Sore or cracked nipples

Some tenderness in the first weeks is common while your nipples get used to feeding. Pain that lasts, cracks or bleeding are signs to get help. Most causes can be fixed.

Common causes

• A shallow latch is the most common cause. Nipples that look flattened, wedged or white after a feed point to it. See the latch guide.
• Tongue tie can make a deep latch hard. See the tongue tie guide.
• A pump can hurt if the flange is the wrong size, the suction is too high, or sessions run very long.
• Skin irritation from breast pads, detergents or creams, including lanolin for some people.
• A white dot on the nipple (a bleb) is a sign of inflammation in the duct. Leave it alone, since popping it can make things worse.

What helps

• Fix the latch first. Other tips won't help much while the latch is off.
• Relatch if it hurts. Slide a clean finger into the corner of your baby's mouth to break the suction, then try again.
• Keep feeding as long as your baby wants.
• Dab a little breast milk on cracks after feeds.
• Change breast pads often, ideally ones without plastic backing. Wear a supportive bra without underwire.
• Skip saline soaks, and avoid nipple shields where you can.

White or purple nipple (vasospasm)

• The nipple turns white, then purple or red, with sharp, shooting or burning pain.
• It often happens after a feed, stepping out of a warm shower, or in the cold.
• It's more common in people with cold hands and feet or Raynaud's.
• Warmth right after a feed or when the pain starts helps. Keep cold off your nipples.

A nipple that's white and flattened right after a feed can also mean a shallow latch.

Thrush signs

• In you: burning nipple pain, especially after every feed, itchy nipples, or white patches or tiny blisters on the nipple or areola.
• In your baby: creamy white patches on the tongue, gums or roof of the mouth, or a diaper rash that won't clear.
• What to do: see your doctor. You and your baby are treated at the same time, and you can keep breastfeeding. Nipple pain has many causes and the role of yeast is debated, so a check beats guessing.

When to call your doctor

Call your doctor, midwife or an IBCLC (lactation consultant) if:

• Your nipples crack or bleed. Broken skin raises the risk of infection.
• Pain isn't easing over the first 1 to 2 weeks, or has lasted more than 2 weeks.
• It still hurts with a good latch.
• You see signs of thrush in you or your baby.
• There's a red, hot, painful area or you feel feverish. See the blocked ducts and mastitis guide.