Sore, cracked or bleeding nipples

What causes sore nipples?

It’s normal for your nipples to become more sensitive in the first weeks of breastfeeding.

They may feel tender when your baby attaches to your breast and starts to suck. The pain should get better after a couple of minutes. Over time, the discomfort and sensitivity should resolve.

If the pain doesn’t go away, the most common reason is that your baby is not attaching well to your breast. This means your nipple is not positioned well in your baby’s mouth. Your nipple can become damaged as it is squeezed between your baby’s tongue and palate.

Some babies have a tongue tie, which can make it hard for them to attach well.

Pain that doesn’t go away can also be a sign of other nipple problems, such as:

• thrush or other infections
• vasospasm
• a blocked milk duct
• eczema

How can I tell if my baby is not attaching well?

You might notice that your nipple looks squashed or the wrong shape after a feed. You might see cracks in the surface of your nipple, blisters, grazes or bleeding.

Watch your baby as they start to suck. They may not be attaching well if:

• their cheeks are sucked in
• their mouth doesn’t look wide open
• they don’t stay firmly on your breast, but come on and off
• you hear clicking sounds during the feed

When should I seek help?

If you have sore or cracked nipples, you may need to ask a lactation consultant for assistance. They can also check your baby for a tongue tie.

If your baby is attaching well but your pain still doesn’t improve, see your doctor. They can check whether you have another problem, such as a nipple infection or eczema.

See your doctor if you see yellow fluid coming from your nipple, or if a crack is taking a long time to clear up. These can be signs of infection, and you might need medicine to treat it.

How are cracked or bleeding nipples treated?

There are a few things you can do to heal cracked or bleeding nipples. It may help to:

• put some warm water or breastmilk on your nipples after feeding and leave it to dry
• keep your nipples dry as much as possible
• gently rub purified lanolin on your nipples after feeding
• change your breast pads often

If you can, continue breastfeeding. If it’s too painful, you may need to take your baby off the breast for 12 to 24 hours, rest your nipple and feed your baby expressed breast milk.

It might be less painful if you use a nipple shield. Talk to a lactation consultant or breastfeeding counsellor first, to make sure you’re using the shield correctly.

It is usually quite safe for baby to feed on a bleeding nipple. However, this is not recommended if you have hepatitis B or hepatitis C, as your baby could become infected. Talk to your doctor about what to do in this situation.

If you’re going to use a cream or pain-relieving medicine, talk to your doctor, midwife, lactation consultant or pharmacist to make sure it’s safe for breastfeeding.

How can nipple problems be prevented?

Getting your attachment right early can prevent problems later. Try to make sure your baby’s mouth is attached correctly from the first few days of breastfeeding.

When expressing milk, make sure that the suction on your breast pump is not too strong.

Change your breast pads regularly. Don’t get soap or shampoo on your 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. Express some milk to soften the areola and lubricate the nipple.

How to get your 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.
• Position your baby so the first contact point is their chin on your areola — the coloured area around your nipple. This should make your baby open their mouth wide.
• 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, much of the areola and some surrounding breast are in your baby’s mouth.
• If your baby only takes your nipple into their mouth, without a mouthful of breast they will not feed well and it may cause pain.
• Your baby’s mouth should be open wide with a large amount of your breast inside.

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

If the attachment feels uncomfortable, 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. Try different feeding positions.

After the breastfeed

Check your nipples for redness and misshapen appearance. Nipples that are creased, ridged or squashed are a sign that your baby is not properly attached.

Wipe your breasts with clean water and let them dry. It can help to leave your bra off for a while and allow your nipples to air. Make sure your bra fits you well.

Gently rub a few drops of milk over your nipples to protect them.

Complications of nipple problems

Some people have such trouble with nipple pain that they stop breastfeeding early.

If your nipples become damaged, you could develop a breast infection called mastitis.

Resources and support

If you need further help or are experiencing prolonged nipple pain, talk to your doctor, midwife, lactation consultant or breastfeeding counsellor.

Visit the Australian Breastfeeding Association for more information or call their breastfeeding helpline on 1800 Mum 2 Mum or 1800 686 268.

The Australian Breastfeeding Association provides various links to reliable videos on positioning and attachment.

Read more on causes, symptoms and treatment of nipple thrush.