Will I have sore nipples?

Sore Nipples? Read below to understand the causes and to learn various solutions

The number one reason moms give up breastfeeding is because of pain - it hurts too much and they don’t know how to fix it. The second reason mom’s switch to formula is low milk supply or “perceived milk insufficiency.” Newborns have tiny tummies and should eat frequently. Women from various cultures feel colostrum is not enough milk for their new baby or that a hungry baby is a bad baby. Having a basic understanding of what is normal and what is not normal is important for all moms and counselors as new websites launch every day that prey on mom’s fears about starvation and dehydration. Remember, knowledge is POWER!

Sore Nipples

A good latch is all about the lips. The baby’s lips must be flanged out like a fish. The baby must open as wide as possible, stick the tongue out as far as possible, and extend the tongue around the nipple and suck. If the baby is not opening wide enough and has a shallow latch OR if he or she is sucking in the bottom lip, then this will cause nipple damage, pain and contribute to less milk being removed. A drained breast makes more milk and a full breast slows production down.

When checking a latch, the mother, partner or bedside nurse should “peek and tweak” the latch, check on the bottom lip and make sure it is flipped out.  The best way to do this is to slide a finger onto the baby’s chin, push down, and flip the lip out. Mothers often gain immediate improvement in latch pain and the baby learns to open wide. As a baby opens wider and gains more milk, the newborn’s short term memories of latch will turn into long term memories and a successful latch builds day by day.   

The Finger Test

One way to teach the importance of proper positioning is with the Finger Test. Put your right pointer finger in your mouth just back to the first knuckle and then suck on it. You should feel your tongue rub the end of your finger. This is what happens to the tip of mom’s nipple when the baby does not get enough of the breast into his or her mouth.

Now put your finger in your mouth again but this time go between the first and second joint and suck as you did before. This time there is no rubbing. The tongue will come up under the finger compressing it with the roof of the mouth and not touch the end at all. This is a good latch. A wide, deep latch is the goal.

Now try this again with your bottom lip pulled in. Now try to suck, feel the bad latch. Now, while sucking, take your left pointer finger and push down on your chin and/or bottom lip and help the bottom lip flange out like a juicy, pouty lip. Now the tongue can slide into the right spot and create a good seal. Just this little adjustment between mom and baby can make all the difference in the world!

5 Levels of Pain Management

Nipple tissue is as thin as the skin on your eyes, so there are levels of treatment a mother can try. If a mother has latch pain, is tearful and is reporting pain while nursing, the goal is to feed the baby, treat the pain, and build the supply. 

• Level 1: Air dry breasts after feeds, after hand expressing a small amount of breastmilk on the areola and nipple, as breast milk heals skin.
• Level 2: Use hydrogel pads, breast shells or Silverettes to wear in the bra in between the feeds.
• Level 3: Apply lanolin based nipple cream, lanolin-free nipple butters or pure oils like Coconut or Olive Oil to the nipples after breastfeeding, all safe for baby with no need to wipe off.
• Level 4: “Dips for the nips” Make a salt water soak with 1 cup of warm water a teaspoon of table salt, dip for a few minutes only after breastfeeds, then apply lanolin or creams.
• Level 5: Call the OBGYN or Midwife and get a script for magical nipple cream. In U.S and Canadian pharmacies: Dr. Jack Newman's All Purpose Nipple Ointment, APNO https://ibconline.ca/information-sheets/all-purpose-nipple-ointment-apno/ or print out my handout on a U.S. version: Triple Nipple Cream.                                                                                                                   See my handout link at the bottom of the page. 
• Over the Counter version: Mix tube of Polysporin and tube of Hydrocortizone Ointment 1% and apply to nipple safter breastfeeds for a few days
• Avoid: Soap on nipples while showering, Vaseline, A&D ointment, Vitamin E, witch hazel, tea bags.  

