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Breastfeeding - sore breasts and nipples

breast; breastfeeding; breast; feeding; nipples; pain; engorgement; vasospasm; thrush; cracked; blocked; ducts; mastitis; sore; bite; biting; reynaud;

Many women have sore breasts or nipples, especially when they begin breastfeeding. Try the ideas here, but seek help if the pain does not go away.

Contents

Engorgement - very full breasts

Many women have full breasts for the first couple of weeks, and the best way to manage this is to breastfeed more often and express a little after a feed.

Engorgement is when the full breast becomes very tight, hard and uncomfortable.

  • It usually happens during the first week after the birth or if you suddenly feed the baby a lot less than usual.

What you can try

  • Wear a supportive bra, but make sure it is not too tight.
  • It usually helps if you demand feed - whenever the baby wants a feed.
  • It is important that your baby's position and attachment are right (see 'positioning and attaching your baby' in the topic Breastfeeding - a new baby).
  • A hot shower or hot pack before feeding can help. You can buy hot and cold packs from chemists, or use hot and cold face washers or cloths.
  • Express some milk before the baby starts to feed to soften the areola (brownish area around the nipple), so the baby can attach more easily.
  • Use cold packs after feeds.
  • You could take paracetamol for pain.
  • A one-off complete emptying of both breasts may help, for example use an electric breast pump or hand pump after a feed.

Sore or cracked nipples

The most common cause of sore or cracked nipples is when your baby is not attaching well. It is usual to have some tenderness when you start breastfeeding but it should settle quickly.

The following ideas may be useful:

  • Check that your baby is going on to the breast properly with their mouth well onto the areola. If you are not sure, get someone who knows about breastfeeding to watch you feed, or see your local child and family health nurse, Australian Breastfeeding Association counsellor, or lactation consultant.
  • Start the feed on the least sore side.
  • Do your best to relax. Take some deep breaths and drop your shoulders.
  • Express a little milk to start your let-down before putting the baby on.
  • To take your baby off the breast, break the suction with your finger in the corner of their mouth rather than just pulling your baby off as this could hurt your nipple.
  • Let your baby suck as long as he needs to, but if he starts to doze off and just ‘nibble’, take him off and try the other side. This will start the let-down on the other breast and he should start swallowing again.
  • Express a little of the fatty milk left at the end of the feed and smear it over the nipple.
  • Allow air to your nipples after feeds. Leave your bra off for a while, or use nipple protectors or breast shells that you can buy from a pharmacy.
  • Purified lanolin ointment sometimes helps with the healing. This can be bought from a pharmacy.
  • Another way of helping with sore nipples is to use patches called hydrogel discs. If you find the hydrogel discs make your nipples too moist, stop using them. You may find these at your local supermarket or pharmacy.
  • Keep breast pads dry and change them often.
  • Check your bra is not too tight and rubbing.
  • Do not use soaps or drying lotions on your nipples.

Check with your child and family health nurse, lactation consultant or doctor if a cracked or painful nipple persists. There may be other causes (e.g. thrush infection or dermatitis).

Blocked duct

If you notice a tender, hard lump in your breast, you may have a blocked milk duct. The area may also be hot to touch and look red.

  • Ask your midwife or child and family health nurse to check the way your baby is attaching to the breast. Have a look at the section 'Positioning and attaching your baby' in the topic Breastfeeding - a new baby.
  • Feed often from the sore side to help clear the blockage.
  • Try different positions. Change from a front hold to an underarm position.
  • Try to point your baby’s chin towards the sore area and make sure she takes a good mouthful of nipple and areola.
  • Use heat (e.g. hot showers, hot cloth) before the feed to help milk flow.
  • Massage the sore spot gently during the feed and express after feeds to empty your breast as much as you can. Have a look at the section on 'Expressing' in the topic Breastfeeding - Expressing and storing breastmilk
  • Relieve pain with a cold pack after feeds and take paracetamol if you need to.

If the lump gets bigger and more painful, and the skin over it looks red, or you feel ill, you may have mastitis and you will need to see your doctor.

Breast infection - mastitis

You may find that despite trying to fix the blocked duct the lump or red area gets worse and more painful. You may have a fever and start to feel as if you have the ‘flu’. This might mean you have a breast infection or mastitis. See your doctor as you may need antibiotic treatment (there are several types that are safe for your baby).

Keep feeding from both breasts. This is the best way to make sure your breasts are drained well. Milk from the affected breast will not harm your baby. Keep doing all the suggestions for blocked ducts. Get some extra rest and ask family and friends for help and support.

Some women find they still keep getting breast infections. These ideas might help:

  • Treat sore or cracked nipples and blocked ducts (lumps) quickly.
  • Try to avoid over-full breasts and rushed, interrupted feed times.
  • Express if you miss a feed for some reason.
  • Make sure your bra and other clothing are comfortable and not pressing on part of your breast especially if you wear your bra at night.
  • Avoid lying on your stomach to sleep which can cause pressure on the breast.
  • Avoid pressing on the breast during a feed (e.g. to clear it from the baby’s nose).
  • Make sure you take care of yourself – eat well and get enough rest.

Thrush

  • Thrush is an infection which sometimes affects the baby's mouth and nappy area and the mother's skin on the nipples and around the nipples.
  • Thrush infection may be the reason why sore nipples don't get better.
  • There may be an itchy pink rash on the nipples.
  • It is possible that thrush may cause sharp, shooting or burning pain in the breast without the nipples being very sore. Whether it is thrush that causes this pain is not known for sure.
  • The baby may have thrush in the mouth. In the baby's mouth it looks like white patches, while on the breast it looks pink or red.
  • You need to see your doctor if you think you or your baby might have thrush so it can be properly treated.

Vasospasm

  • This is a rare cause of sore nipples and breast pain.
  • It happens more often to people who get Raynaud's Disease (cold, white, painful fingers and toes in winter).
  • With vasospasm, the nipples are very sensitive to cold. They will look white when the baby comes off the breast, then change to blue or purple, with stinging or stabbing pain. Some women feel this between feeds or even during pregnancy.
  • If this is a problem for you, keep yourself as warm as possible, especially before or during feeds.
  • Make sure the baby attaches and sucks well. If the nipple is really "squashed" by feeding it will be even more painful.
  • As soon as the baby comes off one breast, put a hot pack or hot face washer or towel over the nipple and keep it there while you offer the other side. Have another hot face washer ready to put on the second side.
  • Hot showers may help between feeds.
  • Both caffeine (in coffee, tea, cola drinks) and smoking may make vasospasm worse.

If vasospasm is severe, see your doctor as other treatments may be possible.

Biting

Some babies start to bite the nipple during or towards the end of a feed. Sometimes this seems to happen when their gums are uncomfortable due to teething. If they are teething you could try giving them lots of things to chew at other times during the day. Some teething gel on the gums before a feed may help.

Sometimes babies start to bite when they have finished sucking. Older babies are able to feed quite quickly and they may only need to suck for 5 minutes or less. If they are left on the breast they may start to nibble on the nipple rather than suck. If they bite at this time, you could detach them as soon as their sucking pattern changes.

Pulling them off and saying "no" when they bite is not likely to work as babies are not able to understand that the biting action is what you are saying "no" about.

Resources

South Australia
Parent Helpline (Child and Family Health Service)

  • 1300 364 100

Your local Child and Family Health Nurse

  • Ring 1300 733 606 for an appointment

General
Australian Breastfeeding Association

World Health Organisation, 'Breastfeeding'

Book
Women's and Children's Health Network (SA): Breastfeeding your baby. AUD$5.50 plus postage and handling. Ph: (08) 8303 1522.

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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