Sore nipples while breastfeeding: Causes and remedies

Love and Breast Milk > Breastfeeding problems > Sore nipples while breastfeeding: Causes and remedies

Sore nipples are a fact of life for breastfeeding moms. Yes, we all know that breastfeeding is not supposed to hurt – and it’s true, if baby is latched on well it should not hurt – but at some stage, you’re likely to be troubled by nipple pain. Even lactation consultants, when they start breastfeeding their own babies, get sore nipples sometimes. So it’s important to know how to identify the problem and what to do about it. In this post we will look at a few of the most common reasons why you may struggle with sore, and what can be done in each situation.

What is normal

At the risk of angering a lot of breastfeeding promotors, let me just come out and say it: a certain amount of pain is normal when you’re beginning to breastfeed. I’ve never seen a completely painless start to a breastfeeding journey (although I’ve seen plenty where the nipple pain was barely worth a mention), and yet I’ll always be alert if a mother tells me she’s experiencing pain while breastfeeding. Pain is almost always a sign that something is not working as well as it should – and yet, there can be some pain even when everything is fine. Confused? I don’t blame you! Let me start by clarifying what is normal and what is not.

Normal nipple pain

When you start breastfeeding for the first time, your nipple is being pulled and squished in ways it never was before (well, unless you’re into re-enacting your favourite scenes from Fifty Shades of Grey – but let’s not go there…) Did you know that with every suck baby gives, your nipple is being stretched to 2-3 times its resting length? If you consider how many sucks a baby gives in a feed, and how many times a day you breastfeed, it quickly becomes clear that your nipples are taking quite a beating.

This unaccustomed stretching can cause your nipples to feel sore in the beginning of the feed when baby starts to suck, but the pain then goes away as baby settles into a comfortable suckling rhythm. It’s very similar to having sore muscles after a workout: when you start your next workout, it’s agony, but as soon as the muscles warm up the pain is gone. In the same way, your nipple should feel more comfortable as the feed progresses.

I teach a simple rule of thumb: as soon as baby is latched on and starts suckling, slowly count to 20, then ask yourself how it feels: If the pain is gone, you’re good to go; carry on feeding. If it still hurts, baby is probably not latched on well; in that case you will need to take baby off the breast and start again.

NOT normal

Pretty much any nipple pain other than what I’ve described above is not normal, including:

• Pain that lasts for the entire feed
• Pain in-between feeds, when baby is not suckling
• Pain that is so severe that you want to scream or cry
• Cracked, broken or bleeding nipples. Take note: broken skin is never normal!
• Nipples that suddenly become sore after they’ve been fine for some time

If any of these things happen to you, please try to figure out what’s going on; and if you can’t manage by yourself, get help. Ignore the people who tell you to must just “hang in there until your nipples toughen up” – that’s nonsense. The pain gets better with time because you and baby figure out how to breastfeed effectively, not because your nipples get tough. And the good news is, with a bit of knowledge and some skilled help, you can figure things out a lot more quickly and easily, and be breastfeeding pain-free as soon as possible.

Common causes of sore nipples

There are many, many things that can cause sore nipples – I will discuss some of the more common problems here, as well as what to do to fix them.

Latch

Most of the time, sore nipples are caused by a bad latch. If baby is not latched deeply – in other words, if baby doesn’t take a large part of the breast into his mouth – the nipple will become sore. If your baby isn’t latching deeply, nipple pain is inevitable. So the first thing to do is to make sure your baby is really latched on well. Look at your nipple as it comes out of the baby’s mouth after breastfeeding: if it’s squashed to a point, like a new lipstick, your baby probably isn’t latching deeply enough. You can find a whole post on latching here, including some great tips on how to get a nice deep latch.

A look inside baby’s mouth, showing how a shallow latch causes sore nipples. A tongue tie will cause the same problems.

Unfortunately, in the beginning it is usually necessary to really concentrate on latching baby well. It’s so easy for that tiny mouth to latch onto the nipple only, instead of the whole breast – and it only takes one feed with a bad latch to cause a cracked nipple. There is some good news, though: it gets much, much easier with time: as baby’s mouth gets bigger, it’s easier to get a deep latch, and eventually you will be able to do it without even trying. This is especially true if you have very large nipples; they can make it quite difficult (if not impossible!) for baby to latch deeply, but the problem is guaranteed to resolve itself over time.

