The best treatment of sore nipples is prevention. The best prevention is getting the baby to latch on properly from the first day. Mother and baby skin to skin contact immediately after birth for at least the first hour or two will frequently result in a baby latching on all by himself with a good latch. See the information sheets Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact.
Early onset nipple pain is usually due to one or both of two causes. Either the baby is not positioned and latched properly, or the baby is not suckling properly, or both. However, babies learn to suck properly by getting milk from the breast when they are latched on well. (They learn by doing). Thus, “suck” problems are often caused by poor latching on. Fungal infections of the nipple (due to Candida albicans) may also cause sore nipples. Vasospasm (which is due to irritation of the blood vessels in the nipple from poor latching and/or a fungal infection) may also cause sore nipples (see the information sheet Vasospasm and Raynaud’s Phenomenon). The soreness caused by poor latching and ineffective suckling hurts most as you latch the baby on and usually improves as the baby breastfeeds. However, if damage is severe, the soreness of a poor latch and/or ineffective suckling may go on throughout the feeding. The pain from the fungal infection often goes on throughout the feed and may continue even after the feed is over. Women describe knifelike pain from the a poor latch or ineffective sucking. The pain of the fungal infection is often described as burning but it does not have to be burning in nature. A new onset of nipple pain when feedings had previously been painless is a tip off that the pain may be due to a Candidal infection, but a Candidal infection may also be superimposed on other causes of nipple pain, so there was never a pain free period. Cracks may be due to a yeast infection. Dermatologic conditions may also cause late onset nipple pain. There are several other causes of sore nipples.
It is not uncommon for women to experience difficulty positioning and latching the baby on. If the mother positions the baby well, she facilitates the baby’s getting a good latch and a good latch not only decreases the risk of the mother becoming sore, but also reduces the baby’s chances of becoming “gassy” because a good latch allows the baby to control the flow of milk better. Thus, poor latching may also result in the baby not gaining adequately, or feeding frequently, or being fussy. See also nbci.ca for videos that show how to latch a baby on, how to know a baby is getting milk and how to use compression.
Good positioning facilitates a good latch. A lot of what follows under latching comes automatically if the baby is well positioned in the first place.
At first, it may be easiest for many mothers to use the cross cradle hold to position your baby for latching on. Hold the baby in your right arm, pushing in the baby’s bottom with the side of your forearm so that your hand turns palm upwards (towards the ceiling). This will help you support his body more easily as the baby’s weight is on your forearm rather than your wrist or hand. Holding the baby like this also will bring the baby in from the correct direction so that he gets a good latch. Your hand will be palm up under the baby’s face (not shoulder or under his neck). The web between your thumb and index finger should be behind the nape of his neck (not behind his head). The baby will be almost horizontal across your body, with his head slight tilted backward, and should be turned so that his chest, belly and thighs are against you with a slight tilt upwards so the baby can look at you. Hold the breast with your left hand, with the thumb on top and the other fingers underneath, fairly far back from the nipple and areola.
The baby should be approaching the breast with the head just slightly tilted backwards. The nipple then automatically points to the roof of the baby’s mouth.
The baby learns to suckle properly by breastfeeding and by getting milk into his mouth. The baby’s suckle may be made ineffective or not appropriate for breastfeeding by the early use of artificial nipples or from poor latching on from the beginning. Some babies just seem to take their time developing an effective suckle. Suck training and/or finger feeding (See the information sheet Finger and Cup Feeding) may help, but note, taking the baby off the breast to finger feed instead is not a good idea and should be done as a last resort only.
The pain associated with this blanching of the nipple is frequently described by mothers as “burning”, but generally begins only after the feeding is over. It may last several minutes or more, after which the nipple returns to its normal colour, but then a new pain develops which is usually described by mothers as “throbbing”. The throbbing part of the pain may last for seconds or minutes and then the nipple may turn white again and the process repeats itself. The cause would seem to be a spasm of the blood vessels (often called “vasospasm” or Raynaud’s Phenomenon) in the nipple (when the nipple is white), followed by relaxation of these blood vessels (when the nipple returns to its normal colour). Sometimes this pain continues even after the nipple pain during the feeding no longer is a problem, so that the mother has pain only after the feeding, but not during it. What can be done?
If you are unable to put the baby to the breast because of pain, in spite of trying all the above measures, it may still be possible to continue breastfeeding after a temporary (3-5 days) cessation to allow the nipples to heal. During this time, it would be better that the baby not be fed with a rubber nipple. Of course it is also best for you and the baby if the baby is fed your expressed milk. Feed the baby with a cup or use the technique called “finger feeding” (see the information sheet Finger an Cup Feeding). Once again, it should be emphasized that this is a last resort and taking a baby off the breast should not be taken lightly. Furthermore, it often doesn’t work.
We do not recommend nipple shields because, although they sometimes help temporarily, they often do not. In fact, they may often increase the degree of trauma to the nipples. They may also cut down the milk supply dramatically, and the baby may become fussy and/or not gain weight well. Once the baby is used to them, it may be impossible to get the baby back onto the breast. Use as a last resort only but get help first.
The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!
©IBC, updated July 2009
Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.