Sore, cracked or bleeding nipples

Sore, cracked or bleeding nipples are common. Some mothers have such trouble with them that they stop breastfeeding early.

Make sure the way your baby latches to your breast is correct. If you’re unsure, ask for help.

As a new mother, you may find it could take a few days or weeks to adapt to the strong suck of a healthy baby on your breasts.

It is normal for your breasts to become more sensitive in the first weeks after you have given birth. They may sting, burn, ache or feel tender. Over time, the discomfort and sensitivity should resolve.

If you have sore nipples, it may be that your baby isn’t attaching properly to your breast. This pain usually lasts about half a minute while baby first draws your nipple into their mouth.

Try to make sure your baby’s mouth is attached correctly for suckling from the very first breastfeed.

If you do not correct your baby’s latch, your nipples could be damaged, which causes problems like mastitis (infections).

How to get baby to attach to your breast correctly

• Make sure you are sitting or lying comfortably.
• Position your baby’s chest against your chest, with their mouth and nose facing your nipple.
• If you are lying down, let your baby’s cheek rest against your breast.
• If you are sitting up, lift your breast slightly so it does not press on your baby’s chin.
• Position your baby so the first contact point is their chin on your areola – the coloured area around your nipple.
• Bring your baby’s head to your breast, not the breast to baby’s head.
• Support your baby to move to where they are trying to go – towards your nipple.
• Ensure the nipple and much (or all) of the areola and some surrounding breast are in your baby’s mouth.

After a few rapid gulps, your baby should start to suck and swallow in a regular rhythm. Once you have got the hang of it, breastfeeding can be enjoyable and should not be painful.

Managing sore nipples

Before putting baby to the breast

• Wash your hands.
• Sit in a comfortable position and try to relax.
• Apply a warm washer to the breast and gently massage or express to help milk flow.

At the breast

• Make sure the way your baby latches to your breast is correct. If you are not sure, ask for help from a health professional.
• If the attachment feels uncomfortable after 30 seconds, break your baby’s suction by putting your finger in the corner of their mouth. Take your baby off and let them re-latch to your breast.
• Experiment to find the most comfortable feeding position.
• If your nipples are tender, limit your baby’s comfort sucking.

After the breastfeed

• Check your nipples for redness and misshapen appearance.
• Wipe your breasts with clean water and let them dry.
• Change breast pads frequently.
• Allow air to your nipples after feeds. Leave your bra off for a while.
• Ensure you have a well-fitting bra.
• When expressing milk, make sure that the suction on your breast pump is not too strong.

If the pain in your nipples increases after the first week, talk to a health professional.

Finding the cause of cracked or bleeding nipples

• Check if your baby is latching on correctly. You may need to ask a health professional for assistance.
• Have your baby checked for problems with their lips and tongue.
• Check whether you have medical problems like dermatitis or nipple infection.
• If you use a nipple shield, make sure it is the correct size.
• If you’re using a breast pump, make sure you’re doing it properly.

Treatment of cracked or bleeding nipples

• Wash your nipples with water after every feed.
• Clean and sterilise your nipple shield after each feed.
• If you can, continue breastfeeding (it is quite safe for baby to feed on a bleeding nipple).
• If it’s too painful, you may need to take your baby off the breast for 24 to 48 hours, rest the nipple and feed your baby expressed breast milk.
• If you’re going to take pain-relieving medication, talk to your doctor or pharmacist.
• Gradually reintroduce the breast after resting for a short time and take special care with positioning and attachment.

You may need to apply a thin coating of topical antibiotic if cracks are infected. Many household remedies are ineffective or harmful.

If you need further help or are experiencing prolonged abnormal breast pain, contact your doctor, lactation consultant, breast feeding counsellor, child health nurse or Pregnancy Birth and Baby on 1800 882 436.

Sources: , Australian Breastfeeding Association(Sore/cracked nipples) Australian Breastfeeding Association (Mastitis) , Australian Breastfeeding Association (Attachment to the breast) , Raising Children Network (Breastfeeding attachment techniques) , Women’s and Children’s Health Network (Breastfeeding – sore breasts and nipples)