Sore nipples when breastfeeding can be a problem in the early days and beyond. This article outlines causes of sore nipples and suggests methods to ease the pain.
Nipples come in all shapes and sizes; most stick out, but flat or inverted nipples are also common. Surrounding your nipple is darker skin called the areola (plural is areolae). Your nipples may also have a number of small bumps called tubercules; these produce an oily substance to protect your nipple.
What happens to my breasts during pregnancy?
Once you’re pregnant, the hormone progesterone may make your areolae swell, your nipples may become sensitive and your breasts may tingle or feel tender as your milk-producing cells and ducts start to grow. This is your body preparing your breasts to feed your baby. Breasts contain lobes, which are structured a little like bunches of grapes. Each lobe consists of milk ducts, and several lobules, which produce and store milk; the milk then goes along the ducts to tiny openings in the nipple.
Women have between four and 18 of these ducts, so the milk will come out of several tiny holes, rather like water from a watering can. The rest of the breast is made up of tissue and fat. The size of your breasts depends on the amount of fat, and has no impact on breastfeeding.
During pregnancy your body has high levels of the hormone oestrogen and this tends to prevent milk production, unless you are already breastfeeding another baby.
Colostrum, the very early fluid produced before milk, starts being made in mid to late pregnancy, though you may be unaware of it. Some women find their nipples leak, or get crusty, as the colostrum dries after leaking. Others feel and see nothing at all.
As birth approaches, your nipples and areola may become darker and more obvious.
Can I breastfeed with flat or inverted nipples?
Yes, these are quite normal and your baby will often draw them out when they feed. Getting your baby in a comfortable, effective position is the most important thing (see below). Your baby’s mouth needs to be wide open so that the nipple is in the top part of their mouth; their tongue can then lie underneath a long stretch of your breast.
Should I limit my baby’s time at the breast to avoid getting sore nipples?
Limiting time at the breast is rarely helpful, as it means your baby may not get all the milk they need. Also, it could reduce your milk supply if your body doesn’t receive enough stimulation to produce the right amount of milk. If your baby is well attached, they can feed for as long as you both want without you getting sore.
Is there anything I can do to prepare my breasts and nipples for feeding?
There is no evidence that preparing your nipples in any way with products like creams and lotions makes any difference. You also don’t need to eat or drink anything special in order to breastfeed; just eat or drink when and what you want to.
How do I avoid sore nipples?
Many women have sensitive nipple skin for a while after the birth, and breastfeeding can feel slightly uncomfortable, especially as you won’t be used to the strong sensation of your baby’s feeding action. Try to relax with slow deep breathing at the beginning of the feed, and try to help your baby become attached, before they start to cry.
When your baby starts to feed, wait for a short time, and if you still feel uncomfortable, take them off by putting your little finger into the corner of their mouth to break the suction and start again. If pain continues, or if your nipples are damaged or distorted in any way, talk to your midwife, breastfeeding specialist or breastfeeding counsellor.
What causes sore nipples?
Enabling your baby to become attached (or ‘latched on’) to the nipple in a way that’s comfortable for both of you reduces the chance of soreness, and helps make feeding more effective. Your baby needs to be in a position where they can draw in a mouthful of breast, which means the nipple ends up at the back of their mouth. If you and your baby find this awkward or difficult, ask your midwife for help, and explore different ways to hold and/or position your baby.
Another less common cause of sore nipples is thrush, which is a fungal infection that can affect the skin. Both you and your baby will need medical treatment for thrush.
Some babies may also have difficulty attaching properly because of a condition called tongue-tie, which prevents a baby’s tongue from moving as it should. If tongue tie needs treating, this can be done quickly and easily by someone trained in snipping the frenulum (the skin between the tongue and the bottom of the mouth). Ask your midwife, health visitor or breastfeeding counsellor about this service.
What can you do? Treating sore nipples when breastfeeding
If your nipples become damaged or cracked, they will be very painful; though they will heal quickly once the underlying reason is dealt with. There is little research to show what helps healing but some women find it helpful to gently spread some expressed breastmilk over their nipples at the end of a feed. Alternatively, you could use some highly purified lanolin ointment on your nipples until they heal. This prevents scabs forming and keeps the nipple skin moist. Women can also find it soothing. Pat your breasts dry before applying it. You don’t need to remove it before the next feed.
Keep asking for help until you find someone who can show you a more comfortable position in which to feed your baby. A very small change can make all the difference.
Try to keep feeding your baby if you can, as this will help to maintain your milk supply. If the pain is worse on one side, then a temporary option might be to start a feed on the other side. You can then swap breasts once your baby is feeding less hungrily. Always seek help if you’re finding feeding painful.
What about nipple shields?
It may be suggested that you use a nipple shield to prevent further damage and to protect your nipple, although suction through the nipple shield can open cracks. If feeding doesn’t feel possible without a shield, then this may be one option.
The main problems are that using them does not necessarily lead to better positioning and they may alter your baby’s sucking action. They may also make it harder for your baby to remove milk effectively, and this can reduce your supply. Some women also find it hard to get rid of nipple shields afterwards – their babies seem to prefer the super-stimulation of this artificial nipple.
Why might I have sore breasts?
When your baby is feeding, your breasts ‘let down’ milk. A few women find this sensation painful. You may also feel your womb contracting. It should pass quickly; try to relax through it.
If you find you have red, inflamed areas on your breast and a flu-like feeling, this could be a sign or symptom of mastitis, which is an inflammation of the breast. Try to rest and keep feeding your baby, as stopping breastfeeding will make the problem worse. Usually mastitis results from blocked ducts, an attachment that is not quite as it could be untreated engorgement or delayed feeds.
Very gentle hand expression (ask your midwife or breastfeeding counsellor) can sometimes be necessary to make things more comfortable for you and your baby and to relieve the pain of sore breasts during breastfeeding.
Your GP may prescribe an anti-inflammatory drug. If you can treat the problem, the mastitis will ease, and you will not need medication. In a few cases, mastitis results from an infection so needs antibiotics. There’s a chance it can lead to an abscess. If you can identify why you got mastitis, you can prevent it happening in the future, so talk it through with a breastfeeding counsellor.
Sore nipples after breastfeeding for a while
Once you have established breastfeeding with your baby but you're experiencing persistently sore nipples, there are a number of things you can do.
Check the way your baby attaches to the breast, as changes here can often make a difference and this is the most frequent cause of sore nipples. A small minority of babies may have a tongue tie that makes comfortable attachment more difficult to achieve.
Once you’ve ruled out those possibilities, other things to consider include:
- Thrush – a fungal infection that can also appear in your baby’s mouth. Signs are red, shiny-skinned nipples, sometimes with cracks and sometimes with white patches plus white patches in your baby’s mouth. Your GP can prescribe treatment. Some people who provide breastfeeding support believe that thrush can also affect the milk ducts, causing sharp pains in the breast, but not everyone agrees that this is thrush.
- Skin irritation caused by sensitivity to clothing or washing powder. Very rarely, women can also become sensitive to their babies’ saliva after solids have been introduced – you might be able to work out which foods this happens with, if you keep notes.
Always seek help from a breastfeeding counsellor if you need it. For more information about other possible problems you might encounter later on with breastfeeding, read our article here.
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.
NHS information on mastitis.
Best Beginnings - Bump to Breastfeeding DVD Chapter 7 'Overcoming Challenges'.