Sore, cracked or bleeding nipples

What are sore, cracked or bleeding nipples?

Sore or cracked nipples can happen during breastfeeding, especially in the early days and first few weeks after giving birth. Some tenderness is normal as you adjust to breastfeeding. Ongoing pain, cracks or bleeding are often signs of nipple issues or conditions affecting your nipple or breast, for example, poor attachment or infection.

What symptoms are related to sore, cracked or bleeding nipples?

It’s normal for your nipples to feel more sensitive in the first weeks of breastfeeding.

They may feel tender when your baby attaches to your breast and starts to suck. This should get better after a couple of minutes. Over time, the discomfort and sensitivity should go away. If your nipples are sore, you may notice they are squashed, pale, ridged or flattened after a feed. The skin on your nipple may become red and inflamed and it can break. This is known as a cracked nipple.

Sometimes the crack is small and hard to see. Breastfeeding with a cracked nipple can be painful and the nipple may bleed during feeds.

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What causes sore, cracked or bleeding nipples?

If the pain doesn’t go away, the most common reason is that your baby is not attaching well to your breast. This means your nipple is not positioned well in your baby’s mouth. Your nipple can become damaged as it is squeezed between your baby’s tongue and palate. Some babies have a tongue tie, which can make it hard for them to attach well.

As your baby grows, new challenges can happen. Teething may lead to difficulties with attachment and some babies might start biting. Hormonal changes may also make your nipples more sensitive.

Pain that doesn’t go away can also be a sign of other nipple problems, such as:

• skin problems, such as thrush or eczema or blisters
• infections
• vasospasm
• a blocked milk duct or mastitis

How can I tell if my baby is not attaching well?

You might notice that your nipple looks squashed or the wrong shape after a feed. You might see cracks in the surface of your nipple, blisters, grazes or bleeding.

Watch your baby as they start to suck. They may not be attaching well if:

• their cheeks are sucked in
• their mouth doesn’t look wide open
• they don’t stay firmly on your breast, but come on and off
• you hear clicking sounds during the feed

How is the cause of sore, cracked or bleeding nipples diagnosed?

If breastfeeding is uncomfortable, a lactation consultant may help you. They can take a close look at how breastfeeding is going and check your baby’s mouth to find out the cause.

They may refer you to a specialist for further diagnosis and treatment.

When should I see my doctor?

If you have sore or cracked nipples, you may need to ask a lactation consultant for assistance. Your lactation consultant can guide you or help you decide if you should see a doctor.

If your baby is attaching well but your pain doesn’t improve, see your doctor. They can check whether you have another problem, such as a nipple infection or eczema.

See your doctor if you see yellow fluid coming from your nipple, or if a crack is taking a long time to clear up. These can be signs of infection and you might need medicine to treat it. If you feel unwell, flu-like symptoms (fever, chills or fast heart rate) or your breast is red or hard you may have mastitis and should see your doctor as soon as possible.

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How are sore, cracked or bleeding nipples treated?

Sore, cracked or bleeding nipples can be treated with a combination of self-care and adjustments to your breastfeeding technique. If needed, pain-relief medicine may help you to treat pain.

Self-care at home

There are a few things you can do to heal sore, cracked or bleeding nipples. It may help to:

• start the feed on the side that is less sore
• put a warm water compress over your nipples after feeding
• apply your hand-expressed breastmilk or a small amount purified lanolin on your nipples after feeding and leave it to dry
• keep your nipples dry as much as possible
• change your breast pads often
• hand express/massage prior to breastfeeding to increase milk flow

If you can, continue breastfeeding. If it’s too painful, you may need to take your baby off the breast for 12 to 24 hours. Rest your nipple and feed your baby expressed breast milk.

It might help to use a nipple shield. Talk to a lactation consultant or breastfeeding counsellor first to make sure you’re using the shield correctly.

Medicines

You may use pain-relieving medicine if needed. Talk to your doctor, midwife, lactation consultant or pharmacist to make sure it’s safe for breastfeeding.

Other treatment options

It is usually safe for your baby to feed on a bleeding nipple. If you have cracked or bleeding nipples and you also have hepatitis B, hepatitis C or other transmittable diseases, it’s important to temporarily stop breastfeeding. This is because there is a risk of passing the infection to your baby.

Talk to your doctor about what to do in this situation.

What are the complications of sore, cracked or bleeding nipples?

Some people have such trouble with nipple pain that they stop breastfeeding early. If your nipples become damaged, you could develop a breast infection called mastitis.

How can nipple problems be prevented?

Getting your attachment right early can prevent problems later. Try to make sure your baby’s mouth is attached correctly from the first few days of breastfeeding.

When expressing milk with a breast pump, make sure that the suction on your breast pump is not too strong.

Change your breast pads regularly. Don’t get soap or shampoo on your nipples.

Before putting baby to the breast

Wash your hands, go to the toilet and have a bottle of water next to you. Sit in a comfortable position and try to relax.

Apply a warm washer to the breast and gently massage or express to help milk flow. Express some milk to soften the areola and lubricate the nipple.

How to get your baby to attach to your breast correctly

• Make sure you are sitting or lying comfortably. Position your baby’s chest against your chest, with their top lip and nose facing your nipple.
• Position your baby so the first contact point is their chin on your areola. This is the coloured area around your nipple. This should make your baby open their mouth wide.
• Bring your baby’s head to your breast, not the breast to baby’s head. Support your baby to move to where they are trying to go — towards your nipple.
• Ensure the nipple, much of the areola and some surrounding breast are in your baby’s mouth.
• If your baby only takes your nipple into their mouth, without a mouthful of breast they will not feed well. It may also lead to pain.
• Your baby’s mouth should be open wide with a large amount of your breast inside.

After a few rapid gulps, your baby should start to suck and swallow in a regular rhythm. Breastfeeding should not be painful.

If the attachment feels uncomfortable, break your baby’s suction by putting your finger in the corner of their mouth. Take your baby off and let them re-latch to your breast. Try different feeding positions.

After the breastfeed

Check your nipples for redness and misshapen appearance. Nipples that are creased, ridged or squashed are a sign that your baby is not properly attached.

Wipe your breasts with clean water and let them dry. It can help to leave your bra off for a while and allow your nipples to air. Make sure your bra fits you well.

Gently rub a few drops of milk over your nipples to protect them.

Resources and support

• If you need help or are experiencing prolonged nipple pain, talk to your doctor, midwife, lactation consultant or breastfeeding counsellor.
• Visit the Australian Breastfeeding Association for information or call their breastfeeding helpline on 1800 Mum 2 Mum or 1800 686 268.
• The Australian Breastfeeding Association provides various links to reliable videos on positioning and attachment.
• The Women's provides tips for breastfeeding success.

Other languages

NSW Multicultural Health Communication Service offers translated information and support about breastfeeding topics, such as:

• Breastfeeding tips for new mothers
• Support services to learn the skill of breastfeeding
• Mastitis causes, prevention and treatment

Aboriginal and/or Torres Strait Islander peoples

• The Australian Breastfeeding Association provides breastfeeding resources for Aboriginal and/or Torres Strait Islander people.
• Breastmilk Talk- ‘Ngaminjang Djama’ Aboriginal and Torres Strait Islander mums having a yarn about the benefits of breastfeeding for mum and bub.