Breastfeeding problems like sore, cracked, or bleeding nipples are a common issue that can impact someone’s ability to breastfeed. Read on to learn more about why cracked nipples happen, how they can be prevented, and how to treat them. 

 

By OBGYN and reproductive health specialist Dr. Mare Mbaye

The importance of breastfeeding for both parent and infant health, as well as bonding, is agreed upon worldwide. However, breastfeeding problems like sore, cracked, or bleeding nipples are a common issue that can impact someone’s ability to breastfeed. Some people have so much trouble with this that they are forced to stop breastfeeding earlier than they may have wanted to. Read on to learn more about why cracked nipples happen, how they can be prevented, and how to treat them.

What’s “normal” to expect when beginning breastfeeding?

Nipple discomfort and tenderness is common when someone first starts breastfeeding or chestfeeding. In fact, cracked nipples affect up to 90% of breastfeeding parents! It is most likely to happen in the first month postpartum, as both you and your baby are getting used to feedings. 
It’s important to remember that your nipples will take some time to adjust, especially if it is your first time breastfeeding (check out our postnatal vitamin to support during lactation). It's not unusual to have nipple soreness last a few weeks as your breasts and nipples become used to the process of nursing. However, the discomfort should go away once you and your baby have established a good feeding routine. Simple changes like changing breastfeeding positions should be all you need to prevent nipple fissures from getting worse if they do begin to develop. 

What causes cracked nipples when breastfeeding?

There are several possible causes for nipple fissures in breastfeeding parents. Let’s go through the most common ones.

  • Bad latch. When your baby is first learning to breastfeed, they may not get your nipple and areola far enough into their mouth. This can cause damage to your nipples, causing them to become painful and crack, bleed, or scab. Ideally, your baby should have the whole nipple and part of the areola in their mouth. Sometimes, babies have a physical trait that makes latching correctly hard for them. 

    • Tongue-Tie. Tongue-tie happens when the tissue connecting the tongue to the floor of the mouth is short or pokes out too far to the front of the tongue. These babies tend to latch on and chomp and bite instead of sucking. If your baby's tongue cannot reach past the lower lip when they cry or the tongue looks heart-shaped, they may have a tongue-tie. 

    • High Palate. Babies with a high palate or who are not able to open their mouths wide enough also can have a hard time getting a deep latch and sucking effectively.

  • Nipple or breast problems. There are various nipple and breast issues that can lead to cracked or painful nipples. 

    • Flat or inverted nipples. If you do a “pinch” test on your nipple by compressing the areola (the dark area around your nipple) about an inch behind your nipple, and the nipple doesn't slightly harden and become erect, then you might have what's called a flat nipple. If you perform the “pinch” test and your nipple retracts, then it's considered to be inverted. Both flat and inverted nipples can make it hard for your baby to latch properly during breastfeeding, which can lead to nipple soreness.

    • Breast and nipple engorgement. Engorgement is when the breasts become too full and hard. This can lead to nipple discomfort because the fullness causes the nipples to stretch and flatten. Reducing some of the pressure in the breast tissue by expressing milk before feeding can help. 

    • Milk blister. This is a painful white spot on or around the nipple. It’s made up of thickened milk or some skin that's overgrown a milk duct and blocked it, which causes the milk blister

  • Breast pump misuse. Using a breast pump incorrectly (by setting the suction too high or using a poor-fitting flange, for example) can hurt or damage your nipples and cause cracks or bleeding. Flanges that don't fit properly can rub against your skin and cause blisters.

  • Vasospasm. After a breastfeeding session, some women may experience pain that extends from the nipple into the breast. This can be due to constriction of the blood vessels — called vasospasm — in the breast.

  • Eczema. Your nipples can crack or bleed because of eczema or other very dry skin conditions. Eczema can show up as scaly red patches that may be itchy or painful. Some people develop eczema for the first time while pregnant or breastfeeding.

  • Thrush. Thrush is a contagious yeast infection that can infect your nipples and cause nipple pain. If you notice white or yellowish patches anywhere in your baby's mouth or on the lips or if they have cracked skin at the corners of the mouth, then you may be dealing with thrush. The symptoms of thrush you may notice on yourself include cracked nipples, shooting pains in your breast during or after breastfeeding, itchy or burning nipples, and unusually red nipples that are shiny or flaky.

  • Mastitis. This breast infection can happen when a milk duct becomes blocked and prevents the milk from properly getting out. The milk builds up behind the blockage, causing pain and swelling in your breast and nipple. Other symptoms you may notice are red streaks on your breasts, flu-like symptoms like fever and body aches, and a hard lump in the breast. Mastitis usually happens in only one breast.  

  • Other causes.

    • Not breaking the suction before removing your baby from your breast can be both painful and can damage breast tissue and your nipple.

    • Bras that are too tight can put pressure on your nipples and irritate them.

    • Certain soaps, perfumes, and laundry detergents can dry the nipples and make it easier for them to be irritated and sore. 

