Common causes and treatment of sore or cracked nipples.

If your nipples hurt, your latch might need a little help. Putting up with the pain could make things worse. Talk to a health care professional.

Common causes for sore nipples

  • Poor latch. Some mothers have trouble getting a pain-free latch when they first start breastfeeding. Learn more about getting a good latch.
  • Flat or inverted nipples. Some babies have no problem latching onto a flat or inverted nipple, especially in the first few days before breasts can become full with milk. If you are having trouble you may consider using a nipple shield. It would also be helpful to talk with a public health nurse.
  • Bottle-fed baby. Bottle-fed babies can sometimes have difficulties latching back on the breast. The way a baby feeds and sucks from a bottle is very different than the breast. If your baby has been receiving bottles of milk, it's still possible to get your baby back to the breast. Practice lots of skin-to-skin and let your baby learn slowly. Licking and nuzzling at the breast is good practice for breastfeeding. Some babies go to the breast readily with the use of a nipple shield. This feels familiar to the baby yet you are actually breastfeeding. Nipple shields are usually used for a short time, then taken away. Talk to a public health nurse for help with this.
  • Thrush. Learn more about the common signs and symptoms of thrush. Speak to your health care professional. You and your baby will need treatment.
  • Tongue-tie. Some babies are born with a tight piece of skin between the underside of their tongue and the floor of their mouth. Tongue-tie can make it hard for your baby to attach effectively at your breast and can cause sore nipples. Other babies might be affected by a strong piece of tissue between the upper lip and the gum. This may cause problems with breastfeeding. Talk to your health care professional.

General care for sore or cracked nipples

  • Squeeze (express) out a drop or two of your milk at the end of a feed and gently rub it into your skin.
  • Let your nipples dry before getting dressed again.
  • Change your breast pads at each feed (if possible use pads without a plastic backing).
  • Don't use soap, as it dries out your skin.
  • Wear a cotton bra so that air can circulate.
  • Treat any cracks or bleeding with a thin smear of purified lanolin. Put the ointment on the crack (not the whole nipple) to help it heal and prevent a scab forming.
  • Don't stop feeding. With skilled help and a little practice, you should find that breastfeeding quickly becomes more comfortable again.

Nipple shields

Nipple shields can be helpful for breastfeeding when your milk supply has increased (about two to five days after birth) and:

  • You have flat or inverted nipples.
  • Your baby is used to a bottle and you want to get back to breastfeeding.
  • Your baby is premature, has an immature suck or has neurological challenges.

Nipple shields are available at local pharmacies and baby equipment stores. Call ahead to see if they carry nipple shields. They come in various sizes. Try to get one that is closest in size to your own nipple.

How to use a nipple shield

  • Some mothers find that it helps their baby latch if they use warm wet compresses and breast massage to get their milk flowing first.
  • It may help to place the shield in clean, hot water to make it more flexible and help it stick to your breast. Breast milk or lanolin ointment under the rim also helps it stick.
  • Fold the rim of the shield back (like a Mexican hat) and centre it over your nipple.
  • Spread the rim back over your breast to form a seal.
  • Hand express some breast milk into the nipple shield. You can try keeping a finger over the holes in the tip to keep milk from spilling. The milk will help your baby want to latch.
  • Hold the shield in place at the edges with your thumb and forefinger as baby latches on. The shield may stay in place on its own after a while.

During feeding

  • Place your baby’s lower lip at the bottom of the shield nipple.
  • Wait for your baby to open wide like a “yawn” then bring her quickly onto the shield. If at first you don’t succeed, try again.
  • Be sure your baby is latched deeply onto your breast, not just the shield nipple. He may not get enough milk if he is nursing only on the tip.
  • You can relax your hand once she has latched on, but make sure the rim of the shield doesn’t cover his nose.
  • Let your baby nurse as long as he wishes. Switch breasts if he is still hungry after the first breast.

After feeding

  • Wash the shield with hot soapy water, rinse and dry between uses. Refer to the manufacturer’s information for care instructions.
  • Boil five to 10 minutes per day if your baby is preterm or ill.

Short-term use only

A nipple shield can really help with breastfeeding. However, it is meant for short term use.

It is best for your baby to be off the nipple shield in three to 10 days. Sometimes it may take longer than 10 days, but as long as your baby keeps gaining weight there is no concern.

You might want to connect with a breastfeeding expert while using a nipple shield.