Baby Mum: Sore Nipples And Nipple Infections

Sometimes breastfeeding mums have issues with sore nipples and nipple infections. If you have sore nipples, start by checking your baby’s breastfeeding attachment. For a nipple infection, you need to see your GP.

Oversupply of breastmilk

Oversupply of breastmilk might be the problem if your baby has a lot of wet nappies, and if you’re noticing other issues with or after feeds.

For example, your baby might seem to have a tummy ache or wind, or baby might be crying a lot and is fussy especially after feeds. Often your baby won’t want the second breast.

In some cases, milk seems to flow very quickly, and your baby can’t swallow fast enough to keep up. Your baby might also gag or gulp, especially at the start of a feed.

Other symptoms include baby vomiting after a feed or having green and frothy poos after feeding.
If oversupply sounds like your situation, you can try any of the following:

• Feed your baby from only one breast at each feed. Put him back on the same breast if he needs a top-up soon after the feed. Use the other breast for the next feed 3-4 hours later. 
• Check your position and technique – our illustrated guide to breastfeeding techniques and illustrated guide to breastfeeding positions might help.
• Express a little bit of milk if your breasts feel uncomfortable. But too much expressing will make more milk, so express just enough to relieve pain or discomfort.

Sore nipples caused by baby not attaching properly

The most common reason for sore nipples or damaged nipples is your baby not attaching properly to your breast.

You can expect some tenderness in the first few days or weeks of breastfeeding, but it’s not normal to feel actual pain.

If you’re in pain from sore nipples, you have at least two options. You could seek help from a child and family health nurse, midwife, ABA breastfeeding counsellor or lactation consultant. Or you could try the baby-led method of attaching your baby.

More options for sore nipples

If you’ve checked your attachment and you still have sore nipples, don’t give up just yet.
The problem of sore nipples doesn’t usually last, and there are more things you can try:

• Try to trigger your let-down before your baby attaches to the breast. Damaged nipples hurt most at the beginning of the feed, before your milk lets down. The pain usually eases when the milk is flowing. To trigger your let-down, you could try looking at your sleeping baby, thinking about a tender moment, or massaging your breast with a warm, wet cloth.
• Offer your baby a feed before she’s crying with hunger. A calmer baby will be gentler on your nipples. You can also start the feed on the breast that’s less sore.
• If you can, avoid using teats, bottles or dummies. Babies need to suck differently on breasts and bottles, and they can get confused if they’re being offered both in the early days of breastfeeding.
• If your nipples are very sore, express your milk either by hand (the gentlest method) or with a good-quality breast pump on a gentle setting. Feed your milk to your baby by cup or spoon until your nipples feel better.
• Check your nipples at the end of each feed for signs of damage like cracks or looking squashed. If you think your nipples are damaged, see your GP or child and family health nurse.  
• Air-dry your nipples after breastfeeding, and change breast pads often to keep your nipples dry. Avoid using shampoos and soaps on your nipples.
• Work with a lactation consultant if you want to try nipple shields. They might help with sore nipples in the short term, but they can sometimes create more problems than they solve. 

If the soreness doesn’t get better each day, it’s worth talking to an ABA counsellor, midwife or your child and family health nurse. They might suggest that an experienced lactation consultant or paediatrician examines your baby’s mouth. There could be a  tongue tie or something else about the shape of your baby’s mouth that’s affecting his ability to breastfeed.

Sore nipples that develop after a period of comfortable feeding are most likely caused by a bacterial infection, thrush infection or both. In this case, you should talk to your GP. There’s also more information about nipple infections below.

Even if you’re finding it too painful to feed your baby, you still need to keep your milk moving by expressing it. If you don’t take the milk out regularly, your breasts might become engorged and you’ll be at risk of mastitis. Not emptying milk regularly will also reduce your milk supply.

Nipple infections

Sometimes, cracked nipples can get infected with bacteria (Staphylococcus aureus or ‘staph’), thrush (Candida albicans) or both. It can be hard to diagnose which of these is causing problems. Sometimes women might develop nipple thrush after they’ve had a course of antibiotics.

Symptoms of nipple infection might include sore nipples and shooting pain in the breast. Not only is nipple infection particularly painful, but it can also be passed back and forth between mother and baby.
There isn’t a standard treatment for nipple infection. It’s normal for different doctors to treat it differently.

If the doctor suspects thrush, treatment is likely to involve an oral gel or drops for your baby’s mouth and an ointment for your nipples. Sometimes there might be another ointment for your baby’s bottom. The doctor might also prescribe antifungal tablets for you.

If the doctor suspects staph, the doctor might prescribe antibiotic ointment and/or possibly oral antibiotics for you. Some doctors might prescribe a combination of treatments for your nipples.
Nipple creams rarely help, unless they’re prescribed for a medical reason – for example, an infection. A few drops of your own breastmilk – expressed by hand at the end of a feed and spread over your nipple – is the best ‘nipple cream’.