This list is not exhaustive. Keep in mind that it's possible to be dealing with more than one of these conditions at the one time!

Tips to prevent cracked nipples 

With so many causes for cracked nipples, how are you supposed to take care of your tiny human, yourself, and avoid having to deal with painful, cracked nipples? Thankfully, taking the following steps can help prevent cracked nipples.

  • Make sure that your baby is latching properly to your breast. The nipple should be fully inside the baby’s mouth with most of the areola in the mouth, too. If you are having trouble with this, contact your provider or a lactation consultant as soon as possible so they can help you figure out good adjustments to make. They can also help you figure out how to continue breastfeeding as you cope with this challenge. 

  • Hand express a small amount of breast milk before feeding the baby so that the breasts do not become engorged.

  • Wash your breasts with warm water only and avoid using harsh soaps or products to prevent dryness.

  • Gently pat your nipples dry after a feeding and then apply colostrum, breast milk, or nipple cream to soothe and heal them.

  • If you find that your breast milk leaks between feedings, use bra/breast pads and make sure to change them often (at least change them after every feeding). Breast pads made from natural materials, like cotton or lanolin, can reduce friction on the nipples. Avoid plastic-lined nursing pads as they will trap moisture which can make nipple irritation worse. 

  • Consider wearing loose, cotton bras that will allow air to circulate and irritate your nipples more by rubbing. 

  • Use breast shields to help prevent clothing or your bra from rubbing against your nipples and irritating them.

  • Always allow the baby to come off the breast naturally. As mentioned above, not breaking suction properly will be painful and can cause damage to the nipples.

Remedies for cracked nipples

Now what can be done once you already have cracked nipples? First and foremost, unless your healthcare provider tells you to stop, try to stick to your regular breastfeeding schedule as much as possible. This is true even if you have an infection like thrush or mastitis. Slowing down or stopping breastfeeding could reduce your milk production, and it can be very hard to get it back.

Beyond this, relieving nipple pain depends on figuring out the underlying cause. Always listen to your provider, but in the meantime, here are a few tips to use during and after breastfeeding sessions to help. Note that these tips will not be helpful if the issue is a bad latch.

While Breastfeeding

  • Check your baby's latch. The best latch position is off-center, with more of the areola below the nipple in your baby's mouth. One way to do this is to line up their nose with your nipple so their bottom gum is far away from the base of your nipple when they open their mouth. Once their mouth is open, bring your baby to your breast, not your breast to them. Your nipple should be positioned deep in your baby’s mouth. As you nurse, your baby’s lower lip should be fanned outward over the nipple rather than being tucked in. If you gently pull down the corner of his mouth while he’s feeding, you should be able to see the bottom side of his tongue, and it should be cupping the breast. If you’re unsure, talk to your provider or a lactation consultant. Many have virtual options now so you don’t even have to leave the comfort of your home to be evaluated.

  • Try different positions. You may find that certain positions make it easier for your baby to latch on correctly and are much more comfortable. One analysis of a dozen studies concluded that women experienced less nipple pain and nipple trauma — and better latch position — in the laid-back position. This might help prevent repeated friction from your baby’s mouth on the same areas on your nipples.

  • Use cold therapy. Briefly applying a cold pack to numb the injured nipple area before nursing can help dull the pain. This is especially helpful during the initial latch, which tends to hurt the most.

  • Breastfeed often. Nursing every two to three hours can help prevent engorged breasts. An engorged breast is harder for your baby to latch on to. 

  • Limit the duration of breastfeeding. Some babies will continue to suck even when they're not getting milk, which can irritate your nipples. Listen for your baby swallowing, and when they're no longer swallowing, gently detach them from your breast.

  • If you are engorged, pump before nursing. Pumping for one to two minutes before nursing can help prepare the nipple for easier latching. A hand pump, which is more gentle than an electric pump, is typically best for this.

  • Try “reverse pressure softening.” This is a helpful technique if your breasts are engorged or your nipples are flat or inverted. This involves applying gentle pressure with your fingers around the base of the nipple. This temporarily moves some of the swelling slightly backward and upward into the breast to help create a softer nipple and areola for your baby to grasp. 

  • If one side is less painful than the other, nurse on that side first. Babies often nurse more gently on the second side since they're less hungry. You can also consider pumping on the more painful side and breastfeeding on the other, if pumping is more comfortable than breastfeeding. You can give your breastfed baby a bottle of your pumped milk after they've finished nursing on the one side.

  • Exclusively pump until your nipples are healed. If it's too painful to nurse, you can try to pump exclusively and bottle feed your baby.

After Breastfeeding

  • Break suction first, then detach your baby gently. Normally, a baby will let go of a breast when they're finished feeding and no longer getting any milk. Sometimes they don't, though. If you need to detach them yourself, instead of just pulling your baby away, first put your clean finger into the corner of their mouth to break the suction.

