It seems that most women assume that breastfeeding is painful during the first few days or even believe that you have to wait for the nipples to “toughen up,” but this is not the case at all. Sore nipples, when breastfeeding, should not be part of the motherhood journey, just as there should never be pain when breastfeeding.

What are sore nipples?

Sore nipples from breastfeeding are wounds of bigger or smaller size to the nipple: at the front, sides, or base of it. They affect the breastfeeding experience by making it from unpleasant to unbearable for a mother.

Nipple damage can be very different: superficial, scratch-like, deep wounds, or even wounds that can result in loss of nipple tissue. As you can see, not all sore nipples are the same, and depending on the damage that has appeared on the skin, we must treat them in one way or another.

I am pregnant; how can I avoid getting sore nipples from breastfeeding?

Sore nipples can’t be avoided. Although various ointments and preparations are still recommended for nipples during pregnancy, these preparations are useless because nipples do not need to be prepared for breastfeeding. Nipples are designed to be able to breastfeed. And if nipple damage appears during breastfeeding, it’s because something is going wrong.

You should not use a rough glove on your nipples in the shower, and it is not necessary or appropriate to rub your nipples with alcohol and/or petroleum jelly. Not only do these things not help to prevent nipple damage, but they can also be harmful and prevent you from breastfeeding because they might make you associate breastfeeding with pain.

If you want to do something to avoid sore nipples when breastfeeding, go to a breastfeeding support group during pregnancy and observe how babies are breastfed closely and how a baby should be positioned correctly. Observing and learning will be part of success.

How do I know if I have sore nipples?

If you’ve never seen nipple damage before, it is hard to know if you have it or not. In this picture from our Instagram channel, you can see a variety of nipple damage. If you’re sensitive, be warned that some images can be distressing.

Why do sore nipples occur?

Sore nipples from breastfeeding happen when something is wrong; the damage doesn’t just appear. In general, these are the reasons why this occurs:

• Bad positioning of the baby at the breast
• A poor latch onto the breast
• Tongue-tie (short lingual frenulum, ankyloglossia)

What definitely doesn’t cause sore nipples is the normal “use” of the nipple by your baby. Some people recommend that you breastfeed on a routine schedule or don’t allow your baby to feed for more than a certain amount of time per feed on each side to avoid damage to your nipples. This is completely wrong because you won’t get sore nipples if the baby is feeding in the correct position in the first place.

I have had the baby’s latch checked and been told that it’s ok. Why do I still have sore nipples?

If you have sore nipples, something isn’t right. Maybe it’s not the latch, but something isn’t going well, and that’s what’s causing the injury. Sometimes, it is necessary to get help from a trained breastfeeding professional (IBCLC level) to have all possible causes checked one by one.

Can I put my own milk on the wound?

Sometimes, it is recommended that you apply a little breastmilk to your nipples at the end of each feed. But it is better not to generalize this recommendation to every form of nipple damage.

If you have nipple damage that looks like a scratch (a dark scab), allowing the breast to air dry can help it heal faster. In this case, applying a little of your own milk will not be harmful.

If the wound is light pink (similar to the color you would use when drawing a piglet), this can indicate that the wound is infected, and applying milk can be counterproductive, as it is not sterile: it contains over 700 different types of bacteria, and some of these can make the damage worse.

When the wound is deep (lack of tissue or the mother feels a sharp, throbbing pain), applying milk or leaving traces of milk can make the damage worse and prevent it from healing.

What about lanolin?

Lanolin is a yellowish fatty substance secreted by the sebaceous glands of animals with wool that helps them not to get completely soaked when they get wet. Therefore, lanolin is a substance that cannot be mixed with water (in this case, with milk), and it protects the skin.

Nipple damage needs to heal as soon as possible, and by applying lanolin over the sore area, a wet layer is created that actually prevents healing. So, the best thing for sore nipples from breastfeeding is that they keep being aired and dry.

I have been told that honey is useful in preventing and healing sore nipples

Honey has antiseptic and healing properties; in fact, it has been used for years to cure bedsores in the elderly. But honey cannot be given to babies under the age of one-year-old because it can contain botulinum toxin spores. These spores can remain in your nipple wounds even if you are washing your breasts before breastfeeding.

Creams, hydrogel patches, beeswax and silver nipple shields

There are many options on the market that supposedly “cure” nipple damage, and you might find a mother who will tell you: “It worked for me.” It probably did, or the underlying problem has been fixed, but let’s look at each product separately:

• Commercial creams for sore nipples often contain a local anesthetic that often interferes with your baby’s sucking motions and makes the baby breastfeed even worse.
• Antibacterial creams should be prescribed by a health care professional and used only in case of severely infected wounds or damage to the nipple tissue.
• Nipple shields can reduce breastfeeding pain, but they must be the right size, and the baby must latch on well with them. If this is not the case, the damage and cracks may get worse.
• There is no scientific evidence that silver or wax breast pads are effective.
• Hydrogel breast patches or similar are wonderful but not affordable for all pockets
• Gel breast pads: these dressings can help speed up healing and decrease the sensation of pain.
• Protective shells are recommended because they allow the nipple to be aired without the bra touching and shield textiles coming into contact with the wound.

My nipples hurt so much that I can’t breastfeed any more!

When breastfeeding causes that much pain, even the bravest of us think of quitting. Each mother should decide what she thinks is best in her specific situation but do consider the option of pumping until your breasts have recovered. This means expressing breastmilk with a breast pump and giving it to your baby, for example, with the finger-syringe feeding technique or with a cup/spoon-feeding (find more information on supplemental feeding methods in the LactApp App).

Pumping is usually less painful because you can control the pressure of the pump. If you want, you can express your breastmilk for a few days until your nipples have healed.

My breast pump made the damage

Here, the size of the breast pump funnel is key: you must use the right size to achieve efficient and pain-free pumping. Breast pump damage is often caused at the base of the nipple by a cup that is either too large or too small. Finding the right individual cup size for you is essential for expressing milk with a breast pump.

To summarize, sore nipples can only be avoided if the underlying problem that causes them is found and corrected. If you want to prevent nipple damage, go to a breastfeeding support group and learn as much as you can about breastfeeding positions and attachment, a good latch, and tongue-tie. In this way, if any difficulty comes up or you notice any signs that breastfeeding is not going well, you can react as soon as possible.