Tongue ties

A tongue tie occurs when the little membrane under the tongue is too short, too thick or too far forward, which stops the tongue from moving freely. Because the tongue does most of the work in breastfeeding, a baby with a tongue tie can find it very difficult to breastfeed effectively. These babies tend to move their tongue in a different way to try and “hang on” to the breast, which can cause severe nipple pain for mom – many moms have described it as feeling like sandpaper rubbing against the nipple.

When a baby has a tongue tie, he cannot lift his tongue or stick it out. Sometimes the tip of the tongue forms a notch or heart-shape when the tongue is lifted or stuck out. Sometimes you can even see the thick white membrane anchoring baby’s tongue to the floor of the mouth. When baby is suckling, the tongue tends to pull back into the mouth and the “push” the nipple out. You may also hear clicking or smacking sounds as the tongue slips off the nipple. If you see any of these things, and you are worried about a possible tongue tie, it is best to see a medical professional who can assess it accurately: an IBCLC or SACLC would be the best; otherwise a speech therapist who has experience in dealing with tongue ties is the best option.

Engorgement

If your breasts are engorged, your nipples can get damage from two sides: partly because of all the swelling and stretching that the engorgement causes, and partly because it is very difficult for a baby to latch deeply on an engorged breast. In my experience, engorgement is one of the biggest causes of sore nipples in the early days. If you are struggling with engorgement, please check out this post for plenty of ideas to help you get back to normal.

Vasospasms and Raynaud’s phenomenon

A vasospasm happens when the blood vessels that supply blood to the nipple constrict, cutting off then nipple’s blood supply. The result is a sudden jab of pain that makes it feel as if your nipple (or even your whole breast) is on fire. If you look at your nipple, you will see that it is literally white or even bluish from the lack of blood. Some women experience nipple vasospasm during pregnancy, which may or may not continue after the baby is born.

Vasospasms are often triggered by cold, so it makes sense to use heat to treat it. Simply put, make sure that the nipple is warm before you start to feed (use a hot beanbag or a hairdryer on a low setting), and make sure that your body stays warm while feeding. A shallow latch can also trigger a vasospasm, so make sure that baby is latched on well.

Raynaud’s phenomenon is a type of vasospasm that is often (but not exclusively) seen in people that suffer from lupus; it often affects the fingers and toes. In Raynaud’s, the nipple first turns white, and then turns blue and/or red before returning to its normal pink colour.  If you suspect you are suffering from Raynaud’s and heat therapy doesn’t help, you can speak to an IBCLC or SACLC to discuss options for medical treatment with your doctor.

Thrush

Did you know that you can get thrush on your nipple? Yes, the same yeast infection that causes vaginal thrush and thrush in baby’s mouth can also affect the nipple. Thrush is especially common when you or baby have had antibiotics recently – and antibiotics are routinely given if you have a c-section.

If you have thrush on the nipple, you may notice that the nipple is a lot pinker than the surrounding skin (you don’t get white spots on the nipple like you would see in baby’s mouth). Often you will also see signs of thrush in baby: white spots in the mouth that you can’t wipe away, or a nappy rash that is red and bumpy. You yourself may also be suffering from vaginal thrush.

There are plenty over-the-counter medicines that can be used to treat thrush. The two most common ones are nystatin and miconazole. You can ask the pharmacist for a medicine that you can use in baby’s mouth, since those medicines are also safe to use on the nipples. It’s very important to remember that if either you or baby have thrush, you must both be treated – even if you don’t both have symptoms of thrush. If you treat only the one or the other, you will keep passing the infection back and forth.

Recap

In case you’re suffering from extreme information overload now (I wouldn’t blame you!), here’s a summary of the common causes of sore nipples and what to do about each one:

• Shallow latch: make sure baby gets a good, deep latch at each feed (more info here)
• Tongue ties or lip ties: have baby assessed by a trained, experienced medical professional such as and IBCLC or SACLC.
• Engorgement: treat the engorgement, and soften the nipple to help baby latch (you can find advice on how to do both those things here)
• Vasospasms and Raynaud’s phenomenon: use heat and massage to keep blood flowing to the nipple, and make sure baby has a good latch.
• Thrush: get medicated ointment from the pharmacy and treat both your nipples and baby’s mouth.

Problem solved?

Hopefully one of the causes I described here matches your situation, and helps you to figure out what the problem is.  In the meantime, check out this post for some ideas on how to treat a nipple that’s already hurting to help it heal. If things don’t get better soon, please see a lactation consultant to help you figure out what the problem is! A good lactation consultant can, in most cases, sort out the problem in a single consultation, so there’s really no need to suffer.