Cracked, Painful or Grazed Nipples

Nipple Pain

Some discomfort is normal in the first week of breastfeeding but if pain persists it is important to seek help as early as possible.

  • In the first few weeks the most common cause of sore nipples is due to positioning and attachment issues. Having an IBCLC, or a health professional knowledgeable about breastfeeding, watch a breastfeed and suggest small changes can make all the difference.
  • Has your baby been checked for tongue tie? Many hospitals routinely check before discharge, but not all. Less obvious (posterior) tongue ties may go unnoticed. Baby Steps Health Centre has a Tongue and Lip tie clinic twice a week, where breastfeeding is assessed and tongue ties can be affordably treated on the day.
  • If pain continues past the first week or suddenly appears after a period of pain-free breastfeeding consider nipple infection. Nipple swabs and milk samples can be taken to rule out bacterial or thrush infection. Signs of thrush include: red nipple, burning or itching sensation after/ between feeds, nappy rash on baby, white patches in babies mouth that are hard to scrape off. If the nipple is obviously infected, or pain is in the breast then an oral (systemic) antibiotic may be considered.
  • Check for milk blisters on the tip of the nipple. These are often easier to see straight after your baby releases the nipple. Gentle exfoliation with a wash cloth in the shower may help to clear it.
  • Vasospasm can occur in the nipple, when blood vessels constrict and temporarily prevent blood flow to the nipple. You may notice the nipple changes colour from white to red / blue/ purple. This is more likely in mothers who may already have a history of Raynaud’s phenomenon where their hands and feet are prone to cold and turn white. It can also be caused by nipple trauma. Pain can range from mild to severe.
  • Other reasons for sore nipples may be related to pregnancy, teething, skin conditions – dermatitis.

There are many treatment options available depending on the cause of nipple pain. An IBCLC can help to troubleshoot the issue with you by taking a full history.
Treatment options include:

  • Breastfeed from least sore side first.
  • Expose your nipples to the air and / or sun to promote healing.
  • Change breast pads regularly, moisten them before removing if stuck to the nipple.
  • Express some breastmilk on the nipples after a feed and let air dry (not recommended if you have been diagnosed with thrush).
  • Consider resting the nipple(s) for 24-48 hours – during this time express using a hospital grade pump at least 8 times a day to maintain your supply.
  • Try different positions – underarm hold, lying down to feed.
  • Genesis Physio at Baby Steps offer laser treatment & practical advice to assist with sore/cracked nipples. They can also help to unblock milk blisters.
  • Some mothers find the use of gel pads to be soothing. Hydrogel breast discs and Multi-mum compresses promote moist wound healing and are available for purchase through Baby Steps. Lansinoh may also help.
  • For suspected nipple vasospasm.
    •  Keep your nipples warm – this may help to relieve pain immediately.
    • Wear an extra layer of clothing
    • Apply warmth to the nipple, such as a warm pack.
    • Use “breast warmers” or large breast pads.
    • Avoid cold exposure (or sudden temperature changes).
    • Do not “air” your nipples.
    • Warm your bathroom before undressing for showers, etc.
    • If the pain continues, you may consider taking supplements or medication. Supplements include: fish oil capsules (containing essential fatty acids) or evening primrose oil (gamma linoleic) may improve blood vessel relaxation; magnesium tablets help to relax the blood vessels (1-2 x 300mg tablets daily ); medication: prescription medication may be appropriate. Contact a lactation consultant or medical professional for more advice.
  • Various topical treatments have been proven to be helpful depending on the diagnosis. Discuss these with your medical doctor:
    • Thrush – Miconazole gel, Nystatin, Coconut oil, diluted vinegar.
    • Bacterial infection - Bactroban, manuka honey.
    • Kenacomb is a cream that combines an antifungal, antibacterial and low dose steroid to treat many causes of nipple pain.
    • Salt water rinse (normal saline) – Use store bought sterile normal saline or make your own -1/2 teaspoon of salt in one cup (8 oz) of warm water. Apply to nipple or soak the nipple briefly in the solution – pat dry afterwards.

Breast Pain

Sometimes a nipple infection can spread to the breast. Consider breast infection if you feel breast pain at any time (eg. Shooting, stabbing, burning, aching)– swabs and milk samples can be taken to rule out bacterial or thrush infection. Contact your health care provider if you notice: fever, inflammation/redness, swelling, oozing, pus, or other signs of infection. It is possible to have multiple infections (both fungal and bacterial). Oral antibiotics may be considered.

Milk blisters on the tip of the nipple can often cause breast pain. They can prevent milk from leaving the breast, leading to blocked ducts.

Check your breasts for any lumps or hard areas. See Baby Steps handout for blocked ducts. Genesis physio offers ultrasound treatment for persistent blocked ducts.

While the evidence is still in its infancy, research suggests that probiotics may be helpful with breast/ nipple infections.