Sore Nipples and Breasts in Breastfeeding Mothers

It is not uncommon for mothers to experience some form of soreness in the breasts or nipples, especially when the child first latches on to the breast during the first few weeks of breastfeeding. However, if the discomfort intensifies and becomes painful, if there are visible sores on your nipple or areola (darker skin around the nipple), or if you are thinking of stopping breastfeeding because of the pain, seek medical advice.

Causes

There are many possible causes for nipple and breast pain. Improper latching to the nipple by the baby is the most common cause. Other sources of pain during breastfeeding include:

  • Cracked nipple or areola
  • Fissured or chapped skin on the nipple or areola
  • Fungal (yeast) or bacterial infections
  • Eczema on the nipple or areola
  • Nipple vasospasm (blanching of the nipples brought on by contact with cold air which reduces blood flow to the nipple)
  • Use of an irritating or allergy-causing product on the nipple or areola (soap, cream)
  • Engorgement, mastitis and abscess (see the Vigilance handouts specific to these topics)

There are many myths about breastfeeding. Nipple soreness however, is in no way related to skin or nipple colour or to lack of nipple preparation during pregnancy.

Persons most at risk

Mothers with chronic skin conditions (ex.: eczema) and those who suffer from Raynaud's disease or diabetes are at a greater risk. Any condition in the child that hinders proper latching can also cause pain. Among some of the most common conditions in children are a tight lingual or labial frenulum, cleft lip or palate, lack of muscle tone or being preterm.

Symptoms and Diagnosis

The severity of symptoms and pain varies depending on the cause. They are helpful indicators in providing proper diagnosis and treatment.

Poor latch: severe pain when the baby begins to nurse but gradually diminishes during the feeding. Can lead to sores including chapping, fissures and crevasses on the nipple and areola if latching is not corrected.

Fungal infection: pain is present for the entire feeding and even afterwards in some. The pain is described as a stabbing or burning sensation. Nipples and areola may appear cracked, redder than normal or shiny. Thrush in the child's mouth or a fungal infection on the baby's buttocks may also be present.

Bacterial infection: intense pain accompanied by red irritation with or without pus.

Eczema: pain described as burning or stabbing. The nipples and areola appear dry and red. The amount of sores increases when the area frequently goes from dry to moist. Oftentimes, there are lesions elsewhere on the body. More common in those with asthma or allergies.

Nipple vasospasm: pain described as a burning sensation that only starts once the feeding is completed. The nipple blanches on contact with cold air. It may take several minutes for the nipple to regain its normal colour. The burning sensation then becomes a pulsating pain.

Treatment

A comprehensive evaluation by a qualified lactation consultant of the baby's latching and positioning at the breast and of the mother's and the baby's physical condition should be carried out before initiating any treatment whatsoever. Treatment may involve adjusting the infant's position at the breast, topical or oral medication, etc. Adequate follow-up is key to successful treatment and will allow the mother to continue breastfeeding under the best possible conditions.

Prevention

The best prevention is to make sure that the baby is properly latched and positioned at the breast as of the very first day. If you experience pain in spite of taking precautions, consult a medical professional as promptly as possible to prevent the situation from deteriorating any further and to prevent the premature discontinuation of breastfeeding.

If you have any questions, speak to a health care professional.

For more information:

La Leche League Canada

www.allaitement.ca (French)

www.lllc.ca (English)

Breastfeeding Committee for Canada

www.breastfeedingcanada.ca

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