Sore nipples during breastfeeding

Sore nipples during breastfeeding are a very common problem, affecting more than 9 out of 10 breastfeeding mothers. If your nipples are sore, you may notice some cracks, or that they look unusually red. This is a shame, because as well as being uncomfortable it may make you give up breastfeeding completely. There are many possible reasons.

One of the commonest causes is that the baby is not latching on to the breast very effectively (Journal Perinatal Neonatal Nursing 2008;22:267–74).
Dermatitis (eczema) is another common cause, especially if you have sensitive, dry skin and have eczema in the past.
Sore, cracked nipples can also be caused by thrush (particularly if you had antibiotics recently, or have vaginal thrush). As well as cracks, the nipple area may be red, shiny, or flaky, and there may be a burning pain of the nipple area and a deep burning, shooting, or stabbing pain in the breast.
Intense pain, burning, numbness, prickliness, or stinging that is helped to some extent applying something warm to the nipple may be caused by a condition called Raynaud’s, in which some of the tiny blood vessels go into a temporary spasm.

What can be done

Most importantly, contact your nurse of doctor for advice straight away. If the problem is that the baby is not latching onto the breast effectively your nurse will certainly be able to help; often it is a simple matter of positioning your baby slightly differently. Your doctor and nurse will also be able to decide whether you have thrush or any other problem that needs a specific treatment.
Some mothers find that applying a warm-wet pad, tea bags or some of their own milk is soothing. If you use your milk, apply a few drops to the nipple and surrounding skin, and leave it to dry.
Oils (such as vitamin E, olive oil, mineral oil) are sometimes recommended, but are not a logical treatment. They have not been shown to promote healing, and do not penetrate to the deeper layers of skin. Cracked, dry skin lacks moisture, not oil (Journal Perinatal Neonatal Nursing 2008;22:267–74).
Creams are an appropriate treatment, because they provide a moisture barrier to prevent the cracked skin from drying and forming a scab as it heals. Various suitable creams are available; your pharmacist or nurse can advise.
You may wish to cover the nipple and surrounding skin with a dressing between feeds. Chooses a ‘hydrogel’ type dressing. These are glycerin-based or water-based dressings that keep the area moist and help to relieve pain.

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Monday, January 16th 2012

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