Treatment of Sore Nipples

While sore and damaged nipples are common, they’re not an inevitable part of breastfeeding. Myths surrounding pain and breastfeeding are one of the most frequent reasons moms quit breastfeeding. Women are often told to tough it out and that the pain will get better with time. Sometimes the pain does get better with time, but there are many different reasons and solutions for pain during breastfeeding. Each of the following is a sign there is an underlying issue, needing to be addressed…

• Pain not subsiding within less than a minute of latching

• Pain occurring between feedings

• Discomfort lasting beyond 4-7 days postpartum

• Nipples with any cracks or visible damage

• Pain that’s getting worse

• Feelings of dread for the next feeding

The most common cause of nipple pain is poor latching at the breast. Often this is a result of the position of you and your baby. The following videos contain evidence-based information on latching.

Attaching Your Baby at the Breast

Exaggerated Latch

Latching a Baby On More Comfortably

At times nipple pain can be the result of a fungal (thrush) or bacterial infection. In order to prevent infection in damaged nipples, there are a variety of possible protocols, depending on the mom’s specific situation. Most IBCLCs recommend soaking with a warm saline solution after nursing or pumping.

A saline soak is used to gently cleanse, soothe, and support healing of irritated tissue. In the breastfeeding world, it’s most often recommended for sore nipples, milk blebs, or minor nipple damage.

• Soften a milk bleb
• Reduce surface inflammation
• Cleanse small cracks or abrasions
• Promote comfort and healing

Mix ½ teaspoon of table salt into 1 cup (8 ounces) of warm water. Stir until fully dissolved. The water should feel comfortably warm, not hot.

Option 1

Pour the solution into a small clean cup and lean forward, placing your nipple into the cup so it is submerged. Soak for about 5 to 10 minutes.

Option 2

Soak a clean cloth or gauze in the saline solution and hold it against the nipple for 5 to 10 minutes.

After soaking, gently pat dry. If you’re breastfeeding right away, you do not need to rinse. If you are not feeding immediately, you may rinse with plain water and pat dry to prevent salt residue from irritating the skin.

Topical applications typically suggested in the lactation community are Silverettes, medihoney, calendula hydrosol, breastmilk, or coconut oil. Lanolin is popular, but some research shows it may contribute to infection. Lanolin can also contain impurities and is allergenic. Vasospasm is another cause of nipple pain. 

Vasospasm happens when blood vessels tighten too much and reduce blood flow to an area. You may have heard of Raynaud’s phenomenon, where fingers turn white and are painful in the cold. The same type of vessel constriction can happen in the nipples, especially during pregnancy and breastfeeding.

Nipple vasospasm can be painful, but it is treatable. It is also often mistaken for yeast. Candida infections of the nipples are commonly overdiagnosed. If your symptoms fit vasospasm, it is best to address that first.

Common symptoms include burning, stabbing, throbbing, or pins and needles pain in the nipple and sometimes deep in the breast. The pain often begins after your baby comes off the breast. It can also be triggered by cold, such as stepping out of a warm shower or going outside on a cool day. Some moms notice color changes in the nipple. The nipple may turn white, purple, or red and may shift back and forth between colors for several minutes or longer.

Because blood flow is reduced during vasospasm, healing of cracked or damaged nipples may be delayed.

The most common trigger is nipple trauma. Anything that causes nipple pain, especially a shallow latch or pulling at the breast related to milk flow issues, can lead to vasospasm. Addressing the root cause is key.

1. Improve the latch. Most nipple pain starts with latch. Optimizing positioning and attachment is foundational to healing and preventing recurring spasms.

2. Keep nipples warm. Cold is a major trigger. Cover the nipple immediately after your baby unlatches. Wrap your breasts before stepping out of the shower. Wool breast pads retain warmth better than cotton or disposable pads. You can also apply dry heat using a heating pad or warm compress over clothing. Air drying nipples, often suggested for soreness, can actually worsen vasospasm.

3. Use gentle massage with olive oil or nipple ointment. Warm a small amount between your fingers and massage into the areola inside your bra. Warmth combined with massage can help restore circulation.

4. Massage the chest muscles. Massage firmly below the collarbone and above the breasts for about 60 seconds per side after feeds or at the onset of pain. Massage under the breasts or in the armpits more gently.

Nifedipine is a prescription medication that relaxes blood vessels and is highly effective for vasospasm. A 30 mg slow release tablet once daily often resolves pain within two weeks. If pain returns after stopping, another short course may help. It can be used longer term if needed. Side effects are uncommon, though headache is the most reported.

If medication is not an option, vitamin B6 in a B complex with niacin at 100 mg twice daily or magnesium bisglycinate or citrate at 250 to 300 mg twice daily may help. If there is no improvement after a few weeks, discontinue. If helpful, continue until pain free for two weeks, then stop.

Vasospasm is painful but manageable. These are all issues an IBCLC (International Board Certified Lactation Consultant) can also assist with.

Moms regularly blame themselves for nipple pain and feel they’re doing something wrong. However, nipple pain may be an issue with the baby. Oral restrictions (tongue tie), suck dysfunction, musculoskeletal issues, or a receded chin are just a few things that can lead to nipple pain. 

Babies with oral function problems are often very creative problem solvers. They develop movements called “compensations” to try to make feeding work for them. These compensations can be painful for both mom and baby. Sometimes babies will stress and strain their facial muscles with compensations so much so that they have a trembling jaw after feeds. These babies can be very fussy.

Prematurity can be both a structure and function problem. Some babies are born before their feeding reflexes are fully developed. They may not have the nervous system development to feel the breast or food in their mouth. Fortunately, with modern technology, we are able to feed these babies and keep them healthy until they can grow and catch up. Most premature babies have a small mouth, making it challenging to open wide and latch to a full breast. Again, the miracle of growth over time will help work this out. A properly trained IBCLC can thoroughly assess your baby’s oral function.

Poorly designed breast pumps, improperly sized flanges, improper cleaning of pump parts, and high pump suction can all lead to nipple pain. Using Legendairy Milk’s Silicone Nipple Ruler or Free Nipple Ruler can give you a good idea of your flange size. Adding lubrication to the flange/shield can reduce friction and make pumping more comfortable. The oils in Legendairy Milk’s Pumping Spray are also nourishing to your skin during and after pumping.

The key takeaway is that nursing and pumping should be comfortable and not cause soreness or pain. Take note of anything that has changed to help determine the cause and the best solution to eliminate your discomfort and avoid future sore nipples.