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Nipple problems while breastfeeding 

Sore nipples

Sore nipples are a common problem and are considered to be caused by the baby not taking the nipple into its mouth properly, often because of breast engorgement. The problem is preventable with careful attention to the position of the baby at the breast and the baby's sucking technique.

How are sore nipples managed?

It is important to be as relaxed and comfortable as possible (with your back well supported) and for your baby to suck gently, so:

• Try to use the 'chest to chest, chin on breast' feeding position.
• Vary the feeding positions. (Make sure each position is correct.)
• Start feeding from the less painful side first if one nipple is very sore.
• Express some milk first to soften and 'lubricate' the nipple. (Avoid drying agents such as methylated spirits, soap and tincture of benzoin and moisturising creams and ointments, which may contain unwanted chemicals and germs.)
• Gently break the suction with your finger before removing the baby from the breast. (Never pull the baby off the nipple.)
• Apply covered ice to the nipple to relieve pain
• Keep the nipples dry by exposing the breasts to the air and/or using a hair dryer on a low setting.

Cracked nipples

Cracked nipples are usually caused by the baby clamping on the end of the nipple rather than applying the jaw behind the whole nipple. Not drying the nipples thoroughly after each feed and wearing soggy breast pads are other contributing factors. Untreated sore nipples may progress to painful cracks.

What are the symptoms?

At first, the crack may be so small that you cannot see it. The crack is either on the skin of the nipple or where it joins the flat, dark part of the nipple (the areola). A sharp pain in your nipple with sucking probably means a crack has developed. Feeding is usually very painful, and bleeding can occur.

How are cracked nipples managed?

• Cracked nipples nearly always heal when you get the baby to latch onto the breast fully and properly. It usually takes only 1 day to heal.
• Follow the same rules as for sore nipples.
• Do not feed from the affected breast-rest the nipple for 1 feed.
• Express milk from that breast by hand.
• Feed that expressed milk to the baby.
• Start feeding gradually with short feeds.
• A sympathetic expert such as an experienced nursing mother will be a great help if you are having trouble coping.
• Contact your doctor if the problem is not resolving. A pliable nipple shield will help a difficult problem.
• Take paracetamol just before nursing to relieve pain.

Inverted nipples

What is an inverted nipple?

It is a nipple that inverts or moves into the breast instead of pointing outwards when a baby tries to suck from it. When the areola is squeezed, the nipple retracts inwards.

What is the treatment?

Breast shields or shells such as the Meredith shield or Cannon breast shell can be very effective. These are silicon shields with a central hole from which the nipple points out.

A simple treatment, which should start at the beginning of the seventh month of pregnancy, is the Hoffman technique:

1. Draw an imaginary cross on the breast with the vertical and horizontal lines crossing at the nipple.
2. Place the thumbs or the forefingers opposite each other at the edge of the areola on the imaginary horizontal line. Press in firmly and then pull the thumbs (or fingers) back and forth to stretch the areola.
3. In the vertical position, pull the thumbs or fingers upwards and downwards.

Repeat this procedure about 5 times each morning. The nipple will become erect and is then easier to grasp, so that it can be slowly and gently drawn out.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia