I think we have all heard or experienced it…the sentiment that breastfeeding is painful. Especially to your nipples. Maybe just at first, as you toughen them up. Maybe once the baby gets teeth or tries to bite. Maybe from falling asleep with the pump settings cranked too high. Either way, there is some sort of normalization, initiation phase, or excuse about how nipple pain is just part of the journey. Well, I am here to tell you that it doesn’t always have to be! We can minimize or even eliminate nipple pain as part of the breastfeeding journey.
While the thought of toughening up a part of the body as sensitive and delicate as the nipple is somewhat terrifying, the concept behind the sentiment does ring a little true. Breastfeeding is generally the first time this part of our body will be used for a specific purpose with regularity. And, oh will it be regular! We expect a new baby to feed at least 8-12 times per day and often for over 30 minutes at a time. Going from zero to this frequency with any unused body part would cause a little fatigue or potentially an overuse injury. Then add in that the baby suckles with its wet mouth causing suction or seal, and you can see how nipple pain, or some damage, is a common experience.
Here are some tips to avoid nipple pain:
Take a prenatal breastfeeding class. Learn about a proper latch and how to recognize it.
Only pump when necessary in the beginning. For instance, if your baby is in the NICU, you’re experiencing low supply, heading back to work early, exclusively pumping, etc, use your pump. If not, keep the pump in the box for the first few weeks. Focus on your latch.
If you experience damage or injury, correct and heal. Damage from a shallow latch, an infant with a tongue tie, and improper pump use may leave you with some healing to do. Make sure while you heal that you continue to express milk and protect your milk supply. You may want to pump a little more while you correct a latch or await tongue tie release. You might feed only at the breast if you are working with your IBCLC on flange fit or pump settings. Either way, give yourself and nipples a little grace on the feeding journey. Just always make sure to take the milk to make the milk or protect your supply through expression.
Care for yourself. Keep your nipples clean and dry, use a breastfeeding safe balm to protect them, trust your body, and reach out for help with questions or concerns.
Proper management of nipple pain or damage
First, correct the issue at the source. Work with your IBCLC to get a deep latch. They may recommend temporarily trying a nipple shield. If pumping, you may need to adjust your pump settings. Using the highest setting for the longest time is not a best practice. Get a flange fitting. Make sure the friction of the pump is not contributing to nipple irritation. Do not use a lubricant to make pumping more comfortable. Pain is your body letting you know the tissue is being damaged!
Healing a damaged nipple can feel like an uphill battle as you need to continually express milk to maintain supply and feed your baby. Here are tips to promote healing and minimize pain from nipple damage:
Keep the nipples clean and dry. Make sure to change out tanks, bras, or pads that are wet as wet fabric rubbing will worsen damage.
Put your breast milk to use! With antimicrobial and antiinflammatory properties breastmilk is a heal-all! Express some milk and rub it on your nipples, allowing it to dry fully before dressing or snapping back on that nursing bra.
Apply a nipple balm. This can be lanolin (though you should avoid it if you have a wool allergy/sensitivity) or anything else that is soothing, moisturizing, and safe for breastfeeding nipples.
Use hydrogel dressings. These can be cooled in the fridge for extra soothing. They can also be used on top of balm to trap it in for absorption so it doesn't rub off on a bra or tank.
Try silver nursing cups-silverettes. These little cups give the nipple some air and space so they do not come in contact with a shirt or tank. Plus, silver has antimicrobial, healing properties.
Seeking professional care for nipple damage
While following the tips above will help to avoid nipple pain or damage and promote healing, you should seek care from an IBCLC or healthcare provider in the following scenarios:
You tried standard care, and the pain is not improving or getting worse. While it might not be cured overnight, you should expect improvement within 48 to 72 hours.
Your nipples have deep cracks or ulcerated spots. These can be harder to heal and often need professional attention.
You made adjustments, but still are not achieving a deep latch.
You have a milk bleb on the nipple that isn’t resolving with conservative interventions.
You are concerned about tongue tie, or your infant is showing signs of thrush.
While persistent nipple pain and damage can occur with tongue tie or tethered oral tissues in an infant, it does not automatically indicate the need for a release procedure in a baby. Tongue tie diagnosis and the recommendation for release should come from your team of healthcare providers (pediatrician, IBCLC, consulting pediatric ENT, dentist, etc). This same team can help you with feeding strategies if you opt to not release a tongue tie as well.
Nipple pain or damage with feeding is a common reason why people stop breastfeeding. It can inhibit people from meeting their breastfeeding goals or ruin their experience. While breastfeeding is hard work, as it is physically demanding, exhausting, time-consuming, and sometimes causes discomfort, don’t let nipple pain end your journey earlier than desired. Know what signs to look for and habits to avoid. Recognize when you need help and have resources available. Don't just “tough it out!”
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