Dealing with Sore and/or Cracked Nipples

Contrary to popular belief breastfeeding is not as simple as it may seem and most mothers need some guidance before they can get it right. Most hospitals offer breastfeeding guidance during your stay in hospital after delivery and it is important to make the most of this time and consult the lactation consultant, nurses or attending doctors if you face any challenges with breastfeeding.

Breastfeeding should be a warm, comfortable and loving experience and nipple soreness or pain due to cracked and/or bleeding nipples is often a sign that something is wrong.. A good breastfeeding experience is key as the reverse could lead to negative feelings towards the process which could in turn affect milk production.

Causes of Sore and/or Cracked Nipples:

1) Poor/Shallow latch:
The most common cause of nipple soreness is a poor or shallow latch. A good latch is when most of the dark part of your nipple (called the areola) is in your baby’s mouth with your nipple near the soft palate of the upper part of their mouth with theirs tongue extended outwards. If your baby hasn’t latched on properly then your nipple will land near the hard palate of their upper mouth (this is found closest to the front of the mouth) where there is bound to be a lot of friction often causing nipple damage. This means that your baby has latched onto your nipple and not your breast.

2) Tongue-tie (ankyloglossia): 
This is a congenital condition where a membrane connects the bottom part of the tongue to the floor of the mouth decreasing the ability for the tongue to move. If your baby is unable to move their tongue forward they might not be able to extract milk efficiently.
A few ways in which you can confirm if your baby has tongue-tie is by:
i) Checking if they can stick their tongue out of their mouth.
ii) Checking if they lift their tongue to the roof of their mouth when they cry.
If you suspect that your baby might have tongue tie, it is important to consult your paediatrician immediately for assistance and guidance on the matter.

Other causes of sore and/or cracked nipples include:
3) Thrush: an irritating yeast infection which can be found on the nipple of breastfeeding mothers or in the baby’s mouth.
4) A bacterial infection in the nipple and/or milk ducts which may also be characterized by pain, redness, shiny areas and/or sections of the breast which are flaking or have white specks.
5) A milk blister/blocked nipple pore: this is a small blister at the end of the nipple caused by a small amount of skin growing over the opening of a milk duct causing milk to back up behind it. It is also known as a nipple bleb
6) Raynaud’s phenomenon: this is when the nipple turns white (blanching) after a feeding due to reduced blood flow to the nipple. It may be characterized by some pain (which often leads to its confusion with Thrush) though this is not always the case.

How to Minimize the chances of getting Sore and/or Cracked Nipples:

1) Ensure a proper latch (see photo for more details):
The best way to ensure your baby is latching properly is to let them latch onto the breast themselves. Place your arm behind the back of your baby to support them while turning them close towards you with their stomach facing yours. Let their head title back slightly while you place your nipple near their nose to allow them to open wide and take in the nipple and breast; with the nipple aimed towards the roof of their mouth. Make sure that the baby’s chin is towards the breast while his/her nose is away from the breast; this will help ensure a deep latch and help prevent the baby’s nose from being covered by the breast while they breastfeed. Most babies should be able to self latch effectively as breastfeeding often comes innately to babies of not just humans but most animals. However, if you required any medical intervention during labour, the drugs might inhibit your baby’s ability to efficiently latch hence s/he might need your assistance.

If you notice that your baby is not latched on properly, try to adjust their position by moving them closer towards you to a more comfortable position. If this does not help, then you might want to unlatch them by gently inserting your finger (to maintain hygiene ensure that your finger is clean) into their mouth from the edge of your baby’s mouth as you remove the nipple. It is important to avoid doing this often as it might frustrate your baby making them refuse to continue breastfeeding afterwards.

Breastfeeding is a delicate art hence it might take some time to get it right but be positive and patient with yourself, as you find a position that works for both of you, bearing in mind that each breast and baby are different.

2) Check for Early Signs of Hunger:
If you notice early enough that your baby is getting hungry and feed them at this moment it will make them more willing to let you spend some time trying to get the latch right.

If one of your nipples is sore, offer the breast with the least sore nipple first as your baby is bound to feed more vigorously in the beginning.

3) Change your Bra Pad Often:
To avoid any bacterial build up it is important to change your bra pad after every feed. Also, try and avoid plastic-backed nursing pads since they could prevent air circulation among other things.

4) Use proper soaps and towels:
Avoid using bathing soaps which might dry your nipples as well as rough wash clothes and towels which could damage the surface of your nipples and breast.

5) Use a proper Breast pump (Check out our article on ‘CHOOSING A BREAST PUMP’ for more details):
Ensure you use a breast pump which allows for you to adjust the suction power. A breast pump with a strong suction or wrong cup size could damage your nipple.

6) Ask for Help
If you are facing any challenges getting your child to latch on effectively or notice anything unusual with your breast or breastfeeding sessions, it is important to ask for help from your doctor or lactation consultant as soon as possible, waiting too long could worsen the situation.

Remedies for Sore and/or Cracked Nipples:

1) Apply some milk: squeeze some breast milk onto your nipple(s) and let it air dry.
2) Air- dry your nipples as often as possible to facilitate healing. Cotton bra’s are also best as they promote air circulation, if possible buy some comfortable breastfeeding cotton bras.
3) Use 100% lanoline cream: before you use lanoline we would advise consulting your doctor since should there be thrush it is possible that the lanoline could make it worse.

It’s also important to avoid nipple creams which need to be wiped off before you feed your baby just in case you forget to wipe it off or do not wipe properly. 

Before opting to use any cream to treat any nipple condition it is important to FIRST consult your doctor or lactation consultant to get a professionally prescribed cream specific for you.

4) Express from the affected nipple for a while as you wait for it to heal while feeding your baby the expressed milk and/or from the other breast. Some mothers during this period also apply petroleum jelly as they wait for it to heal. As long as you are not allergic to the product and you use it properly this should be okay. It is best to express the milk by hand, however if you find this difficult ensure to use a comfortable breast pump which will not worsen the situation.

If your condition does not improve even after applying the above remedies and prevention techniques then it is important that you consult your doctor or lactation consultant as soon as possible. However, bear in mind that if the cause of the nipple soreness and/or cracks is not resolved first no matter how long you apply the above remedies the condition might not improve or will return.

Lastly, it is important to remember that most mothers (especially first time mothers) face a bit of difficulty breastfeeding their child in the beginning. This is okay, since with time and proper coaching and assistance from your doctor and/or lactation consultant you too shall be able to share in the heavenly bliss that is breastfeeding. 

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