Sore Nipples and Nipple Pain

• Poor latch or positioning.
  • Baby’s lips are tucked in.
  • Baby’s tongue is improperly positioned.
  • Baby clamps down on the breast.
  • Baby has shallow latch, not behind nipple.
  • Mother and baby’s position is not closely aligned.
  • Mother’s breast is not well supported.
• Mother’s feeding position is not well supported.
• Unrelieved negative pressure; the suck is too strong, and the baby is removed from the breast without first breaking suction.
• Prolonged intervals between feedings causing an aggressive latch from overly hungry baby.
• An infection, bacterial or fungal, of the nipple and areola.
• Tongue-tie (Ankyloglossia).
• Dermatitis or other skin condition.
• Biting (in an older baby).
• Raynaud’s syndrome.
• Pumping. (This may be caused by incorrect flange size, or by pumping with too much vacuum.)
• Pregnancy while nursing a baby.

Assessment of the baby’s position and latch will be a top priority. If the nipple trauma is due to poor latch and positioning, breastfeeding can continue with little or no pain once latch and position are corrected and nipples are healed.

• Give the mother support and help to assess latch and position. Refer her to a Lactation Consultant as needed.
• Encourage her to rest and use relaxation techniques.
• Topical Treatments:
  • Rub breastmilk onto nipples at the end of feeds.
  • Use hypoallergenic, medical grade or modified lanolin.
• Moist Wound Healing
  • Use water-based, glycerin-based and gel dressings. These dressings provide a moist environment for healing. They should not be used in conjunction with other treatments. They should not be used if an infection is present.
• If the skin integrity is broken:
  • Wash nipples once a day with a non-antibacterial, non-perfumed soap.
  • Rinse after each nursing with mild saline solution, pat dry with clean cloth or paper towel and air dry for 10 minutes.
  • Consider prescribing a prophylactic topical antibiotic-antifungal cream. 
• If unresolved or not considerably better in 24 hours, refer her to a lactation consultant or schedule appointment with physician for a complete evaluation immediately. Sore nipples are a major deterrent to continuing breastfeeding.

Recommendations for Patient 

• Apply warm compresses and hand expression before feedings to soften the areola and begin the milk flow.
• Consider use of analgesics as pain can interfere with letdown
• Encourage her to wear cotton bra and nursing pads. Avoid disposable nursing pads with a plastic or moisture barrier.
• Have her consider the use of breast shells with holes for ventilation for short periods to keep bra or pads from sticking.
• Nipple shields can be used by moms temporarily until damaged tissue has healed. Continued follow up with her for evaluation of milk supply and infant weight gain is needed.
• In cases of severe nipple trauma, it may be necessary to temporarily avoid putting baby to the breast. It is important to maintain milk supply by hand expressing or pumping using a hospital-grade electric breast pump.

Guidelines

• Berens, P., Eglash, A., Malloy, M., & Steube, A. M. (2016). ABM Clinical Protocol #26: Persistent Pain with Breastfeeding. Breastfeeding Medicine, 11(2), 46–53. 
• Holmes, A. V., McLeod, A. Y., & Bunik, M. (2013). ABM Clinical Protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term, revision 2013. Breastfeeding Medicine, 8(6), 469–473. 

References

1. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
2. Dennis, C. L., Jackson, K., & Watson, J. (2014). Interventions for treating painful nipples among breastfeeding women. The Cochrane Database of Systematic Reviews, (12), CD007366. 
3. Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier.