The terms 'mother' and 'breastfeeding' are used throughout our documents; we recognize and respect that individuals and families may use other preferred terminology.
Soreness in the first few days
Your nipples may be tender for the first few days of breastfeeding. This is normal for many women.
You may also experience tenderness more in the first few minutes of breastfeeding. This tenderness should decrease as the feeding continues. Most women find this tenderness decreases during the first week.
It is not normal for the pain to last the whole feeding or to have strong pain. If this is the case, it is important to get help from a breastfeeding expert right away.
Sore nipples may be tender, red, bruised, or cracked. A crack is a break in the skin.
Soreness caused by poor position and latch
Latch is how your baby attaches to your breast. Proper positioning and correct latching at the breast prevents sore nipples. Soreness often lasts the whole feeding if there is poor positioning or poor latch at the breast.
Refer to Breastfeeding for more information about proper position and latch at the breast.
Soreness caused by improper sucking
If your baby is positioned and latched correctly but you still have nipple soreness, your baby may not be sucking properly. If this is the case, the nipple pain usually lasts throughout the feeding.
Ask a breastfeeding specialist to check how your baby is sucking.
Soreness caused by infection
Sore, cracked nipples that do not heal after correcting the position and latch may be due to an infection caused by bacteria. Nipples can also be infected with yeast. A yeast infection can easily be passed between a mother and her baby, so it is important to have your doctor treat both of you. Yeast infection causes pain that often starts suddenly after days or weeks of breastfeeding with no pain. You may experience burning pain during the feeding and between feedings. You may notice itching and or flaky, shiny, pinkish-red skin on the nipple.
Mothers or babies who have been on antibiotics to treat infections may get yeast infections more easily.
It is important to have your doctor check for infection. Your doctor will prescribe an antibiotic ointment to apply to your nipples for a bacterial infection. Antifungal medication is prescribed for both mother and baby for yeast infections. Sometimes cortisone, a medication to reduce inflammation, is added to an ointment as well.
Soreness at the end of feeding
Some mothers have burning, throbbing pain after breastfeeding/pumping. The nipples may turn white, blue or red before turning pink again. This may be caused by vasoconstriction, which is a decrease in blood flow to the nipples due to tightening of the blood vessels. It can be caused by a sudden change in temperature between the colder air and the baby's warm mouth, the baby clenching on the nipple or a poor latch.
Place warm towels on your breasts after feeding. This allows the nipples to cool gradually. Check that your baby is positioned and latched well. Ask your doctor for more help if this pain does not go away.
Soreness from breastfeeding on an engorged breast
Engorgement, which can occur in the first few days after your baby is born, can cause your breasts to be very hard due to a collection of fluid. This may make it difficult for your baby to latch deeply, which can cause nipple soreness.
To soften the area around the nipple, use warm compresses and hand express some of the milk before your baby feeds. The area around the nipple should be soft before latching your baby. Cold compresses after and between feedings can help reduce the engorgement in the breast. Ask for help from a breastfeeding specialist if you are not able to soften your breasts.
Refer to Breast Changes and Conditions for more information.
Soreness from a blocked nipple pore
Some mothers may notice a white dot on their nipple and experience pain throughout the feeding. One of the milk ducts has become blocked as it opens onto the nipple. This is called a bleb or milk blister. Warm compresses before feeding and frequent feeding can help. A couple of techniques that can help open the blocked pore after applying heat include:
- Using a warm washcloth to rub over the area and then hand expressing and/or breastfeeding
- Rolling the nipple between your finger and thumb and then hand expressing
If there is no improvement in a few days, your doctor can open the nipple pore with a sterile needle.
Nipple soreness when your baby is tongue-tied
If you think your baby may have a tongue-tie, which is when the tongue is attached too tightly to the floor of the mouth, please make sure to have their tongue function assessed by an experienced health-care professional. Nipple soreness can often be resolved with positioning and a deeper latch.
Nipple soreness when you are pumping
If you are pumping, nipple soreness is not normal. The soreness may be related to the type of pump you are using, the length of time you are pumping, the flange size or the pump settings you are using.
Refer to Expressing Milk Occasionally for your Healthy Baby and Expressing Breast Milk for your Hospitalized Baby for more information about pumping.
Measures to help prevent and treat sore nipples
Breast care
- You do not need to wash your breasts and nipples before breastfeeding or pumping.
- Use cotton nursing pads that you can wash instead of nursing pads that you throw out. Do not use nursing pads with plastic linings; they keep the skin too wet. Soak the nursing pad off if it sticks to your nipple to prevent pulling off the skin.
Lactation supplies can be ordered in person, on the phone, or online from the Specialty Food Shop at SickKids in Toronto. For details, go to www.specialtyfoodshop.ca or call 1-800-737-7976. The Specialty Food Shop may be able to ship these supplies to your home.
When feeding
- Remember to put your finger in the corner of the baby's mouth through the lips and gums to break the suction to take the baby off the breast.
- Feeding in different positions may ease the soreness.
- Feeding more often but not as long may make you more comfortable.
- Try feeding on the least sore breast first for a few feeds to rest the other side.
- If you are too sore to breastfeed or are limiting feeding on one side, it is recommended that you express (pump) your breast(s) on the same schedule as your baby feeds to maintain your milk supply.
If your nipple pain persists after trying the recommendations above, please consult with your health-care provider or a lactation consultant.
If your baby is an inpatient at SickKids and you have sore nipples, ask your baby’s nurse to put in a Lactation Consultant referral for an assessment and support.
