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Sore nipples and nipple infections

0-18 months

Sometimes breastfeeding mums have issues with sore nipples and nipple infections. If you have sore nipples, start by checking your baby’s breastfeeding attachment. For a nipple infection, you need to see your GP.

Getting help for sore nipples and nipple infections

If you’d like some help with breastfeeding, support services are available. Your child and family health nurse, midwife, GP or the Australian Breastfeeding Association (ABA) can support you with breastfeeding your baby. They can also help you find a lactation consultant if you need one.

An ABA counsellor can also help – phone the National Breastfeeding Helpline on 1800 686 268.

This article covers sore nipples and nipple infections. If you’re having other issues with breastfeeding, you could check out our articles on mastitis and blocked milk ductsbreast refusal and bitinghow to increase supply and how to manage oversupply and engorgement.

Sore nipples caused by baby not attaching properly

The most common reason for sore nipples or damaged nipples is your baby not attaching properly to your breast.

You can expect some tenderness in the first few days or weeks of breastfeeding, but it’s not normal to feel actual pain.

If you’re in pain from sore nipples, you have at least two options. You could seek help from a child and family health nurse, midwife, ABA breastfeeding counsellor or lactation consultant. Or you could try the baby-led method of attaching your baby.

Video

Breastfeeding and baby-led attachment

7:42

This video shows you how to use baby-led attachment when breastfeeding. A lactation consultant suggests trying when your baby is relaxed and having skin-to-skin contact to help baby find your breast. Some mums say that using baby-led attachment gave them more confidence and helped them overcome breastfeeding problems. The video shows a baby finding the breast by herself, attaching and starting to feed.

Checking your attachment is a good first step for the problem of sore nipples. Our article on breastfeeding attachment techniques explains two approaches – baby-led attachment and mother-led attachment. You might also like to look at our illustrated guide to breastfeeding techniques.

More options for sore nipples

If you’ve checked your attachment and you still have sore nipples, don’t give up just yet. 

The problem of sore nipples doesn’t usually last, and there are more things you can try:

  • Try to trigger your let-down before your baby attaches to the breast. Damaged nipples hurt most at the beginning of the feed, before your milk lets down. The pain usually eases when the milk is flowing. To trigger your let-down, you could try looking at your sleeping baby, thinking about a tender moment, or massaging your breast with a warm, wet cloth.
  • Offer your baby a feed before she’s crying with hunger. A calmer baby will be gentler on your nipples. You can also start the feed on the breast that’s less sore.
  • If you can, avoid using teats, bottles or dummies. Babies need to suck differently on breasts and bottles, and they can get confused if they’re being offered both in the early days of breastfeeding.
  • If your nipples are very sore, express your milk either by hand (the gentlest method) or with a good-quality breast pump on a gentle setting. Feed your milk to your baby by cup or spoon until your nipples feel better.
  • Check your nipples at the end of each feed for signs of damage like cracks or looking squashed. If you think your nipples are damaged, see your GP or child and family health nurse.  
  • Air-dry your nipples after breastfeeding, and change breast pads often to keep your nipples dry. Avoid using shampoos and soaps on your nipples.
  • Work with a lactation consultant if you want to try nipple shields. They might help with sore nipples in the short term, but they can sometimes create more problems than they solve. 

If the soreness doesn’t get better each day, it’s worth talking to an ABA counsellor, midwife or your child and family health nurse. They might suggest that an experienced lactation consultant or paediatrician examines your baby’s mouth. There could be a  tongue tie or something else about the shape of your baby’s mouth that’s affecting his ability to breastfeed.

Sore nipples that develop after a period of comfortable feeding are most likely caused by a bacterial infection, thrush infection or both. In this case, you should talk to your GP. There’s also more information about nipple infections below.

Even if you’re finding it too painful to feed your baby, you still need to keep your milk moving by expressing it. If you don’t take the milk out regularly, your breasts might become engorged and you’ll be at risk of mastitis. Not emptying milk regularly will also reduce your milk supply.

Nipple infections

Sometimes, cracked nipples can get infected with bacteria (Staphylococcus aureus or ‘staph’), thrush (Candida albicans) or both. It can be hard to diagnose which of these is causing problems. Sometimes women might develop nipple thrush after they’ve had a course of antibiotics.

Symptoms of nipple infection might include sore nipples and shooting pain in the breast. Not only is nipple infection particularly painful, but it can also be passed back and forth between mother and baby.

There isn’t a standard treatment for nipple infection. It’s normal for different doctors to treat it differently.

If the doctor suspects thrush, treatment is likely to involve an oral gel or drops for your baby’s mouth and an ointment for your nipples. Sometimes there might be another ointment for your baby’s bottom. The doctor might also prescribe antifungal tablets for you.

If the doctor suspects staph, the doctor might prescribe antibiotic ointment and/or possibly oral antibiotics for you. Some doctors might prescribe a combination of treatments for your nipples.

Nipple creams rarely help, unless they’re prescribed for a medical reason – for example, an infection. A few drops of your own breastmilk – expressed by hand at the end of a feed and spread over your nipple – is the best ‘nipple cream’.
Video

Breastfeeding: getting support

6:00

In this video a counsellor and lactation consultant explains that if you’re having problems with breastfeeding, get support early. Mums talk about having mastitis, nipple pain and attachment issues – and about getting help. One mum says she was about to give up on breastfeeding but got help from a lactation consultant. This meant she could look at her baby breastfeeding and smile for the first time.

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Last updated or reviewed
27-07-2016

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Raising Children Network is supported by the Australian Government. Member organisations are the Parenting Research Centre and the Murdoch Childrens Research Institute with The Royal Children’s Hospital Centre for Community Child Health.

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