References:

1. About Kids Health - Breastfeeding problems: Sore nipples
2. Toronto Public Health – Breastfeeding Protocols for Health Care Providers | Protocol #4: Sore Nipples

• Nipple pain is the main reason why people stop breastfeeding

Signs and symptoms

• Nipples are:
  • Tender
  • Painful
  • Itchy
  • Red
  • Bruised
  • Blistered
  • Cracked
  • Bleeding
  • Shiny/flaky

Causes

• Poor position and latch
• Engorged breast
• Flat or inverted nipples
• Pumping incorrectly
• Baby not sucking properly
• Baby is tongue-tied
• Issues with the baby’s palate
• Receding chin
• Artificial nipple and device use
• A baby teething or biting down on the breast
• Pregnancy
• Candidiasis, mastitis or other infection
• Skin condition
• Sensitivity to nipple creams and ointments
• Blocked nipple pore (bleb)
• Decreased blood flow due to the tightening of blood vessels (vasospasm)
• Ending feedings before baby is ready without breaking suction
• Wearing wet pads or pads with plastic coating
• Using a breast shell with poor ventilation
• Detergent left over on clothing from washing
• Sensitive nipples
• Sudden change in temperature

Prevention

• Address the cause of the nipple soreness (refer to the specific content page for prevention and treatment information)

Breastfeeding with sore nipples

• Before:
  • Relaxation strategies – breastfeeding in a quiet, comfortable position, heat application, etc.
  • Breastfeed early when the baby shows signs of hunger
  • Hold baby skin-to-skin
  • Massage breasts
  • Simulate nipples
  • Express some milk onto the nipple before latching baby
  • Feed on the pain-free side first to initiate letdown
  • Apply ice to the nipple right before feeding
• During:
  • Change positions each feed
  • Ensure baby is sucking and swallowing well
  • Use breast compressions as needed to improve milk flow
  • Feed until the baby is finished
  • Do not pull the baby off the breast, always break the seal of the baby’s mouth before taking baby off the breast
• After:
  • If no tissue damage, express breast milk onto the nipples and areola, then allow to dry before putting on a bra
  • Apply saline compress onto the nipples and areola, then allow to dry before putting on a bra
  • If there are skin breaks, cracks or fissures, wash nipples once a day with warm, soapy water and rinse well
  • Use a breast shell with good ventilation
  • Wear a properly sized bra with no underwire
  • Do not use nursing pads with plastic lining

Alternative Feeding Method

• If it is too sore to latch a baby to the breast, express breast milk at least 8 times in 24 hours, including at least once during the night, to keep supply of breast milk
  • Feed baby expressed breast milk with an alternate feeding method

Treatment

• Address the cause of the nipple soreness (refer to the specific content page for prevention and treatment information)
• Discuss with a health care provider if an ointment or cream can be used to help nipples heal

Further Your Learning:

1. Toronto Public Health – Breastfeeding Protocols for Health Care Providers | Protocol #4: Sore Nipples
2. About Kids Health - Breastfeeding problems: Sore nipples

Shareable Resources For Clients:

1. Best Start - Breastfeeding Matters

Referral Sources:

1. Niagara Parents - Infant Feeding Appointment with a Public Health Nurse - 905-684-7555
2. Health811 - Breastfeeding advice and referrals - 1-866-797-0007
3. La Leche League Canada – Mother-to-mother breastfeeding support - 613-238-5919