Got tender breasts or sore, cracked nipples? Welcome to the world of nursing.
Rest assured, most breastfeeding problems are usually temporary and resolve on their own, but they can make nursing anything but a breeze. Here's a look at some of the most common causes of sore nipples and breastfeeding pain, and how to handle them.
What causes nursing breasts to hurt?
Sore breasts are unfortunately often a rite of new motherhood, especially if you're breastfeeding. It can be anything from general breast tenderness to your milk coming in, to something more serious such as a breast infection. The good news is most breast pain passes, and there are things you can do to make it less of an annoyance.
Breast engorgement
What is breast engorgement? Once your transitional milk comes in on about the third or fourth day after birth, your breasts grow heavier and larger as they fill with fluid and swell. Though it's a sign that your breasts are filling up with milk, the pain and swelling are also a result of blood rushing to the site, ensuring that milk production is in full swing.
How to relieve breast engorgement: Thankfully, breast engorgement lasts only a few days to a week. But it can make your breasts so hard and swollen that the nipples may be flat and difficult for your baby to get a grasp on, making breastfeeding more challenging.
You can help relieve engorgement by applying warm washcloths to the areolas at the start of each nursing session, which will stimulate letdown. After nursing, you can place ice packs or chilled cabbage leaves in your bra. And remember the rules of engorgement: The more frequently you feed, the less engorgement you'll encounter and the faster you'll be able to nurse pain-free.
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Milk letdown
What is milk letdown? Every time you start to feed your baby, you may notice a strange pins-and-needles sensation in your breasts. Not only is this normal, it's also a necessary part of the nursing process — a signal that milk is being released from the ducts that produce it. It's usually more intense in the early months of breastfeeding.
How to relieve painful milk letdown: Relaxation techniques (the same ones you may have used during labor) can help. Make sure you use good positioning techniques: your back, arms, feet and elbows should be well-supported, and your shoulder and neck muscles should be relaxed (so you're not straining or leaning over your baby). The good news is this usually resolves as baby gets older.
Clogged milk ducts
What are clogged milk ducts? Breast milk is produced in your breast and flows through milk ducts out the nipple. When one of those ducts becomes clogged, milk can back up and cause a small, tender lump.
How to fix clogged milk ducts: Without treatment, a plugged duct can lead to a breast infection. Before each feeding, place a warm compress on the affected breast to help get milk flowing. Make sure you empty the breast thoroughly at each feeding, and also change breastfeeding positions (from cradle to football to crossover) so all milk ducts get stimulated equally.
You can also try a mini breast massage, where you apply gentle pressure to the plugged duct both before and during a feeding. Don't stop breastfeeding, which can make matters worse, since more milk will back up and compound the clog.
Mastitis
What is mastitis? Mastitis, or breast infection, develops when bacteria (either from the skin's surface or from your baby's mouth) enter the breast through a crack in the nipple or through one of the milk ducts. It can occur at any time during breastfeeding but is most likely to happen within the first six weeks. The condition usually affects only one breast. Symptoms include swelling, pain, redness, a breast that feels warm to the touch and a fever.
How to treat mastitis: See your doctor right away for a diagnosis. Oral antibiotics usually do the trick, clearing the infection and making you feel better pretty quickly. If you don't improve within a day or two after starting the antibiotics, call again.
You can — and should — continue nursing, as it can help clear the infection.
Tips for soothing painful breasts when nursing
- Try using a warm compress, which helps soften the areola and encourages letdown, before nursing and using a cold compress afterwards. You can also place chilled cabbage leaves on each breast or try some cooling bra inserts.
- Use your hand or a pump to express a little milk and relieve some pressure. Don't express too much, though, because the more you express, the more milk you'll make, which will worsen engorgement.
- Massage your breasts gently while nursing to help get the milk flowing.
- Alter the position of your baby — try the cradle hold one time, the football hold at the next feeding — to ensure all milk ducts are being emptied.
