nipple shields or breast shells and should I use them?

Nipple shields are thin, protective covers worn over the nipple while breastfeeding. Breast shells are hard, protective covers worn inside the bra. It’s advised where possible not to use nipple shields or breast shells because they might contribute to incorrect positioning and attachment.

You might wish to consider expressing breast milk if your nipples are very sore or cracked. Try to get some breastfeeding support to help you identify and solve any breastfeeding issues (NHS, 2016; NICE, 2017).

Treatment of sore nipples

Get breastfeeding support early on to make sure your baby is positioned and attached well. Some women treat nipple cracks with a thin smear of white soft paraffin, such as Vaseline, but the evidence for this is inconclusive. Sore nipples won’t get better if the positioning and latching of your baby does not improve (NHS, 2016a). Read our article on self-help tips for sore nipples.

This page was last reviewed in July 2018.

Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 021.

Best Beginnings - Bump to Breastfeeding DVD Chapter 7 'Overcoming Challenges'.

Breastfeeding Basics. (2015) Sore nipples. Available at: https://www.breastfeedingbasics.com/articles/sore-nipples [Accessed 13th July 2018].

Breastfeeding Support. (2018) Nipple vasospasm and breastfeeding. Available at: https://breastfeeding.support/nipple-vasospasm-breastfeeding/ [Accessed 13th July 2018].

MedicineNet.com. (2018) Breast anatomy. Available at: [Accessed 13th July 2018]. https://www.medicinenet.com/breast_anatomy/article.htm#breast_facts [Accessed 13th July 2018].

NHS (2018) Breastfeeding and thrush. https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-and-thrush/ [Accessed 13th July 2018].

NHS. (2016a) Sore or cracked nipples when breastfeeding. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/sore-cracked-nipples-breastfeeding/ [Accessed 13th July 2018].

NHS. (2016b) Mastitis. Available at: https://www.nhs.uk/conditions/mastitis/ [Accessed 13th July 2018].

NICE. (2017) Breastfeeding problems – management. Available at: https://cks.nice.org.uk/breastfeeding-problems#!scenario [Accessed 13th July 2018].

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