Tips for management & prevention

What are the common causes of sore nipples while breastfeeding?

Why are my nipples sore?

While breasts are incredibly durable and strong, when your nipples get sore and appear to be cracked, it’s very likely you have an injured nipple. During breastfeeding and pumping, there are many circumstances that can leave you with sore and cracked nipples. Here are some of the most frequent situations experienced by moms:

When the nipple is compressed and temporarily deformed during sucking, the skin cracks along a “pressure line”
When your baby sucks excessively strong, suction-related damage can occur

Keep in mind, all these developments can occur together. Below, you’ll learn more about the possible causes

What are the common causes of sore nipples while breastfeeding?

Uncomfortable breastfeeding position: Your baby shouldn’t have to turn their head to latch. Sometimes an uncomfortable angle and position can cause temporary damage to your nipple.
Your baby has trouble latching onto the nipple: Double-check how your nipple is positioned in the baby’s mouth.
Engorged breasts and flat or inverted nipples: All these conditions can make it harder for your baby to latch onto the nipple, so it’s important to evaluate if you might be experiencing this.
Tongue-tie: Babies’ oral anatomy can sometimes lead to breastfeeding difficulties.
Not letting your baby unlatch before setting it down: This can also cause temporary damage to your breast so be sure your baby has let go of your nipple
Your baby is teething: Ouch! Your baby may have accidentally bitten your nipple.
You have a breast infection: Thrush, a yeast infection, or another kind of infection can cause breast pain.
Too much moisture: Air-drying your breasts is very important as too much moisture softens the skin and makes it more vulnerable.

Should I get my sore nipples looked at?

Sore nipples while breastfeeding can be normal but it’s best to solve this issue as soon as you can. Regardless of the possible reason, if your breasts or nipples hurt, consult your midwife, lactation consultant, or doctor. They can help assess the causes of sore nipples and recommend personalized tips and treatments based on your specific situation.

They can also assess whether your baby has tongue-tie or lip-tie that may be contributing to breastfeeding difficulties. In such cases or when dealing with flat or inverted nipples, a nipple shield may help make feeding easier for your baby. Your midwife or lactation consultant can guide you on proper use of nipple shields and precautions to take.

Tips to relieve sore nipples

Pain relief for sore nipples is important. If you feel a burning sensation during breastfeeding and your nipples are cracked, take a moment to think about what might have caused it. Talk to your midwife, lactation consultant, or doctor and consider these measures to support the healing process.

If your nipple seems damaged or injured, here are some tips for healing

After breastfeeding, allow the breast milk to dry on the nipple. It contains nourishing, protective, and restorative elements for healing.
If the nipple has an open wound after breastfeeding, clean it with 0.9% saline solution or boiled lukewarm water.
Avoid pressure from your bra and clothing
Consider a breastfeeding-compatible pain therapy that can be useful and contribute to the wound healing.

Other good tips:

If the nipple is red, but not yet open, clean the breast as part of your normal daily body hygiene.
Don't forget to wash your hands after using the toilet and changing diapers.

If your nipples are an open wound, here are some tips for breastfeeding

To prevent the wound from drying out, forming a scab, and thus reopening during the next breastfeeding, you can use Hydrogel Pads to promote moist wound healing.
To support moist wound healing, silver caps can also be used. A lactation consultant can assess whether these measures are appropriate for you.
If the nipple is inflamed, it must be treated with antibacterial, antifungal, and/or anti-inflammatory agents, depending on the infection type. See the article about breast thrush. Diagnosis and treatment must be performed by medical professionals in this case.

Tips to prevent sore nipples

Alongside advice from a lactation consultant, these strategies can help to prevent sore nipples during breastfeeding.

Check your breastfeeding position and ensure proper latching

It doesn’t matter whether you breastfeed while sitting or lying down. What’s important is that your baby is positioned at breast level and facing your body. Your baby shouldn’t have to turn their head to latch. Feel free to try different breastfeeding positions until you find one that’s comfortable for both of you.

If your baby has trouble latching onto the nipple, it may be positioned poorly in their mouth. This can cause the nipple to be compressed between the gums and hard palate, leading to soreness and irritation. Ideally, your baby should latch onto not just the nipple but also a large portion of the areola, ensuring that the nipple rests between their tongue and the soft palate. That’s why a proper latch is so important. For more details see expert advice: 6 simple steps to a good breastfeeding latch

Relieve and prevent breast engorgement

Swollen and hard breasts can also make it harder for your baby to latch on. Therefore, it is important to take immediate steps to relieve the discomfort and prevent milk stasis and breast swelling. Regular breastfeeding based on your baby's hunger helps to prevent your breasts from becoming too full and difficult for your baby to latch onto.

If your baby still struggles to maintain a latch due to engorgement, you can apply warmth to your breast before feeding to help widen the milk ducts. After a gentle breast massage, you can express a small amount of milk before nursing. See “How to deal with breast engorgement” for more information.

Help your baby latch on to flat or inverted nipples

There are several techniques you can use just before each breastfeed to form your nipples into an easier shape for your baby to latch on to, such as wearing a nipple former before feeds or briefly using a manual pump before feeding to coax out your nipple. If your baby is still struggling to maintain a latch, your lactation consultant or breastfeeding specialist may advise you to feed your baby through a nipple shield. For more details read about “Breastfeeding with flat, inverted or pierced nipples” for more information.

Check your baby's oral anatomy

If you suspect that your baby has tongue-tie, speak to your doctor and lactation consultant. Ask them to check your baby’s tongue. Together you will find a solution. Sometimes, a few special breastfeeding tips from your lactation consultant are all that's needed. See “How Tongue Tie in Babies Can Affect Breastfeeding” for more information.

Stimulate your milk flow through pumping

You can use a breast pump to stimulate milk flow, making it easier for your baby to nurse without exerting too much effort. This can help if your baby has a weaker sucking reflex or if your baby is sucking too hard on the breast because it’s not getting enough milk.

When pumping, check your breast shield size

When pumping always make sure your flange fits properly. Your areola must not be pulled into the tunnel of your breast shield, your nipple should not be squeezed against the flange sides. See flange article for more information on how to find the correct breast shield size. Also, always pump at your Maximum Comfort Vacuum strength and, if your nipples are already sensitive, do not exceed 15 minutes pumping time per breast.

Release your baby's latch before setting it down

Put a clean finger between your baby’s gums to break the suction before you remove your baby from the breast.

Take care of your breast

Your nipples go through a lot during breastfeeding. Take extra care of them with nipple cream like Purelan made of 100% medical-grade lanolin or opt for a vegan nipple balm. Use absorbent, soft nursing pads. Change the pads regularly after breastfeeding to keep your nipples from staying in a warm, moist environment. For more tips see “Nipple care for breastfeeding moms.”