In the initial weeks of motherhood, engaging in skin-to-skin contact fosters a strong connection between you and your baby, enhancing their innate breastfeeding abilities. This, in turn, contributes to an enjoyable breastfeeding experience for both you and your baby. Each mother discovers her own effective techniques, as what works for one may not work for another. The process of learning to breastfeed can resemble a dance between mother and baby, so recommendations should be tailored to your unique needs and your baby. Trust your instincts to determine what works best for you both. You’ll instinctively recognize optimal positioning, ensuring comfort for both you and your baby while also maintaining nipple health and promoting efficient feeding.4
Improving positioning can significantly alleviate nipple soreness. If, within the first three to five days after birth, you experience nipple soreness beyond slight tenderness during latch-on, it may indicate an issue with your baby's latch, position, or suck. Adjusting the latch or positioning can enhance your baby's comfort. Once you have mastered the rhythm of breastfeeding, any soreness or cracks in your nipples will have ample time to heal. If nipple pain worsens after the initial stages of breastfeeding, it may be caused by other factors such as thrush, bacterial infection, or tongue-tie.2,4
Understanding sore nipples
Causes of sore nipples during breastfeeding5
Sore nipples during breastfeeding can have several causes. The most common reason is improper latching, where the baby does not take enough breast tissue along with the nipple into their mouth. This can lead to painful feeds and various nipple issues like blisters, cracks, grazing, or bleeding. Even if the positioning and attachment seem correct, a mother may still experience sore nipples. Other factors that can contribute to sore nipples include variations in the anatomy of both the mother and the baby. For example, the size and shape of the nipples can affect the comfort of breastfeeding. Large breasts or variations in the baby's mouth, such as a small mouth or a receding chin, can also make it challenging to achieve a deep latch. Tongue function, tension in the baby's muscles, and nipple confusion (if the baby is used to bottle feeding) can also cause nipple discomfort. Vasospasm of the nipple, characterized by sudden constriction of blood vessels, can be extremely painful and is often associated with a shallow latch or conditions like Raynaud's phenomenon. Bacterial or fungal infections, such as Staphylococcus aureus or thrush, respectively, can also lead to sore nipples that do not heal easily. Sensitivity to topical creams or food allergens, discomfort or pain in the baby due to conditions like food allergies, milk blisters or blebs, poorly fitted pumping equipment, breastfeeding gadgets like nipple shields or silver cups, and skin conditions like eczema, dermatitis, or psoriasis can further contribute to sore nipples. In rare cases, sore nipples may be a symptom of Paget's disease, a skin condition associated with underlying cancer. It is important to consult with a healthcare professional or lactation consultant for proper assessment and guidance on managing sore nipples during breastfeeding.
Key factors for comfortable breastfeeding
A painful latch occurs when your baby predominantly latches onto the nipple rather than encompassing the breast. This results in an improper positioning of your baby's tongue against the breast. In such cases, your baby may struggle to extract enough milk, and breastfeeding is more likely to cause discomfort. Since babies breastfeed frequently, it won't take long for a painful latch to lead to sore nipples, including cracked, grazed or blistered nipples. A comfortable latch is achieved when the baby's mouth securely grasps a larger portion of the breast. In a deep latch, the baby's tongue effectively cups a greater amount of the milk-producing or glandular tissue within the breast. The nipple is positioned deeply in the baby's mouth at the junction of the hard and soft palate, preventing it from being painfully pinched. To achieve a deep latch, you can stimulate your baby by gently tickling the centre of their bottom lip with your nipple. This encourages them to open their mouth wide, similar to a yawn. Direct your nipple slightly upward towards the roof of their mouth, bringing the baby towards you with their chin leading.8
Key points to ensure a good latch-on for your baby are as follows:4
- The baby's nose is positioned very close to your breast.
- The baby's lips are turned outward.
- At least half an inch of your breast around the base of your nipple is inside the baby's mouth.
If the latch feels uncomfortable or painful, gently insert your finger between the baby's gums to detach them and try again.
