Sore or cracked nipples while breast-feeding

Pain during breast-feeding is a sign of a problem and should not be ignored. Although sore or tender nipples are common during the first few days of breast-feeding, it should improve. Normal soreness or pain usually occurs for about a minute when the baby first latches on to the breast. Pain that is severe, continuous, or that occurs again after it seemed to resolve is a sign of a problem and should be corrected. Other problems may include cracked, bleeding, or bruised nipples.

Sometimes sore nipples develop when the baby begins to suck harder because he or she is not getting milk quickly. This often is caused by:

• Improper positioning.
• Problems with latch-on.
• A poor let-down reflex.
• Inverted nipples.

Sore nipples and breasts may also result from:

• The baby sucking for comfort ("hanging out") without a proper latch after falling asleep at the breast.
• Pulling the baby's mouth away from the breast without first breaking the suction.
• The baby having a short frenulum (the frenulum connects the tongue to the bottom of the mouth). This is also called "tongue-tie."

Before and during breast-feeding

• Take a small dose of acetaminophen (such as Tylenol) about 30 minutes before breast-feeding.
• Make sure that your baby is latching on correctly.
• To minimize discomfort, start breast-feeding on the side that is less sore for the first few minutes, then switch to the other side. The baby's initial sucking is usually the most vigorous.
• Express a little milk from your breasts right before a feeding. This can help with the let-down reflex and soften nipples so that the baby can easily and gently latch on.
• Change your baby's position with each feeding. This changes the pressure from the baby's mouth to a different part of the breast.

General breast care and treatment for sore nipples

• Allow some breast milk to dry on your nipples. Breast milk contains natural skin softeners and antibodies to fight infection, which can help heal nipples and keep them healthy.
• Let your nipples air-dry or dry them gently with a hair dryer after each feeding. This prevents clothing from sticking to and irritating the breast. Moistening the nipple helps detach stuck clothing.
• Apply modified lanolin or other specially formulated ointments or creams made with hypoallergenic ingredients (such as Lansinoh or modified lanolin USP25).
• To reduce pain, apply cool compresses to your nipples after breast-feeding. Gel pads can also be used on dry nipples.
• If your nipples are very sore, placing breast shields inside your bra to prevent contact between clothes and nipples may help. Using these in combination with modified lanolin (or a similar product) may be especially helpful.
• Use proper breast support. Cotton bras with wide, nonelastic straps will help support your breasts without irritating the nipples. Breast-feeding bras open at each cup to allow breast-feeding and to allow nipples to air-dry. If it is more comfortable, wear a bra at night for extra support.
• If your nipples are very sore, ask your doctor or lactation consultant to check your baby's tongue for a short frenulum. A short frenulum (which connects the tongue to the bottom of the mouth) can limit the baby's tongue movement and cause pain.

Avoid:

• Breast-feeding pads that have plastic liners.
• Most general-purpose lotions and creams. These are not recommended because their properties have an unknown effect on both your nipples and your baby.
• Washing your nipples with soap. Soap removes the nipples' natural lubricants and will dry them out.