What Causes Sore Nipples While Breastfeeding

If you experience some nipple soreness in the first few weeks of breastfeeding, you’re not alone. It’s common for women to experience sore breasts or nipple discomfort in the early stages of breastfeeding.

The good news is this initial tenderness doesn’t usually last long with the right care.

Read on to learn more about what can cause nipple soreness, whether you should keep on breastfeeding if you have sore nipples or breasts and how to soothe the pain.

What Can Cause Sore Nipples When Breastfeeding?

There are lots of reasons you might have sore nipples when breastfeeding, especially in the early stages. Most of these can be traced back to how effectively your baby latches on to your breast.

If you’re troubled by sore nipples check in with your health visitor or doctor – or a lactation consultant – sooner rather than later. Generally speaking, breast discomfort can be easily fixed once you know what’s causing it.

Here are some common causes of sore nipples while breastfeeding:

Improper Attachment

The most likely cause of sore nipples in the early days of breastfeeding is improper attachment. If your baby doesn’t latch on to your nipple properly, your baby’s mouth or tongue can chafe against the skin of your nipple, making it sore.

Latching problems can also stop your baby from getting all the milk he or she needs from each feed. If your little one seems still hungry or unsettled after feeds or falls behind with his or her growth or weight gain, the cause of your discomfort may be related to this.

Another sign that your baby may not be latching on properly is if your nipples look flattened or white after each feed.

Other factors can contribute to latching issues when breastfeeding. These include:

• Tongue-tie. In some newborn babies, the flap of skin that connects the tongue to the floor of the mouth is shorter than usual. This isn’t always a problem, but in some cases tongue movement is restricted. This makes it harder to latch onto the nipple when breastfeeding, which in turn may lead to sore nipples.

• Cluster feeding. During growth spurts your baby may go through periods of feeding more frequently than usual. This isn’t necessarily a cause of sore nipples in itself, but any issues caused by improper attachment might get worse due to the more intensive feeding schedule.

• Flat or inverted nipples. Flat or inverted nipples can make it more difficult to achieve a proper latch, possibly leading to nipple soreness. Ask your health visitor or lactation consultant to show you breastfeeding techniques that may help you overcome this problem.

• Breast engorgement. Sometimes your breasts can get a little too full of milk, causing the nipples to flatten, making it harder for your baby to latch on. This might happen if your little one isn’t feeding properly or misses a feed, but it can also happen if you reduce the number of feeds or try to wean your baby a little too quickly. If your breasts feel over-full, warming them and expressing a little milk before feeding may relieve the pressure a bit.

• Not breaking the suction before removing your baby from your breast. Not only can this be painful, but it can damage breast tissue and your nipple. To avoid this happening, gently slide a clean finger into the corner of your baby’s mouth to break the seal before taking him or her off your breast.

Other Causes of Sore Nipples

• Oral thrush in your baby. This is a yeast infection that can infect your nipples, causing nipple soreness. If you notice white spots or patches on your baby’s lips or inside his or her mouth, your little one may be infected with candida, the yeast that causes thrush. If your baby has oral thrust it can easily be transferred to your breasts during breastfeeding. Apart from sore nipples, other symptoms of thrush you may notice on yourself include shooting pains in your breast during or after breastfeeding. If you suspect you or your baby has a thrush infection, see your doctor for treatment and advice on how to prevent reinfection.

• Milk blister. This is a white spot on or around the nipple consisting of thickened granules of milk, which may block a milk duct. Milk-filled blisters sometimes clear up themselves with feeding. If not, it’s important to remove them or they might move down the milk duct and cause mastitis. You can usually do this yourself with a clean fingernail or rough flannel. Ask your health visitor or doctor for advice if you’re at all unsure how to do this.

• Bras that are too tight. This puts pressure on your nipple and can irritate it. A restrictive bra can also prevent all the milk from draining out properly after a feed, leading to blocked milk ducts and other problems. Switching to a cotton, non-underwired bra – or a bra specially designed for nursing – may help ease any discomfort. You might also consider having a bra professionally fitted, either at a high-street clothing chain that offers this service, or at a specialist lingerie shop.

• Soaps or perfumes. These can dry out your nipples and cause irritation and soreness of the skin.

Other Forms of Breast Pain

Sometimes nipple pain may be due to a condition that causes other kinds of breast pain. Examples of these include:

• Vasospasm (nipple blanching). After a breastfeeding session, some women experience an intense pain shooting from the nipple into the breast, accompanied by ‘blanching’ of the nipples – a change in colour from the usual shade to a pale white. This could be caused by a contraction of the blood vessels – called a vasospasm – in your breast. Although some women are more prone to it than others, this too can usually be solved by making sure your baby is properly attached when breastfeeding.

• Blocked milk ducts. A small, tender lump in your breast might be a sign of a blocked milk duct. There are several ducts in each of your breasts, carrying milk from your milk glands to the nipple. These can occasionally get blocked up by milk granules that harden if the duct isn’t properly drained. It’s important to deal with a blocked milk duct straight away, or it could lead to mastitis. The good news is that your little one might be able to help you out here, as giving more feeds from the affected breast may help flush out the blockage. Massaging your breasts or warming them under the shower or with a warm flannel can also help.

• Mastitis. A hot and sore or painful breast may be a sign that you have this infection, which can happen when a blocked milk duct prevents the milk from properly getting out of your breast. The milk builds up, causing pain and swelling in your breast and nipple. Other symptoms include red swollen areas on your breasts, flu-like symptoms like fever and aches and a hard lump in the breast. See your doctor if you think you may have mastitis.

Should You Breastfeed With Sore Nipples?

Unless your doctor advises against it, try to continue breastfeeding as usual, even if you are struggling with sore nipples. Slowing down or stopping breastfeeding could reduce your breast milk supply.

If it’s less irritating to your nipples, an alternative option is to express your milk by hand until the nipple soreness subsides.

Even if you have a breast infection like mastitis, it’s best to continue breastfeeding. In fact, with mastitis, the breast pain and related sore nipples could worsen if you stop breastfeeding or expressing.

Likewise, in the case of thrush, it's best to continue breastfeeding unless your doctor advises otherwise.

How Can You Relieve Nipple Soreness?

Relieving nipple pain really depends on resolving the underlying cause. Always follow the advice of your doctor, health visitor or lactation consultant. In the meantime, you might like to try some of these strategies to help provide some relief:

• Make sure your baby is attaching properly. The nipple should be positioned deep into your baby’s mouth. Your baby’s mouth should be wide open; and usually, if he or she is properly latched, you’ll see more dark skin of your nipple showing above your baby’s upper lip than below the mouth.

• Try different breastfeeding positions. You might find it easier to latch your baby onto your breast effectively in a different position.

• Properly break suction when you need to stop breastfeeding. Before taking your little one off your breast after a feed, gently slide your clean little finger under the side of his or her lip to break the seal.

• Dab a little breast milk or colostrum onto sore cracked nipples after each feed. This is not only soothing; it also helps keep them moisturised. Let your nipples dry afterwards though, and if you’re using breast pads be sure to change them after every breastfeeding session.

• Avoid washing your nipples with soap. Soap can dry your skin, so washing your nipples in nothing but clean water may help them stay hydrated. It can also help to fully rinse any detergents from clothes that might come into contact with your nipples, in case detergents are causing the irritation.

• Apply lanolin or petroleum jelly. If your nipples are dry or cracked, rubbing lanolin or petroleum jelly into the affected areas after each feed may help soothe them.

• Apply warmth. Applying warming gel pads or a wet, warm flannel may help ease breast pain and clear blocked milk ducts.

• Avoid using nipple shields or breast shells. These aren’t thought to help with attachment during breastfeeding, which is the key to avoiding sore nipples in most cases.

• Treat any infections. If your doctor diagnoses an infection like thrush or mastitis, you may be prescribed an antifungal treatment or antibiotics. Ensure that you take these exactly as your doctor instructs and finish taking all the antibiotics you’re prescribed – even if you start to feel better – unless your doctor advises you to stop.

• Ask for professional help. If you experience sore nipples or breast pain don’t hesitate to see a lactation consultant, your doctor or health visitor. The sooner you can get back to pain-free breastfeeding, the more you’ll be able to enjoy those magical moments of closeness and bonding with your little one.

It’s not uncommon to experience sore nipples at some point along the way if you’re breastfeeding your little one. The good news is that most nipple and breast pain can be avoided with a few preventative steps, or treatment if you’re already in pain. Asking for help from your health visitor or doctor or a lactation consultant can help you get there sooner.