When a baby is ready to receive milk, they will suck without swallowing as they position the nipple in their mouth. As the milk starts flowing, you will observe their jaw moving back towards their ear and their temples wiggling. You will also hear them swallowing, initially at a quicker pace and then gradually slowing down as their hunger is satisfied.4
Studies show that proper breastfeeding positions can reduce nipple pain and damage experienced by mothers by 58%.1 Problems related to positioning and attachment can also play a role in slow weight gain, excessive gas, and acid reflux. Therefore, enhancing positioning and attachment is essential not only for addressing nipple pain and damage but also for resolving other challenges that arise during breastfeeding.1
The following are the most common positions that can help with sore nipples:
- Side-lying position
Benefits for sore nipples
This position is ideal for both resting and feeding, particularly if you are bed-sharing or prone to falling asleep while nursing. It offers a secure and stable setup for your baby while promoting relaxation.1 So, if lying down is more comfortable for you and your baby, you can try this position.3
Description and a step-by-step guide
Lie on your side and place your baby on their side, facing you, with their head positioned near your breast. Use pillows to support your back and ensure your baby's nose is not blocked. Position the baby on their side, facing the breast, and gently lower them towards your knees so that their nose aligns with the nipple. This positioning requires them to tilt their head back slightly and look upwards toward the nipple to achieve a proper latch.1,3
- Laid-back or biological nurturing position
Benefits for sore nipples
This particular breastfeeding position is frequently regarded as the most comfortable. It has a calming effect on the baby and provides stability, allowing them to focus on feeding. It triggers feeding reflexes in the baby, leading them to latch onto the breast naturally. Additionally, these positions slow down milk flow, enabling the baby to manage it more effectively. By supporting the baby's weight with your body instead of your arms, these positions eliminate muscle fatigue and strain for you. Babies who are fed in this position tend to be more relaxed, resulting in a deeper and more comfortable latch as their jaw muscles are also relaxed.1
Description and step-by-step guide:2
To adopt this position, find a comfortable spot in bed, on the couch, or in a recliner with back support. Use pillows to support your head, shoulders, and arms. Since you're leaning back, your baby can rest on you in any position that feels comfortable. You recline at an angle ranging from 15 to 65 degrees while your baby can lie on their tummy against your body.
If you're seated, make sure to support your feet with a footrest. Ensure that your baby's entire front is in contact with your front, with their mouth and nose facing your nipple. Position your baby's cheek near your bare breast. Bring your baby close so that their chin touches your breast first, followed by their nose.
Position your baby close to you with flexed hips so they don't have to turn their head to reach your breast. It's important for your baby's feet to feel supported by your body to prevent them from dangling in the air. Use one hand to support your breast if necessary and the other hand to support your baby's thigh or bottom.
- Cradle/Cross-cradle hold
Benefits for sore nipples1
These breastfeeding positions are commonly taught and can be beneficial for public nursing. However, they tend to work better once both you and your baby have practised the laid-back positions. The cross-cradle hold can be particularly helpful for babies who struggle to latch due to physical issues like tongue-tie, as it allows you to provide some assistance.
In the cradle position, ensure that you are comfortable and relaxed while your baby feeds. Lean back in a chair and support your back with a vertically placed bed pillow if needed. Avoid leaning forward or hunching over your baby, and elevate your feet. Take deep breaths and consciously relax your shoulders.
Position your baby on their side, facing you, with their chest securely against your abdomen. Your baby should not turn their head to nurse. Cradle your baby in the arm on the same side as the breast they will be nursing from. For example, if you're breastfeeding on the right breast, rest your baby's head on your right forearm near your elbow, with their nose at the level of your nipple and their head slightly tilted back. Support your baby with your forearm and hold their bottom or thigh with your hand.
Support your breast with your other hand, keeping your fingers positioned above, below, or on either side of the breast, away from the nipple and baby's mouth.
When your baby is latched well, their chin should be pressed into the breast, and their nose should be slightly away from it. If you leave the hand supporting the breast in place, avoid pressing down with your thumb, as it can pull the nipple to the front of the baby's mouth. When you remove the supporting hand, ensure that your baby has enough head control to maintain a good latch. If you have large breasts, placing a small rolled-up towel beneath them for support can be helpful.
In the cross-cradle position, your baby is supported on a pillow across your lap to raise it to the level of your nipple. Pillows should also support both elbows to prevent arm fatigue during feeding. If you are breastfeeding on the left breast, use your left hand to support the breast in a "U" hold. Support your baby with the fingers of your right hand by gently placing your hand behind their ears and neck, with your thumb and index finger behind each ear. Your baby's neck rests in the web between your thumb, index finger, and palm, forming a second neck. Place the palm of your hand between their shoulder blades.
- Football hold
Benefits for sore nipples
This particular nursing position can assist in situations where you have larger breasts, have undergone a C-section, or are breastfeeding twins or tandem feeding. It is especially beneficial for mothers who have had a Cesarean birth, as it helps keep the baby away from the incision area. This positioning prevents the baby from pushing against the chair and can be particularly helpful if you're experiencing engorged breasts or sore nipples. The football or rugby hold also aids in preventing plugged ducts by enabling the baby to empty the lower milk ducts effectively, benefiting both mother and baby.1,2,3
In this position, you will place the baby on your side, with the baby's head under your arm and on the same side that you are breastfeeding. Support the baby's head with your hand and position their back along your arm beside you. Use a "C" hold to support your breast, ensuring the baby is facing the nipple at the appropriate height. You may need to use pillows to adjust the baby's height correctly.
Tuck the baby's legs and feet under your arm, flexing their hips and resting their legs alongside your backrest so that the soles of their feet point towards the ceiling.
If you prefer to nurse while lying on your side, you can hold the baby similarly to how you would hold a football or rugby ball, with their body resting on your forearm and their face turned towards your breast. Position the baby's legs beneath your arm and utilize your other hand to support your breast.
