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Nipple pain is one of the most common reasons why women give up breastfeeding.
Some women tough it out. But breastfeeding is not a pleasant experience for them. They may even come to dread feedings.
Certain situations that cause nipple pain can result in reduced milk transfer. A baby doesn’t get enough milk and doesn’t gain enough weight. It’s easy to see how that kind of scenario will end. Mom is in pain, and baby is not gaining weight. In a situation like that, breastfeeding is unlikely to last very long.
Some moms think that nipple pain is just part of breastfeeding. While nipple tenderness in the early days of breastfeeding is common, it is essential to be able to distinguish the difference between what is normal and what may be a problem.
The good news is that most nipple pain can be easily fixed. If you are suffering from painful nipples with breastfeeding, there is hope.
Sore nipples are actually very common in the first couple of weeks of breastfeeding. However, it’s important to be able to tell the difference between “normal soreness” and soreness that is a big red flag that something is wrong.
Read on to find out what is “normal” nipple discomfort, what’s not normal, and how to get relief for sore nipples while breastfeeding.
What Causes Sore Nipples While Breastfeeding
Soreness can happen at any time during breastfeeding. Different things cause nipple pain from breastfeeding.
Different causes of sore nipples require different treatments.
Sore Nipples in First Few Days of Breastfeeding
Let’s get real. Sore nipples and breastfeeding is common at the beginning. Your nipples have never received that kind of attention before.
Your nipple discomfort it is probably normal if:
- The nipple pain started within the first four days of birth
- The discomfort is when my baby first latches on.
- The pain goes away within the first minute of sucking
- You will feel a strong tugging when your baby sucks. It’s kind of amazing how strong their little mouths are.
- It should not feel pinchy
- Your nipple is round when baby comes off.
- It should not be creased or lipstick-shaped
- Your nipple is normal color (pink or brown) when baby comes off.
- Your nipple should not be blanched white or purple
If you are having nipple pain in the first few days, it is always a good idea to have a lactation consultant take a look at what you are doing. Even when nipple pain is “normal,” there are often things you can do to make feedings more comfortable.
- “Normal” nipple pain peaks around the second to the fourth day.
- It should feel much better by the end of the first week.
- It should be entirely gone by the end of the second week.
- Cracks, bleeding, bruises or blisters are NEVER normal
Why Nipples Hurt in The Early Weeks of Breastfeeding
Positions like in these pictures cause nipple pain. The baby has to turn his head to latch on. It is not comfortable to swallow when your head is turned. Try it yourself. Turn your head and try to swallow.
If a baby is positioned belly up like in these pictures, he will hold onto the nipple and try to turn his head forward, so it is more comfortable for him to swallow.
Good positioning can quickly improve any nipple soreness you are having.
- Your baby should be facing you. If you are holding your baby in the cradle or cross-cradle hold her tummy should be against your tummy – “tummy to tummy.”
- Pull her in close.
- When you are getting ready to latch your baby’s nose should be across from your nipple – “nose to nipple.”
There was a time when women were told that all sore nipples came from poor positioning. End of story. Fix your positioning, and all would be right with the world and your nipples. Your breastfeeding world, anyway. The problem is, that isn’t always true.
Poor Latch Technique
How you bring your baby on to your breast can affect whether you have nipple pain or not. To prevent nipple pain when latching remember to:
- Put your hands on the back of your baby’s neck and shoulders.
- Keep your hands off the back of your baby’s head
- Wait for your baby to open her mouth up wide
- When her mouth is open wide pull her in quickly
- Bring your baby to your breast
- Do not bring your breast to your baby
- Her chin should be pressed into your breast, and her nose should be barely touching your breast or not touching it at all.
Abnormal Sucking Behavior
Clamping or biting
Sometimes parents will tell me that their baby has a powerful suck, when in fact, he is biting or clamping down.
Biting or clamping can happen in the first few days and often resolves on its own. Continued biting past a couple of weeks in a newborn should be evaluated by a speech therapist.
Problems with the way your baby sucks would be diagnosed by a doctor, lactation consultant, speech or occupational therapist.
Variations in Anatomy That Can Cause Nipple Pain
- Tongue-tie or Lip-tie
- An ENT or pediatric dentist can assess whether your baby has a tongue-tie or lip-tie and whether a revision of the tie is recommended.
- Short tongue
- High palate – can result in sore nipples for a period of time. Usually, the soreness will get better with time.
