There are a number of reasons for developing sore nipples during breastfeeding and each can be easily managed and treated. However, before treating the pain, it is important to determine the cause of the soreness and to treat the root of the problem first or the soreness will keep recurring.
Here are some reasons why your nipples might be sore from breastfeeding and what you can do about it. It is important to note that many of these reasons can overlap, for instance having a cracked nipple and a blocked duct at the same time.
1. When your baby hasn’t latched on properly.
When you’re new to breastfeeding, it can be difficult to tell what a proper latch should be like. To top it off, there are many other factors that can compound the problem, such as short nipples, inverted nipples, breast engorgement, etc.
The best thing you can do to identify whether your baby has correctly latched on is to check with a lactation consultant, a hospital nurse or another mother who is experienced in breastfeeding. Ask for advice and get them to check your technique when your baby is nursing.
One way to tell if your baby has a proper latch is to look and see how much of the areolar (the dark-skin area of your breast) is covered by your baby’s mouth. Ideally, it should be most of the areolar, leaving only a thin ring of darkened skin visible. Another way (although I didn’t find this particularly useful for me) is to check the shape of your nipple after a feed. It should still be relatively rounded after your baby comes off. A flattened nipple is potentially a sign of an incorrect latch.
To ensure your baby gets a correct latch on your breast, make sure that your baby’s mouth is open wide with the tongue down before putting your baby on the breast. If the latch is incorrect, break the seal and try again. It is important to make sure your baby learns to latch on correctly because an incorrect latch will be the source of continued nipple soreness.
2. Cracked nipple
This is usually an indication of poor breastfeeding technique. In most cases, your baby isn’t taking in enough of the areolar and is only suckling on the nipple. Sometimes it might be due to unusual anatomy within your baby’s mouth, for instance a tied tongue. Getting someone experienced in breastfeeding to check will help you determine the exact cause if you aren’t sure.
The first step is to correct the source of the problem, for instance, correcting your breastfeeding technique. To help your cracked nipples heal faster, applying a little breast milk onto the nipples after every feed can be helpful. Alternatively, you can apply a breastfeeding ointment like Bepanthen which promotes healing.
If nursing is too uncomfortable, try expressing the milk from the affected side until it heals sufficiently. You can also try nursing on the unaffected side first before switching your baby to the affected side as your baby usually suckles less vigorously on the second breast which shouldn’t hurt as much.
Another option is to use nipple shields. These are plastic coverings that cover your nipples and provides a barrier against the friction of baby’s tongue on raw nipples.
3. Blocked duct
This is usually due to your baby not “milking” your breasts effectively. Your milk is being produced faster than your baby is consuming it. As a result, the milk travels back along the milk ducts and is forced into the surrounding breast tissue causing swelling, tenderness and pain.
Blocked ducts usually affect only one side and are localised. There is a hardened lump in the area of the breast associated with the blocked duct. Aside from the tenderness you feel, the skin in the area is usually reddened and feels warm to the touch. Blocked ducts can appear similar to mastitis with the main difference being the absence of fever and the fact that usually only one side is affected.
Managing blocked ducts:
Keep feeding your baby frequently on the affected side even though it hurts as this is the fastest way to clear the blockage. This is also the most effective way to clear the blocked duct above and beyond all the other measures listed below. With frequent feeds, a block duct can be cleared within 24 hours.
Vary your feeding positions as this will help your baby clear the milk more effectively.
Taking ibuprofen can help to reduce the inflammation and manage the pain if you find it unbearable.
You can also try expressing the milk with a breast pump or by hand, although I believe that no pump will be quite as effective as your baby.
Applying warm or cold compresses directly onto your breast, taking warm baths and massages can also be helpful.
Similar to the symptoms of a blocked duct, mastitis usually affects both breasts and is accompanied by flu-like symptoms. There may be an infection present which will require antibiotic treatment, though not always. If you suspect you have mastitis, consult your doctor for the best course of treatment. Aside from antibiotics, there are additional things you should do which will help to resolve the condition more quickly. Most of these are similar to what you would do if you had blocked ducts.
Rest with your baby and continue nursing regularly and frequently, especially on the affected side. Do not stop nursing as it can increase your risk of developing a breast abscess.
Nursing at this point will be painful so taking ibuprofen can help to alleviate the pain. Ibuprofen also helps to manage the accompanying fever.
Vary your nursing position to help baby empty your breasts more effectively.
Sometimes, though rarely, your baby may object to nursing because of the increased sodium content to your milk resulting from the inflammation. In this case, you will have to express your milk. However, your baby is still the best breast pump you have on hand so it is best to try persisting with nursing. As the inflammation begins to clear, the taste of your milk will return to normal.
Applying warm and cold compresses to the affected areas, taking warm baths and gently massaging the affected area.
Infections such as thrush can also cause sore nipples. Thrush is a yeast infection (caused by Candida) that causes the nipples to become red and tender, and may be accompanied by a burning sensation. If your breasts are infected by Candida, you will also notice white plaques inside your baby’s mouth. Thrush is not an indication to stop breast feeding, however, both you and baby will require antifungal treatment for it. Your doctor can prescribe the appropriate medications.
6. Initial breastfeeding soreness
During the first couple of weeks of breastfeeding, there will be some soreness of the nipples – this is due to the friction of your baby’s tongue against your nipples which can leave them feeling raw. As long as you are breastfeeding with good technique, this tenderness will eventually fade on its own as your nipples toughen up. In the interim, applying a little breast milk or breastfeeding ointment after every feed can help your nipples to heal sufficiently between feeds to reduce the sensitivity during nursing.
When your baby begins teething, you may experience something similar to the initial soreness you felt when you first started breastfeeding. This only occurs with the eruption of the upper front teeth since the lower front teeth are covered by your baby’s tongue during breastfeeding. The sensitivity usually goes away quickly as long as your baby isn’t using your nipple as a teething ring.
At this point, it is important to educate your baby that biting is not acceptable. If your baby bites, simply put away your breast and stop the feed. Your baby will soon get the message. Usually when your baby starts biting your nipple, it is a good indication that the actual feeding part is over and that your baby is just nursing for comfort or playing. A baby that is still actively suckling will be biting his or her own tongue if he or she attempts to bite the nipple.
There are several reasons why your nipples may be sore during breastfeeding. It is important to identify the cause of the pain and treat the underlying problem before applying methods to relieve the pain and sensitivity. Without treating the underlying problem, the pain and soreness of your nipples will continue to persist.