Clinical Reference Systems: Pediatric Advisor 10.0
Breast-feeding should be a comfortable and enjoyable
experience. Unfortunately, sore nipples are a common
complaint among breast-feeding mothers. Often mothers
quit nursing their babies early because of sore nipples, but
this doesn't have to happen. Sore nipples usually can be
prevented or treated.
Mild nipple discomfort at the beginning of feedings during
the first few days of breast-feeding usually needs no
treatment. However, nipple pain that is severe or lasts
throughout a feeding or persists for more than a week is not
normal and should be evaluated by your doctor or a lactation
The most common cause of severe nipple soreness is improper
positioning of your baby's mouth on your breast. The
particular size and shape of your nipples and your baby's
mouth can affect your baby's latching-on technique. In
addition, your infant's unique sucking habits can contribute
to nipple discomfort.
Other possible causes of nipple pain are an infection of
the nipples (yeast or bacterial), a breast infection, or
improper nipple skin care.
If your baby is latching on to your breast incorrectly, he
may not be getting enough milk. Also, nipple pain may cause
you to postpone nursings or may decrease your let-down reflex
and reduce milk flow. This combination of factors can
easily cause a drop in your milk supply. As a result, your
baby may not gain weight well. Sore nipples and low milk
supply often go hand-in-hand.
TREATMENT FOR SORE NIPPLES
The following recommendations should help your nipples feel
better within a day or so.
- Make sure your baby is positioned correctly to nurse.
Support your breast with four fingers below and your
thumb above. Place your fingers far enough behind the
darkened area around your nipple (areola) so they
won't touch your baby's mouth when she attaches. When
your baby opens her mouth wide, quickly pull her toward
you so she grasps both your nipple and as much
surrounding areola as possible. Make sure you center
the nipple in your baby's mouth. Do not let your baby
take only the tip of your nipple.
Throughout the feeding hold your breast from below so
the nipple and areola aren't pulled out of your baby's
mouth by the weight of the breast. Your baby should be
facing you chest-to-chest.
- Begin a feeding on the less sore nipple to trigger your
let-down reflex and start milk flowing.
Babies suck harder at the beginning of feedings. After
your baby has nursed briefly and milk flow has begun,
move her to the second breast. This should make nursing
more comfortable because the baby will suck less
vigorously once milk starts to flow. However, as soon
as possible, resume switching the breast you start each
feeding with to prevent a lopsided milk supply.
- Frequent shorter feedings are preferable to less
frequent lengthy feedings.
If one nipple is extremely sore, temporarily limit
feedings to 10 minutes on that side.
- Keep your nipples dry.
Gently pat your nipples dry with a clean cloth after
nursing or let your nipples air-dry for 15 to 20
minutes. Cleanse your nipples with water when you
bathe. Do not use soap or alcohol because they remove
natural oils. If you wear breast pads, change them as
soon as they become wet.
Don't go to extremes and dry your nipples too much. For
example, don't dry them with a hair dryer and don't
expose them to air for a long time if you live where the
humidity is low. Too much dryness can worsen the
condition of the skin.
At the end of each feeding you can put a thin coating of
USP Modified Lanolin (medical grade) on your nipples.
This will prevent excess drying of the skin. This
purified lanolin product can be obtained from most
breast-pump rental stations, such as Ameda/Egnell at
1-800-323-4060 or Medela, Inc., at 1-800-435-8316.
- If you have cracks or other breaks in the skin, keep
your nipples covered with a soothing emollient.
USP Modified Lanolin (medical grade) is best. Put a
fresh coating on your nipples after each feeding. Also,
wearing Medela or Ameda/Egnell wide-based breast shells
over your nipples between nursings can reduce the
discomfort and speed up healing by preventing direct
contact with your bra.
- Use a pump to express your milk if the pain is so severe
that you cannot nurse your baby.
You can stop nursing and pump milk for 2 to 3 days while
your nipples heal. You can rent a hospital-grade
electric pump temporarily to express your milk
comfortably. Pumping is a convenient way to empty your
breasts and maintain or increase your milk supply while
your nipples heal. Other types of breast pumps
generally are not as comfortable or effective as a
rented hospital-grade electric pump.
To find where you can rent a pump, call Ameda/Egnell
Corp. at 1-800-323-4060; Medela, Inc., at 1-800-TELL-YOU
(1-800-835-5968); or White River at 1-800-342-3906.
- Watch for signs of a breast infection.
A cracked nipple may make you more susceptible to
getting a breast infection (mastitis). Be on the
lookout for any signs of infection. The signs are
described below in the section on when to call your
CALL YOUR DOCTOR IMMEDIATELY IF:
CALL YOUR DOCTOR DURING OFFICE HOURS IF:
- Your nipples sting or burn and you have shooting pains in
your breast, especially after nursing.
You may have a yeast infection of your nipples. A yeast
infection requires treatment with medication. Babies
can get yeast infections in their mouths and diaper
- The nipple pain inhibits your let-down reflex.
In this case, your doctor may prescribe a pain
For tips on triggering the let-down reflex, see
The Let-Down Reflex.
CALL YOUR BABY'S DOCTOR DURING OFFICE HOURS IF:
- Your baby is not satisfied after most nursings.
Your baby may not be satisfied because your milk supply
is low or because your baby is not emptying your breasts.
After weighing your baby, the doctor can decide whether
you need to change your feeding schedule or offer your
baby supplemental breast milk or formula. You may need to
use an electric pump temporarily to express any milk left
after nursings. Pumping will help increase your milk
- Your nipples have a yeast infection, you see white patches
in your baby's mouth, or your baby has had a diaper rash
for 3 or more days.
In this case, your baby may need to be treated for a yeast