Nipple Vasospasm or Raynaud’s Syndrome
These two conditions are very similar. The blood vessels constrict and spasm. The nipple briefly changes color, turning white and or purple.
Women who have Raynaud’s often also complain of very cold hands and feet.
Women describe the pain as:
Treatment of Raynaud’s or Vasospasm
- Warm, dry heat. A heating pad works well.
- Pinching the base of the nipple.
- A medication called Nifedipine can relieve symptoms.
Sore Nipples From Breast Pumping
Breast pumps can lead to sore nipples.
Poorly Fitting Breast Pump Shields
Incorrect breast pump shield fit can cause nipple pain. If the breast pump shield is too small or too large for your nipples it can hurt.
- The nipple itself should not rub against the sides of the shield.
- A little bit of your areola should be pulled in, but not too much.
- Breast size can be very different from nipple size, and nipple size can be different than areola size.
- When in doubt, ask a lactation consultant if you need to try a different sized breast pump shield.
Breast Pump Suction Too High
The correct level of suction for your breast pump is the highest setting that is comfortable. If your breast pump suction is too high you can end up with sore nipples from pumping.
Allergy to the Plastic of Breast Pump Shields
This is a rare occurrence but can happen.
Psoriasis or eczema will cause nipple pain. See a dermatologist to determine the best course of treatment.
Reaction to solids
Sometimes when a baby starts solids and breastfeeds soon after eating them, the residue in his mouth can irritate your nipples. Fortunately, this is rare.
Some Moms will have sore nipples that linger for about the first six weeks until some hormone levels get back to their pre-pregnancy levels. The discomfort won’t be severe, and there will be no trauma associated with it.
If you become pregnant while breastfeeding, the effect on your hormones can cause sore nipples.
You can get pregnant without ever resuming your periods.
Nipple Thrush and Breastfeeding
Nipple thrush is a yeast infection. We all have yeast in our bodies. Sometimes it overgrows and creates itching and burning.
Yeast in the nipples is sometimes apparent visually. The nipples are bright pink and may have flaky skin around them.
There is not always itching. Sometimes there is just nipple pain. The pain associated with yeast is typically described as shooting or burning.
Once your baby starts teething or gets teeth, he may begin biting. Sometimes the biting can cause cuts on your nipple.
- If your baby is sucking actively, he will have his tongue extended and won’t be able to bite.
- Biting usually happens at the end of the feeding.
- If he’s biting due to teething or just experimenting with his new teeth, he can be taught not to do that in the vast majority of cases.
- Take him off the breast immediately.
- Tell him firmly, “no.”
- Say, “Biting hurts, mommy. You’re not allowed to hurt mommy.”
- Let him latch again. If he bites again, then you should end the feeding.
Sore Nipple Relief
First and foremost is to fix the cause, if possible
- Two sore nipple remedies for that common tenderness in the early days:
- Lanolin for breastfeeding – make sure it is approved for breastfeeding. I like Medela Tender Care Lanolin because it is a thin consistency. That makes it easier to apply.
- Breastfeeding gel pads . These were a game changer when they first came out. There are several different brands. I only recommend Ameda ComfortGels.
- Secret tip: put gel pads in the fridge to amp up the soothing power.
- Peppermint tea water blotted on with a cotton ball. I don’t recommend applying the actual wet tea bag or soaked cotton ball directly to your nipples
- I don’t recommend nipple butters or creams that have a lot of different ingredients.
- One of the best treatments for sore nipples is a prescription ointment. It’s called “All Purpose Nipple Ointment.” APNO for short.
- It requires a health care provider to write an Rx and a pharmacy that will compound it.
- It is a combination of an antibiotic, antifungal, and cortisone.
- This type of ointment should be used for no longer than 2-3 weeks.
- According to the pediatrician who developed the recipe it does not need to be wiped off before breastfeeding, .
Final Thoughts on Sore Nipples While Breastfeeding
- Sore nipples while breastfeeding are common
- Nipple pain can occur at any time during your breastfeeding journey.
- There are many causes for sore nipples during breastfeeding.
- There are many treatments for sore nipples.
Are you dealing with sore nipples? What kinds of sore nipple remedies have you tried?
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Andrea Tran RN, MA, IBCLC
Andrea has been working with new families as an RN for over 35 years and a Lactation Consultant for over 25 years.
She has her MA in Health and Wellness with a focus in Lactation.