What Causes Sore Nipples from Breastfeeding?

By: Sabrina Granniss, IBCLC

5 min

Overview

What are some of the reasons for sore nipples from nursing? Positioning Engorgement Latch Pumping Teething Your period returns or pregnancy

“Ouch!” is never something you should say when breastfeeding your baby. You read that right. Breastfeeding should not cause pain. In fact, it is of no benefit to you or your baby if breastfeeding is causing you pain.

Were you given different information and reasons from each provider you’ve seen about breast or nipple soreness? You may have even been told that some pain is normal. Looking at your complete health history, your baby’s health history, and your nursing experience from the beginning to the present can help point you toward why you are experiencing discomfort. There are many causes of sore nipples, and there are always solutions.

What are some of the reasons for sore nipples from nursing?

Positioning

Babies initially rely on their reflexes after birth to find and latch to the breast. The reflexes are innate and intended to help your baby survive. Being skin-to-skin helps your baby initiate moving, to crawl up to your breast, find the nipple, latch on to breast tissue, and begin breastfeeding. Holding your baby close to you, belly to belly, in a slightly reclined position, allows your baby to be more connected to your body by gravity. This makes them feel their body is supported and stable.

Tips for a deep latch:

Your baby needs to be able to get a large portion of breast tissue in their mouth and not just the nipple.
You will find it helpful to hold your baby so their mouth is below the nipple. This will encourage them to gaze slightly up, tilting their head back and pointing their chin towards your breast.
Pulling your baby close to your body when their chin is in a more forward position means the weight of your breast will support and stabilize their chin as they open their mouth very wide and extend their tongue out over the bottom gum line, cupping areolar tissue.

While breastfeeding, you should be comfortable, and so should your baby. Placing your baby on a pillow at your breast can position your baby too high or in an awkward position for feeding. Use pillows to support you, and you support your baby.

Breasts come in many wonderful shapes and sizes. If you have larger breasts, you may find rolling a towel to fit under your breast gives a little boost so you can more easily position your baby. It can be harder to see where your baby is latching if you have a lot of breast tissue. If your breasts are smaller, you may find positioning your baby slightly higher on your body helpful. Try sitting in front of a mirror; this will give a different view than looking down from the top of your chest. The mirror lets you see where your baby is in relation to your breast and nipple. You will quickly form muscle memory and be able to help your baby latch without being in front of a mirror.

Engorgement

Milk increases in volume between days 2-5 after birth. Sometimes, this transition can cause engorgement. Fluids given during birth contribute to engorgement. Your breasts become overly full, making the skin taught and the nipple more flattened and more challenging for your baby to latch on well. Try using reverse pressure softening to push the milk back up the ducts just far enough for your baby to be able to latch on more easily and remove your milk.

If you have difficulty getting milk out, take a warm shower. Lean forward using gravity to help release milk. Using very gentle massage and hand expression can encourage milk to flow and fluid to move. You may find relief using a cold pack on your breast after you have nursed your baby or pumped your milk out. You can take a probiotic like Lacta-Biotic to help with breast pain and support breast health. The strain L. fermentum has been found to relieve pain from plugged ducts.

Latch

Your nipple should look the same after feeding as when you began a feeding. If your baby unlatches and your nipple is misshapen or creased, adjust your positioning. You should contact your IBCLC to complete an oral assessment if it continues.

A lot is happening inside your baby’s mouth that we can not see from the outside of your baby’s latch. How a latch looks is only one measure of how nursing is going. When you share your whole experience of feeding your baby, we better understand how breastfeeding is going.

Your provider should ask about your health history and evaluate your breastfeeding experience, including the baby’s oral anatomy, muscles, reflexes, and body. A shallow latch can cause the nipple to be damaged and cause pain. Recurrent milk blebs, plugged ducts, candida, or mastitis can be indicators of latching issues, oral restrictions, and inflammation.

Pumping

Using the right flange size will be comfortable and maximize milk removal. Using Legendairy Milk’s Silicone Nipple Ruler or Free Nipple Ruler can give you a good idea of your flange size. Many IBCLCs specifically offer flange fittings to help you get the best fit. Adding lubrication to the flange/shield can reduce friction and make pumping more comfortable. The oils in Legendairy Milk’s Pumping Spray are nourishing to your skin during and after pumping.

Your pump uses suction to express milk, but your baby nurses using suction and compression. Adding compressions with your hand while you pump will remove more milk. Using a heat pack before and during pumping to relax the smooth muscles and increase blood flow helps with milk flow and letdowns. (1)

Teething

Babies who are getting teeth often want to chew on everything to soothe their sore gums. Giving your baby a teether between nursing can help massage sore gums. A deep latch means your baby can still latch on even when teeth are poking through their gums, and you will be comfortable. If you have teeth marks on your breast after your baby nurses or pain while nursing when your baby’s teeth come in, a visit with your IBCLC for a functional oral assessment is in order. Sometimes, latch compensations seem to surface and are recognized when teeth erupt.

Your period returns or pregnancy

Hormone changes can cause nipple soreness and sometimes affect milk supply. Before your period, blood calcium levels drop and can slightly decrease your milk supply.

Taking a calcium magnesium supplement can help replenish calcium and decrease soreness. If your period has not returned and you are experiencing nipple soreness, it may be time to take a pregnancy test.

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.