Sore nipples certainly seem to be common, but does that mean it’s normal for breastfeeding to hurt?

Simple: No!

Comfort Measures for Immediate Relief

Until the LC can visit, all mothers deserve pain management. This healing protocol is a good First Aid for sore or damaged nipples.

1. Saline soaks: 1/4 to 1/2 teaspoon of sea salt to 8 ounces warm water. Make this solution and heat it to very warm. Place solution in a shot glass or tea cup and invert over nipple. The salt water will soothe pain, clean any wounds, and promote healing. Soak about 10 minutes. Rinse afterward with fresh water.

2. Nipple ointment: There are hundreds of products on the market. Nipples with broken skin need to be kept moisturized to prevent scabbing.

a)Coconut oil is antifungal, making it a good choice for damaged nipples and preventing thrush. It’s vegetable       based, making it a good choice for vegan/ vegetarian families.
b) Lanolin has been shown to combat soreness. It is thick and stays on the nipple.
c) Olive oil can be used in a pinch. It absorbs into skin and clothing pretty quickly, so reapply often.
d) All Purpose Nipple Ointment is a prescription only product made in a compounding pharmacy. Your doctor or nurse midwife can call this in for you if needed. It contains antibiotic and anti-inflammatory ingredients to ease healing. Some mothers do experience allergic reactions, so this product should only be used after consulting with your provider.

Ideally, after nursing or pumping, mom should apply the saline soak. Rinse then apply nipple ointment. This will give the nipples a rest period to benefit from the treatment.

3. Swelling: Ibuprofen is a pain reliever and anti inflammatory. Call your doctor or midwife to discuss appropriate dosing. A Heating pad or rice sock can help milk flow out of the breast more easily and ease engorgement. This is a much better option than cold packs which can be restrictive and cause milk flow problems.

Next, call the LC and figure out what’s going on in there.

Pain is an indicator that something is off. Pain during breastfeeding can come from a variety of things, and they are all fixable. Most women experience pain caused by poor latch. There are many causes of poor latch.

Tongue tie
Ankyloglossia is the medical term for this easily repaired oral anomaly. Tongue tie is an inherited condition that causes the tongue to have limited range of motion. Tissue under the tongue, usually the connective tissue called the frenulum, is tight, thick, or restricts movement. This is not just a breastfeeding problem. Tongue tied children can have other feeding issues including difficulty with bottles and solids as well as speech problems later in life. There are many classes or types of tongue tie. Not all are visible. To properly diagnose a tie, an LC, pediatrician, dentist, or ENT will need to do an oral exam on your baby that includes feeling inside the mouth. Since it is a heritable trait, mothers who know there is a family history of tongue tie should have their babies checked at birth. This condition is easily remedied in most cases with a short out-patient procedure.

High palate or Bubble palate
Some baby’s are born with the hard palate higher than average or with a scoop or bubble shape in the palate. This is also a heritable trait. Families with a history of orthodontic appliances like palate expanders should ask for evaluation after birth by an LC, pediatrician, dentist, or ENT. Fortunately, breastfeeding helps this palate shape improve as the baby grows. An LC can work with baby and mother on ideal positioning to end discomfort and help the baby transfer more milk.

Lip tie
Similar to a tongue tie, this oral anomaly involves a frenulum that restricts the movement of the lip. This is not just a breastfeeding problem. Children with lip ties are at risk for tooth decay after they begin solids. Fortunately, this too can be completely remedied during a simple out-patient procedure. A simple oral exam can also identify this issue.

Oversupply of Milk and/or Forceful Milk Ejection Reflex
Most moms start with oversupply. Often, the milk is released so rapidly, the tiny newborn has a hard time coordinating suck-swallow-breathe. Babies respond with a shallow, apprehensive latch, pinching or biting the nipple, or breast refusal. An LC can asses the situation and help the mother develop a unique plan for breastfeeding management to make this short period of oversupply fruitful and comfortable.

Some causes of pain are due to health concerns in the mother. Mothers delivering by cesarean or who are Group-B Strep positive may be given antibiotics at delivery. Some mothers may develop thrush, or candida infection of the nipples as a response to antibiotics. This infection can spread to the baby. It is easily treated and is not a reason to discontinue breastfeeding.