After breastfeeding, examine your nipple. If it appears pinched, review the latch and positioning tips to make any necessary adjustments. The nipple should look the same way it did before breastfeeding, neither pinched nor blanched.
Additional tips for soothing sore nipples
While the underlying cause of sore nipples is being identified and addressed, it is important to continue breastfeeding. Ensuring that the baby latches on properly with the nipple deep in their mouth can protect the nipple from further damage. To alleviate discomfort while the cause of sore nipples is being addressed, you may want to try different nursing positions such as the cradle hold, cross cradle hold, football (clutch) hold, and lying down, which can vary the position of the baby's mouth on your breast. Nursing initially on the least sore side until letdown occurs and then gently switching to the other breast while maintaining good positioning and latch-on can also help. Applying a little milk or colostrum onto the nipples after nursing, as well as using ultrapure-modified lanolin or gel pads, can provide relief and promote healing. However, it is important to consult a healthcare professional before using these remedies if you have a yeast infection. If clothing or bra pressure causes discomfort, applying ultrapure lanolin and using breast shells with large openings can help soothe, protect, and heal the nipples.2,6 Additionally, warm water compresses may also help alleviate pain. Warm water can enhance blood flow to the affected area and aid in the removal of waste products. While not a direct treatment or cure, modern silicone nipple shields have proven helpful in reducing the pain associated with sore nipples by providing protection to the nipple. This protection allows mothers to continue breastfeeding while seeking guidance on proper positioning or allowing their nipples time to heal. Nipple shields can also be used as a suck training tool in specific situations, such as for infants experiencing tongue retraction.7
Drying sore nipples with a hairdryer or using a sun lamp is no longer recommended, as these practices can further dehydrate the skin and cause additional damage to tender nipple tissue.2
How to prevent sore nipples during breastfeeding?
Ensuring proper attachment of the baby involves positioning the nipple towards the back of the mouth, near the soft palate. This placement safeguards it from being compressed or irritated by the tongue while feeding. When the baby is not securely attached, and the nipple rests closer to the front of the mouth, it can get squeezed against the hard palate, resulting in initial discomfort and, over time, skin damage and the development of a crack.6
When should I see a doctor?
If you experience discomfort or pain in one or both nipples during every breastfeeding session, or if your nipples become cracked or bleed, it is crucial to seek assistance from your midwife, health visitor, or breastfeeding supporter as soon as possible. They can observe your feeding technique and assist you in ensuring that your baby is properly positioned and latched onto the breast.9
Breastfeeding is a beautiful and natural bonding experience between a mother and her baby, but it can sometimes lead to discomfort, such as sore nipples. As mentioned, positioning techniques and proper latching are highly significant in alleviating nipple soreness and enhancing breastfeeding success. We delve into various recommended positions, including the cradle hold, football hold, and side-lying position, highlighting their unique benefits and how they contribute to the reduction of nipple pain. By understanding and implementing appropriate positioning strategies, mothers can experience relief from sore nipples, fostering a more enjoyable and successful breastfeeding journey.
- Oakley S. Sore nipples and positioning and attachment at the breast [Internet]. [cited 2023 Jul 24]. Available from: https://sarahoakleylactation.co.uk/wp-content/uploads/2021/03/Sore-nipples-and-positioning-and-attachment-sheet.pdf
- Breastfeeding with Sore Nipples [Internet]. Llli.org. 2023 [cited 2023 Jul 24]. Available from: https://llli.org/breastfeeding-info/breastfeeding-sore-nipples/
- UNICEF. Common breastfeeding positions [Internet]. www.unicef.org. [cited 2023 Jul 24]. Available from: https://www.unicef.org/parenting/food-nutrition/breastfeeding-positions
- Positioning [Internet]. Llli.org. 2023 [cited 2023 Jul 24]. Available from: https://llli.org/breastfeeding-info/positioning/
- Glaze PP. Causes of Sore Nipples - Breastfeeding Support [Internet]. Breastfeeding Support. 2015 [cited 2023 Jul 23]. Available from: https://breastfeeding.support/causes-of-sore-nipples/
- Overcoming Breastfeeding Problems: Sore nipples [Internet]. Baby Friendly Initiative. [cited 2023 Jul 23]. Available from: https://www.unicef.org.uk/babyfriendly/support-for-parents/sore-nipples/#:~:text=Even%20very%20sore%20nipples%20can
- Glaze PP. Treatments for Sore Nipples [Internet]. Breastfeeding Support. 2014 [cited 2023 Jul 23]. Available from: https://breastfeeding.support/treatments-sore-nipples/
- Glaze PP. Why Does Breastfeeding Hurt? [Internet]. Breastfeeding Support. 2014 [cited 2023 Jul 24]. Available from: https://breastfeeding.support/why-does-breastfeeding-hurt/
- NHS. Sore or cracked nipples when breastfeeding [Internet]. nhs.uk. 2020 [cited 2023 Jul 23]. Available from: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-problems/sore-nipples/