  • Use a warm compress. You may find it soothing to apply gentle heat on your sore nipples. You can use a heating pad, warming gel pads, or a wrung out, warm washcloth after feedings to help reduce the discomfort. Pat your nipples dry afterwards. 

  • Clean your nipples gently. Cracked or bleeding nipples should be rinsed after each feeding with warm water, then patted with a clean towel and allowed to air dry. Once a day, use a gentle, mild soap to clean the wound, rinse well with water, and air dry. Avoid soaps, skincare products, and detergents with alcohol and fragrances. These can be very drying and irritating.

  • Keep things clean. Bacteria can easily enter cracked, delicate skin. To prevent infection, be diligent about washing your hands before touching your cracked or bleeding nipples. Scrub your hands for 20 seconds with soap and warm water before expressing milk or applying expressed milk, lanolin, creams, or hydrogel pads to your breasts.

  • Apply expressed milk to your nipples. Colostrum and breast milk have healing properties that can soothe irritation and they don’t need to be washed off before nursing. The main caveat is that this is not recommended if your nipple soreness is because of thrush–breast milk can encourage yeast to grow.

  • Apply moisturizing balm or cream to your nipples. Nipple balms or creams may soothe sore, cracked nipples. Use a small, pea-size amount, and gently pat it on to the sore, injured area with clean fingertips after each feeding and after taking a shower or bath. Do not rub it in. If you’re using a balm with lanolin, it is important to know it is a fat made from sheep's wool, so it is not recommended for people with a sensitivity to wool. It is also not recommended for cases of thrush since it can trap moisture and encourage yeast growth

  • Use an antibacterial cream as prescribed. If you have an open wound, show it to your provider. They may recommend an over-the-counter antibacterial cream or give you a prescription. Some of these products need to be removed before nursing, but most don't unless your baby dislikes the taste or smell.

  • If you use them, change nursing pads often. Damp nipples can invite infection. Use nursing pads that are 100% cotton and change them at least once after every feeding.

  • Try hydrogel dressings. These pads are soothing and designed to speed nipple healing. Try to avoid touching your skin right before applying the pad — bacteria from your fingers can get trapped under the pad. They also should not be used with other topical products or if you have thrush. Keep the hydrogel pads in the fridge between uses for an added cooling effect.

  • Wear comfortable nursing bras. To prevent irritation from your bras, make sure to buy ones that are comfortable, made from natural fabrics, and fit you well. Loosely fitted, seamless, and underwire-free bras tend to be the most comfortable. Wash your nursing bras often with unscented laundry detergent and rinse well. 

  • Wear breast shells if needed. If your nipples are too sore to comfortably wear a bra or you have a scab that sticks to your bra, consider wearing breast shells to create a space between your nipples and the bra. Don't use these shells if your breasts are engorged, though, since they can affect milk flow and cause clogged ducts. Always wash your shells between wearings.

  • Take painkillers. Talking with your doctor about taking ibuprofen (motrin) or acetaminophen (tylenol) about 30 minutes before nursing to help with the pain. These medications are safe for breastfeeding moms to take in standard doses.

When to talk to your healthcare provider

Cracked or bleeding nipples can lead to infection, and painful breastfeeding is often associated with both early weaning and postpartum depression. Don't hesitate to check with your provider if any of the following apply to you:

  • You have a cracked nipple that is still painful and/or has a bloody discharge after 24 hours. Learn more about how long cracked nipples take to heal when breastfeeding.

  • You notice a fever, inflammation, oozing, pus, a very tender blister, or other signs of infection.

  • Your nipple and/or areola is shiny or flaky or your nipple is burning.

  • You have nipple pain that radiates into the breast. 

  • Your cracked or bleeding nipples are interfering with breastfeeding.

In addition to your and your baby’s healthcare providers, there are other people you can talk to as you cope with breastfeeding challenges.

  • Lactation consultants are health professionals who are trained and certified in the clinical management of breastfeeding. You can find a lactation consultant through your healthcare provider or your hospital. You can also find one using the International Lactation Consultants Association.

  • Breastfeeding peer counselors are people who have breastfed their own children and want to help and support others who breastfeed. They typically have training but not as much as a lactation consultant. You can find a peer counselor through your local WIC nutrition program, womenshealth.gov/breastfeeding, or you can call the National Breastfeeding Helpline at (800) 994-9662.

  • Breastfeeding support groups are another great option for those who want to get help and support each other with breastfeeding. Ask your provider to help find a group near you or you can go to La Leche League.

  • Friends and family members who have breastfeeding experience can often provide insight.

  • Your partner can be very important as a support person during this process.

Do what’s right for you

Breastfeeding is a great way to nourish your little one, but it’s important to remember that it is not right for everyone. Many people do recover from issues like cracked nipples and continue their breastfeeding journey, but many do not. Talking to your provider and other people who support you can help you in figuring out if continuing to breastfeed is right for you. 

Read more about how to treat sore nipples!

 

Featured Image by Alina Matveycheva