- Make sure your bra fits well. It should be snug and supportive, but not too tight.
What causes sore or cracked nipples when breastfeeding?
Sore, tender, cracked, blistered and even bleeding nipples are common problems for the newbie nursing mom. Know that you're not alone and that eventually your nipples will heal and toughen up. Here are some of the most common causes.
Nipple sensitivity
What is nipple sensitivity? Nipple sensitivity is one of the most common complaints by new moms. It usually increases during pregnancy and peaks about four days after giving birth. You'll notice a pins-and-needles feeling when your baby begins to nurse that lasts for about 30 seconds.
How to improve nipple sensitivity: It usually resolves on its own by the time your baby is about a week old. If it really bothers you, use warm or cool compresses before and after nursing. You can also take an OTC pain reliever like acetaminophen to relieve discomfort.
Poor latch
What is a poor latch? For breastfeeding to succeed, you'll need a proper latch — making sure that baby and breast hook up just right. You'll know if your baby isn't latching correctly if you have nipple pain due to your baby chewing on your nipple instead of gumming the areola.
Ditto if you hear clicking noises, which indicate baby's not latched on properly (and she's likely only sucking the nipple). Other signs include your baby fussing, chewing, rooting and gaping, or even turning red because she's so frustrated.
How to fix a poor latch: Practice makes perfect. Get into the right breastfeeding position, then compress your areola between your fingers. Tickle baby's cheek to stimulate the rooting reflex, which gets her to open wide, then bring your baby right up to the breast.
When she latches on, her mouth should cover the nipple and the areola, and your infant's chin and nose should touch your breast with her lips flaying outward. If you're still having trouble, reach out to a lactation consultant.
Thrush
What is thrush? Thrush is a common yeast infection that thrives on the lactose in milk and can affect both you (your nipples, that is) and your baby. Telltale signs are nipples that are pink, itchy, crusty and/or burn. Check the inside of your baby's cheeks or tongue for a curd-like coating to clue you in on whether she might have thrush, too.
How to treat thrush: If you and/or your baby have thrush, you'll need to treat the problem using a prescription antifungal cream, or you'll keep reinfecting each other. Good hygiene will also help, so take steps such as careful handwashing, keeping separate towels for each family member and wearing a clean cotton bra.
There's no need to stop breastfeeding during treatment. You should expect to feel much better within about a week.
Milk blebs or blisters
What are milk blebs or blisters? A milk bleb or blister is a blocked nipple pore. This usually happens when a milk duct becomes clogged, causing milk to back up. Breast milk becomes thick and hard as a result, which blocks milk flow near your nipple opening.
Sometimes, a small amount of skin can grow over the bleb, preventing it from healing. It may look like a tiny white or yellow spot on your nipple, like a whitehead pimple.
How to treat milk blebs or blisters: Most of the time, they resolve on their own within 48 hours. You can apply moist heat like a warm wet washcloth for 10 to 15 minutes.
When you nurse, try positioning your baby so that her chin is near the plugged area, because this positioning can help open the blister and drain that area. If that doesn't work, see your doctor.
Teething
What is teething? Teething is the pressure your baby feels from her first baby teeth poking through. Symptoms can start as early as 3 or 4 months of age. That discomfort is often relieved by biting and chewing, including on mom's nipples. Ouch!
How to fix painful teething: Before nursing, offer your baby a teething toy or frozen wet washcloth. These may help numb her gums, allowing her to latch and settle into the feeding.
If your baby does gnaw your breast, break the suction immediately and carefully (using a phrase like "no bite") and give her the cold washcloth again. This will help her understand action and consequence.
Dry skin
What is dry skin? Very dry skin or contact dermatitis (from nipple creams or soaps) can lead to sore, tender, painful nipples.
How to treat dry skin: You can express breast milk and gently rub it into your nipples, or apply pure lanolin (sold as Lansinoh or PureLan at most pharmacies). When you take a bath or shower, don't use soap on your breasts or nipples; just plain water is fine.
