McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

Breast-feeding should be a comfortable and enjoyable experience. Unfortunately, sore nipples are a common complaint among breast-feeding mothers. Often mothers quit nursing their babies early because of sore nipples, but this doesn't have to happen. Sore nipples usually can be prevented or treated.

Mild nipple discomfort at the beginning of feedings during the first few days of breast-feeding usually needs no treatment. However, nipple pain that is severe or lasts throughout a feeding or persists for more than a week is not normal and should be evaluated by your doctor or a lactation consultant.

What causes sore nipples?

The most common cause of severe nipple soreness is improper positioning of your baby's mouth on your breast. The particular size and shape of your nipples and your baby's mouth can affect your baby's latching-on technique. In addition, your infant's unique sucking habits can contribute to nipple discomfort.

Other possible causes of nipple pain are an infection of the nipples (yeast or bacterial), a breast infection, or improper nipple skin care.

What problems can sore nipples cause?

If your baby is latching on to your breast incorrectly, he may not be getting enough milk. Also, nipple pain may cause you to postpone nursings or may decrease your let-down reflex and reduce milk flow. This combination of factors can easily cause a drop in your milk supply. As a result, your baby may not gain weight well. Sore nipples and low milk supply often go hand-in-hand.

How are sore nipples treated?

The following recommendations should help your nipples feel better within a day or so.

1. Make sure your baby is positioned correctly to nurse.

   Support your breast with four fingers below and your thumb above. Place your fingers far enough behind the darkened area around your nipple (areola) so they won't touch your baby's mouth when she attaches. When your baby opens her mouth wide, quickly pull her toward you so she grasps both your nipple and as much surrounding areola as possible.

   • Do not let your baby take only the tip of your nipple.
   • Make sure the baby gets enough of the lower part of the areola in her mouth. Not doing so is a common cause of sore nipples.
   • During the feeding hold your breast from below so the nipple and areola aren't pulled out of your baby's mouth by the weight of the breast.
   • Make sure your baby is facing you chest-to-chest.

2. Begin a feeding on the less sore nipple to trigger your let-down reflex and start milk flowing.

   Babies suck harder at the beginning of feedings. After your baby has nursed briefly and milk flow has begun, move her to the second breast. This should make nursing more comfortable because the baby will suck less vigorously once milk starts to flow. However, as soon as possible, resume switching the breast you start each feeding with to prevent a lopsided milk supply.

3. Frequent shorter feedings are preferable to less frequent lengthy feedings.

   If one nipple is extremely sore, temporarily limit feedings to 10 minutes on that side.

4. Keep your nipples dry.

   Gently pat your nipples dry with a clean cloth after nursing or let your nipples air-dry for 15 to 20 minutes. Cleanse your nipples with soap and water when you bathe. If you wear breast pads, change them as soon as they become wet.

   Don't go to extremes and dry your nipples too much. For example, don't dry them with a hair dryer and don't expose them to air for a long time if you live where the humidity is low. Too much dryness can worsen the condition of the skin.

   At the end of each feeding you can put a thin coating of USP Modified Lanolin (medical grade) on your nipples. This will prevent excess drying of the skin. This purified lanolin product can be obtained from most breast-pump rental stations, such as Ameda/Egnell at 1-800-323-4060 or Medela, Inc., at 1-800-435-8316.

5. If you have cracks or other breaks in the skin, keep your nipples covered with a soothing emollient.

   USP Modified Lanolin (medical grade) is best. Put a fresh coating on your nipples after each feeding. Also, wearing Medela or Ameda/Egnell wide-based breast shells over your nipples between nursings can reduce the discomfort and speed up healing by preventing direct contact with your bra.

6. Use a pump to express your milk if the pain is so severe that you cannot nurse your baby.

   You can stop nursing and pump milk for 2 to 3 days while your nipples heal. You can rent a hospital-grade electric pump temporarily to express your milk comfortably. Pumping is a convenient way to empty your breasts and maintain or increase your milk supply while your nipples heal. Other types of breast pumps generally are not as comfortable or effective as a rented hospital-grade electric pump.

   To find where you can rent a pump, call Ameda/Egnell Corp. at 1-800-323-4060; Medela, Inc., at 1-800-TELL-YOU (1-800-835-5968); or White River at 1-800-342-3906.

7. Watch for signs of a breast infection.

   A cracked nipple may make you more susceptible to getting a breast infection (mastitis). Be on the lookout for any signs of infection. The signs are described below in the section on when to call your doctor.

When should I call the doctor?

Call your doctor immediately if:

• You have any of the following symptoms in addition to sore nipples: chills, fever, headache, flulike symptoms, or pain or redness in your breast.

  These symptoms suggest you may have a breast infection (mastitis). The infection requires prompt treatment with antibiotics.

Call your doctor during office hours if:

• Your nipples sting or burn and you have shooting pains in your breast, especially after nursing.

  You may have a yeast infection of your nipples. A yeast infection requires treatment with medication. Babies can get yeast infections in their mouths and diaper areas.

• The nipple pain inhibits your let-down reflex.

  In this case, your doctor may prescribe a pain medication.

Call your baby's doctor during office hours if:

• Your baby is not satisfied after most nursings.

  Your baby may not be satisfied because your milk supply is low or because your baby is not emptying your breasts. After weighing your baby, the doctor can decide whether you need to change your feeding schedule or offer your baby supplemental breast milk or formula. You may need to use an electric pump temporarily to express any milk left after nursings. Pumping will help increase your milk supply.

• Your nipples have a yeast infection, you see white patches in your baby's mouth, or your baby has had a diaper rash for 3 or more days.

  In this case, your baby may need to be treated for a yeast infection.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.