Nipple pain and damage
There seems to be a general perception that nipple pain is a normal part of breastfeeding. Whilst it is very common, and often just improves with time, it doesn’t have to be inevitable, and can be both prevented and treated.
Studies show that 34-95% of women experience nipple pain and damage with breastfeeding, and it is a common reason that women come to see me for help.
What causes nipple pain and damage?
The key underlying cause is nipple drag from an unstable latch and position- this can feel like subtle “pulling” and discomfort during the initial latch (or entire feed) and can progress to severe pain and trauma
Sometimes secondary infection with thrush (candida) or bacteria can cause persistent and worsening nipple pain and damage that is visible to the eye
Dermatitis or eczema affecting the nipple can also contribute to pain- this is more common in women who have a previous history of eczema or sensitive skin. Occasionally products that women use on their nipples can worsen or even cause irritation
Nipple vasospasm can also occur secondary to nipple damage - this causes a sharp, shooting pain that is often worse in cold environments
How can nipple pain and damage be treated?
Have as much time as possible with no bra on and with breast milk only on the nipples.
If it is necessary to wear a bra, use a generous amount of a barrier cream to stop the nipples from rubbing on the bra/ breast pad (use a simple, unscented product, that is safe and approved for use with breastfeeding)
Minimise having anything potentially irritating from sitting against your nipple- consider switching to washable/ reusable breast pads as the disposable ones can be irritating; occasionally soothing gel pads can also irritate the nipples
If there is significant damage, a short break from direct feeding might be necessary - in this case, you will need to express and give the baby expressed milk to protect your supply and ensure they’re getting enough calories while things heal
See a lactation specialist for help with optimising the latch and position, and for advice about expressing and feeding your baby if you need to rest the nipples completely
See a doctor if you have persistent damage and pain to exclude a secondary infection - a swab can be taken to confirm the diagnosis. They can also diagnose eczema or dermatitis, which may also require a prescription steroid cream for treatment
For treatment of vasospasm, keep the breasts as warm as possible. Prescription medications are occasionally required if vasospasm is severe.