You may have heard that you should dry your sore nipples with a hair dryer, but don't: this can dehydrate skin further and make dryness worse.
Eczema
What is eczema? Eczema, or atopic dermatitis, is often thought of as a childhood disease, but it's estimated to affect over seven percent of all adults, according to the National Eczema Society. You may see a red, scaly rash in nooks and crannies like the backs of your knees and elbows, as well as around your eyes and yes, even your nipples.
How to treat eczema: Your doctor can prescribe a prescription topical steroid that you can apply to your nipples after feedings. (Top it off with a good thick hypoallergenic moisturizer to seal in the medicine.) Just remember to rinse off your nipples thoroughly before your baby nurses again, so she doesn't get a mouthful of ointment.
Nipple blanching and vasospasm
What is nipple blanching and vasospasm? Nipple blanching happens when you finish nursing and your nipple pops out of your baby's mouth whitened and in a funny shape — almost like the tip of a brand-new lipstick. This usually occurs because your baby bore down a little too hard on your nipple while she was snacking. As a result, the nipple gets compressed.
A vasospasm is when the blood vessels around your nipple contract abnormally, resulting in stabbing pain. Women who have Raynaud's disease — a rare disorder that causes blood vessels in the fingers and toes to narrow when you're cold or stressed — are often more susceptible.
How to treat nipple blanching and vasospasm: Blanching itself is usually related to a poor latch, so working to fix that with a lactation consultant often solves the problem.
Treating vasospasm can be more challenging. If you notice that your vasospasm gets worse when you're cold, try breast feeding in warm environments, wear warm clothing and put a warm washcloth on your breasts prior to nursing. Avoid nicotine and caffeine, as they can exacerbate the problem. If you still experience pain, try massaging your areola (the ring of pigmented skin that surrounds your nipple) with olive oil.
Pain from pumping equipment
Why does this happen? Over-vigorous pumping (from using too high a suction setting) and too much friction (caused by pulling and rubbing from improper flange positioning or size) can lead to sore nipples.
How to fix pain from pumping equipment: Make sure you're using the right flange size and suction settings on your pump. How can you tell? Your nipple should be centered in the breast flange (breast shield) tunnel and move freely during pumping without an excessive amount of the areola being sucked into the tunnel.
Tips for relieving sore, cracked nipples when breastfeeding
If you're worried about experiencing cracking, bleeding or painful nipples while breastfeeding, or if you're recovering from a painful episode of cracking or blistering and want to keep it from recurring, good news: There are ways to prevent it.
- Get a good latch. The best way to prevent sore or cracked nipples is to make sure your little nurser is properly positioned on your breast. Latch her on the right way by making sure she's taking enough of your breast into her mouth and grasping the areola, not just the nipple, between her gums. If she's nursing just on your nipple, her voracious sucking can leave you feeling chewed up and your nipples feeling red, sore, cracked and oh-so-tender.
- Vary your nursing positions. Alternating the cradle hold and the football hold, for example, can ensure a different part of the nipple and areola is compressed at each feeding, helping to prevent (or ease) soreness.
- Relax and breathe. Relaxation will enhance milk letdown, which means your baby (or the pump) won't have to work as hard and your nipples will thank you. Try a 5-minute meditation or a few yoga poses right before a feed to get you into the Zen zone.
- Express yourself. Squeeze a little milk onto your nipples after nursing to soothe sore nipples. You can also gently pat on a small pea-sized portion of lanolin to the nipple and areola. This provides a moisture barrier.
Where to get breastfeeding support
Most nipple and breast pain related to breastfeeding is easily treatable. So when (or if) you encounter pain, don't give up. That said, you don't have to go it alone. Help from others can be invaluable, including support from:
- Your doctor or midwife
- Your baby's pediatrician
- A lactation consultant (whose consultation may be covered by your insurance). You can find one at the International Board of Lactation Consultant Examiners or the International Lactation Consultant Association.
- A local La Leche League representative
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