Help For Sore, Bleeding, or Cracked Nipples

At some point in your breastfeeding journey, you will probably have sore nipples. Your nipples can feel sore from virtually any reason under the sun: postpartum hormonal changes, early engorgement, shallow latch, dryness, medical conditions such as thrush and vasospasm, suction trauma, a biting baby, allergic reaction to a lotion or fragrance, even sunburn if you’ve been spending your summer beach days European-style. Sore nipples is also one of the first signs of pregnancy for many women.

“The best treatment for sore nipples is prevention.” Probably not what you wanted to hear, but it’s true, says Dr. Jack Newman. The most important part of treating sore nipples is to target the cause of the pain and effectively treating that.

If you’re suffering from sore nipples (whether unbroken skin or broken, cracked skin), it’s time to evaluate a few things:

  • How’s your latch?
  • How about your positioning?
  • Are you engorged so much that your areola skin is constantly stretched very tight?
  • If nipple trauma is persisting, have you considered whether baby might have nipple confusion? (If you use bottles or pacifiers, baby might be enacting the ‘bottle suck’ on your very un-bottle-like nipple).
  • How’s your breast pump working for you — are your flanges the correct size?
  • Are you reacting to the material in a nipple shield or ingredients in a nipple cream?
  • If you’ve introduced solids, have you noticed if leftover crumbs/particles are still hanging out in baby’s mouth when nursing?
  • Have you been following your great-granny’s ‘sage’ advice to scour your nips with something super rough in preparation for nursing? (I really hope not!)
  • Is your baby teething and chewing, or even biting?
  • Have you noticed oozing pus, bleeding, swelling, or indications of a bacterial/fungal infection? If yes, you should consult with your doctor for a diagnosis and possibly an antibiotic.

…okay, that was more than a few things!

While working on a resolution to the source problem, there are a few ways you can find relief for the nipple pain. A little dab oughta do ya:

  • Breast milk has amazing healing properties. You can hand-express a bit and swipe it over the areola to benefit from the sterile, anti-infective, anti-bacterial properties.
  • Medical-grade Lanolin such as Lansinoh is the go-to for most nursing mothers (vegans should avoid as it’s derived from sheep’s wool. Alternatives include extra virgin olive oil and coconut oil). This is safe to leave on the nipples while nursing. Please note, any cream or oil that you use on your nipple — even if you plan to wipe it off before nursing — must be deemed safe for consumption by your baby.
  • Use All-Purpose Nipple Ointment (APNO), created by Dr. Jack Newman, after each feeding.
  • Apply Evening Primrose Oil for soreness around the time of ovulation/menstruation.
  • Coconut oil can re-establish moisture balance to especially dry nipples.
  • If nipples are cracked, apply an ice pack to numb the areola before latching. Then do a salt water rinse (saline soak) after nursing.
  • Between feedings, protect your nipples from rubbing against your bra with clean disposable breast pads. Better still, go topless and give them plenty of air-time.

Some old wives’ tales about nipple care during breastfeeding still circulate in mothers’ groups, families, and even medical communities. Here are a few myths and misconceptions:

  • Despite what granny might insist, it’s not necessary to ‘prepare’ your nipples during pregnancy for breastfeeding. You might hear that you should twist and pull them, rub them with a rough towel, sand them (seriously, women did this once upon a time), and various other pretty horrible things to ‘toughen’ them. Well, you shouldn’t! If you really feel you must do something, you can give them lots of air-time, or practice breast compressions.
  • You should avoid soaps and body lotions on your nipples. The areola has a protective secretion already that is meant to keep the area’s moisture balance in check. Nipples that are supple from their natural oils are good and ready for breastfeeding, not ones that are regularly wiped off and scrubbed. Also, some babies are known to refuse to nurse after mom has freshly showered.
  • Though it seems like the damp warmth of wet tea bags would feel really good on achy nips, they can increase dryness and pain.
  • Drying your nipples with a sunlamp or hair dryer is an outdated, bad idea. You want to promote what’s called moist wound healing (which speaks of internal hydration balance in tissues rather than external moisture), which has been proven to heal nipple abrasions twice as quickly as drying out the area.
  • Be careful with hydrogel dressings commonly given in hospitals because they’ve been associated with high infection rates.
  • Avoid nipple shields as they aren’t proven to prevent (or even decrease, in many cases) nipple soreness.

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