April 28, 2020

By Andrea Tran RN, BSN, MA, IBCLC

Sore nipples are a common complaint of mamas throughout their breastfeeding journey. Some degree of nipple soreness is experienced by the majority of women when they first start breastfeeding. This is true even of those moms who have picture-perfect positioning and use flawless latch technique. Fortunately, this is primarily a breaking-in period for their nipples and it will resolve quickly. New moms should know what they can expect from nipple soreness and what are red flags that something abnormal is occurring.

When is nipple soreness in the first few weeks of breastfeeding considered normal?

• Begins within the first 2-3 days
• Peaks by day four
• Is much better by the end of the first week
• Completely resolved by the end of the second week
• Your nipple is round when the baby detaches
• The nipple is not creased or lipstick-shaped
• No bruising, blisters, bleeding or cracks
• Discomfort passes within the first minute of latching

A lactation consultant should evaluate any nipple pain that is outside of these parameters.

How to minimize early nipple soreness

Using correct positioning and latch technique is crucial for minimizing nipple soreness in the first few weeks of breastfeeding. The cross-cradle and football holds provide you with the most control and your baby with optimum support.

• Your baby should be facing you with his tummy.

  • In cross-cradle, you will be tummy to tummy with your baby.
    
    
    

  • In football hold, your baby’s tummy will press up against your side.
    
    

• His nose should be directly across from your nipple.

• Support his neck and shoulders.
• Keep your hand off the back of his head.
• Keep your forearm along his spine.
• Touch the space between his nose and lip with your nipple.
  • Don’t make your nipple a moving target by stroking back and forth or up and down.
• Wait until he opens wide and then pull him in quickly and closely.
• His chin should be pressed into your breast.
• His nose should be just barely touching your breast or not touching it at all.
  
  
  

How to relieve nipple soreness in early breastfeeding

Even though nipple soreness is common, it still can cause discomfort. There are a variety of remedies available that will provide moms with relief.

• Lanolin formulated for breastfeeding
• Gel pads
• Breast shells for sore nipples
• The prescription ointment, All Purpose Nipple Ointment. This ointment is a combination of an antibiotic, antifungal, and corticosteroid. It was developed by a pediatrician who specializes in breastfeeding.
• Peppermint provides an analgesic effect and has antibacterial and anti-inflammatory properties.
  • Brew pure peppermint tea and let cool.
  • Soak cotton balls in the tea.
  • Blot the nipples with the cotton balls.
  • Let air dry.
  • Rinse off with water before the next feeding.
  • Don’t drink the tea as peppermint has anecdotally been reported to decrease milk supply.

What abnormal conditions can cause nipple pain in early breastfeeding?

Tongue-tie, also called ankyloglossia or short frenulum, affects 4-11 percent of infants and can cause sore nipples. Babies who are tongue-tied may be unable to extend their tongue out far enough and this can result in extremely painful nursing. The nipple will often look flattened or misshapen after feeding. If the position and latch technique look good the mother/baby couplet should be evaluated by a lactation consultant. She can do an exam to see if the baby has any kind of tongue-tie. It is important to note that just looking at a baby’s tongue is not sufficient to determine if a tongue-tie is causing the pain.

If a baby appears to have a tongue-tie an Ear Nose and Throat doctor (ENT) or pediatric dentist can evaluate the baby to determine if a revision is indicated. Releasing a tongue-tie can be done with scissors or with a laser.

Babies who have dysfunctional or disorganized sucks can also cause significant nipple pain when feeding. They may be using their tongue incorrectly or they may be clamping down on the nipple. A lactation consultant can evaluate if this is happening by performing a suck evaluation. Time can help with these conditions. More severe cases may require working with a speech or occupational therapist who can help teach the baby how to suck properly.

What can cause nipple pain throughout breastfeeding?

A yeast infection on a mama’s nipples can cause burning and itching. The pain can be a mild soreness all the way to a stabbing pain. This is also referred to as nipple thrush. The nipples are often bright pink and may have a flaky appearance. They also can look normal so a diagnosis may be made based on symptoms alone. Treatment options include the application of Gentian Violet, which is an antiseptic dye that is used to treat fungal infections. It is available without a prescription but may be kept behind the counter in a pharmacy. Not every pharmacy carries it so call first. Prescription topical and oral antifungals are also used to treat yeast infections on the nipples.

Related: Thrush and breastfeeding

A condition called Raynaud’s Syndrome can cause intense nipple pain. This is caused by vasospasms of the blood vessels in the nipples. A telltale symptom is if a woman’s nipples turn white and then purple when the baby detaches. Treatment can be as simple as apply warm dry heat to the nipple as soon as the baby comes off. If that is not effective some mothers have found relief when a calcium channel blocker is taken. This is a prescription medication.

Teething can result in nipple soreness if a baby bites down on the nipple. Most babies will respond to being told a firm no!

Some moms will experience irritation when their babies begin solids. Having the baby drink some water will usually resolve this issue.

Nipple tenderness is also a common symptom of pregnancy. If no other reason for nipple soreness can be discovered it is worth taking a pregnancy test.

Related: What to expect if you’re breastfeeding while pregnant

While there are many reasons for nipple soreness during breastfeeding, most will be temporary bumps in the road. Nursing moms should be reassured that there are effective remedies that will provide them with relief.

Sources

Walker, M. (2013). Are There Any Cures For Sore Nipples? Clinical Lactation, 4(3), 2013. Retrieved from https://simplesolutionsinternational.com/wp/wp-content/uploads/2017/03/Cures-For-Sore-Nipples-2.pdf

O'Shea JE, Foster JP, O'Donnell CPF, Breathnach D, Jacobs SE, Todd DA, Davis PG. Frenotomy for tongue‐tie in newborn infants. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD011065. DOI: 10.1002/14651858.CD011065.pub2. Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011065.pub2/abstract

Andrea Tran RN, BSN, MA, IBCLC is a freelance writer who has been helping moms and babies breastfeed for over twenty-five years. She is married and the mother of three adult children.