Additional thoughts on the sore nipple treatments:                                                  

 Hydrogel Pads: These are designed to cool and protect sore or cracked nipples, to be worn in the bra in between feeds. (Some brands are: Medela Tender Care, Soothies, Ameda Hydrogel Pads.)                                                                                                          

Breast Shells: If you can’t air out and sit around naked Breast Shells can be put in your bra to increase airflow to the nips. Medela® TheraShell™ Breast Shells Treat sore nipples with large-holed backs or treat engorgement or flat/inverted nipples with small-holed backs.                                                                                                         

Silverettes are expensive and difficult to use with large nipples but Mom’s and IBCLCs love them. “SILVERETTE ® are small cups crafted out of pure 925 silver that fit over and help to protect nipples while breastfeeding. Silver is a natural antimicrobial, antifungal, and antibacterial metal that also contains anti-inflammatory agents.”                                                                                                    

Nipple Butters, Balms and Creams:                                                                                       “Wound care” for humans involves putting a specially designed cream or pads on top of a sore or wounded area so the tissues can heal from underneath. So only certain types of breast creams are best for this: Lansinoh HPA lanolin cream such as Medela Tender Care Lanolin or Lansinoh Lanolin Nipple Cream are two options to name the top two. Before modified lanolin, pure olive oil or coconut oil has always worked well, but now there are many brands of specially designed nipple butters and balms. It is recommended that mom check to see if it says “all ingredients safe for ingestion” and mom rubs it on her nipples and areolas right after breastfeeding. As with all butters and balms that are oil based they can quickly be absorbed into the fabric of mom’s bra or nursing tank top so the goal is to allow time to air out her nipples after applying the nipple butters.  

More Tips:                                                                                                                                    

Fix The Positioning  Mom should use 2 to 4 bed pillows, a nursing pillow or blankets under her breasts to create a ‘nest for your breasts’ so your baby can be turned towards you and have your baby’s chest against your breast.                                                                                                                    

Peek and tweak the latch. Fix those lips. Newborns have certain reflexes, if you push on the chin they will try to open wider and the bottom lip will flip out and the baby will get a wider latch.                                                                                                                      

Wake the baby for feeds in the first week of life. A sleepy baby will not open wide and extend the tongue as far, so taking a few minutes to sit up a sleepy newborn, peel off the layers of blankets and clothing and play with the newborn’s cheeks and lips may activate a wider latch and good feeding behaviors.                                                                                                                Visit with an IBCLC. A lactation consult can include ways to fix the positioning, tweak the latch and wake that baby for active feeding. www.ilca.org; www.uslca.org 

General causes of sore nipples: 

• Improper positioning at the breast
• Soreness at the tip of the nip - because baby is not wide enough, deep enough or the baby is repeatedly sucking in the bottom lip so tongue extension is limited
• Flat or inverted, retracted nipples
• Tongue-tie (ankyloglossia) is a problem with the tongue that is present from birth. It keeps the tongue from moving as freely as it normally would. It occurs when the frenulum on the bottom of the tongue is too short and tight. Symptoms are different in each child.
• Disorganized or dysfunctional  - often due to prematurity or facial bruising
• Breaking suction improperly
• Using nipple shields if the wrong size or not on properly
• Sensitivity to nipple creams
• Improper or excessive use of breast pumps - suction too high or flanges too small 
• Thrush (yeast infection in nipples and/or baby’s mouth)
• Delayed healing of cracks or abrasions on areola or nipple
• Prolonged exposure to wet nursing pads or to dry, abrasive fabric

Some Truth:                                                                                                                        

Breastfeeding is not supposed to hurt but the truth is most moms find they have some initial latch pain for the first few minutes of each latch for the first few days, which should then improve as the milk flows and baby gets better at breastfeeding. Initial tenderness is normal and peaks between Day 2 and Day 5, then mom’s mature milk “comes in” and mom’s milk supply increases to ounces between Day 2 and Day 5. Once mom’s milk starts flowing through her nipples like shower heads, the baby cannot suck as hard then the latch pain should go away. Once mom’s milk has switched from teaspoons of colostrum to ounces of mature milk breastfeeding should feel comfortable.  Milk flow should change the infant’s suck pressure. If initial nipple pain is not getting better, there is help!!!  

Here is an awesome article that is full of more helpful information. https://www.stanfordchildrens.org/en/topic/default?id=ineffective-latch-on-or-sucking-90-P02650