Momentary nipple pain and trauma are normal while breast-feeding is being established, at latch-on, or at the start of pumping. However, prolonged nipple soreness is generally associated with poor attachment and positioning, especially if the nipple is white or blistered.1Ensure that the baby is facing the mother during the feed, being held close to her body, usually with the tip of his nose brushing her breast tissue. The baby’s cheeks should not be drawn inwards: this indicates that the baby is tongue sucking rather than stimulating the maternal milk-ejection response (the let-down reflex). Check that the baby’s tongue is visible under the areolar tissue and nipple, being forward over the baby’s gum-line. The baby’s lip seal must be tight on the breast and he should not fall easily from the breast.
Applying a moisture barrier to the injured nipple (e.g. fresh expressed milk, natural skin oils or a specialist ultra-pure lanolin nipple cream) will help to reduce scab formation, accelerate healing and prevent infection,2 following the principles of moist wound healing.3 Wearing the correct size and type of nursing bra will also help: preferably it should be seamless across the nipple area and made of a natural, breathable material. Mothers can leave the bra flaps down to air-dry the nipples or use breast shells to keep clothing off the sore nipple and allow air to circulate. Occasionally using a nipple shield during breastfeeding may help, as may expressing milk for alternate feeds, or for a few days, on the affected breast: this will maintain her milk supply. The mother can also take paracetamol, for pain relief.
If the mother is relaxed before and while feeding and is sitting or reclining in a comfortable position, she is more likely to help the baby latch on properly. If the mother tenses up as the baby clamps on, positioning may be incorrect. The baby will sense the tension and will not feed properly.
Restricting the baby’s time at the breast will not prevent nipple soreness and will probably reduce the milk supply and quantity of hind milk consumed. The baby will not be affected if the nipple is bleeding.

References1. Cadwell K et al. Pain reduction and treatment of sore nipples in nursing mothers. J Perinat Educ 2004; 13: 29–35.

2. Bainbridge J. Dealing with breast and nipple soreness when breastfeeding. Br J Midwifery 2005; 13: 552 – 556.

3. Sharp DA. Moist wound healing for sore or cracked nipples. Breastfeeding Abstracts 1992; 12: 1.

From: Journal of Family Health Care Bulletin. Directory of Breast-Feeding Advice. December 2009. Published with JFHC 2009; 19(6).