Cracked Nipples From Breastfeeding

By Ece · Founder of Idaho Jones, pumping mom

Causes, relief, and prevention for cracked nipples

First of all, ouch. We feel for you. Cracked nipples don't have to be part of the breastfeeding experience, but sometimes they happen. They're a painful injury that needs to be taken seriously and treated properly so they heal up and don't come back. Let's look at prevention, causes, treatment, and how to keep your baby fed while you recover. Read on for relief.

While cracked nipples can occasionally result from a one-off incident like a teething bite from an older baby, it's far more likely the damage built up over time from a sub-optimal position and latch, or a yeast infection of the nipple (thrush). The two often go together: minor abrasions from a shallow latch become host to yeast, which then proliferates into painful cracks.

If you find yourself with cracked, damaged nipples, don't despair. Have a good cry if you need to, but know there is help and relief available. Cracks will heal. This does not need to be the end of your breastfeeding journey.

First, can you keep feeding at the breast?

Before figuring out the cause, the first thing to determine is whether you can keep feeding at the breast or need to temporarily interrupt and pump instead. If only one nipple is cracked, you could keep breastfeeding on the intact side while pumping the painful side. A breast pump is less likely to further injure the nipple or cause pain, provided the flanges fit properly and do not rub against the nipple (they should not). Keep removing milk from the affected breast during this time, both to protect your supply and to prevent the infection (mastitis) that can follow sudden weaning.

If you don't have access to a quality breast pump that fits properly, your best bet is to keep putting your baby to the breast. The sharpest pain will be at the initial latch and usually lasts only a few seconds before easing.

From Idaho Jones

Soft silicone, gentle on tender tissue

If you're pumping while a nipple heals, the flange shouldn't make it worse. Cushy is soft silicone instead of hard plastic, so it cushions rather than rubs. Lactation consultants have reached for it with clients pumping through nipple damage, and it comes in 2mm sizes from 13 to 30mm for a fit that doesn't pinch.

Shop Cushy →

A few tips to see you through:

1. Feed on the least sore side first. Your baby will likely be gentler on the second breast.
2. Use a different position than you're used to. Get creative, and take a look at our blog post on nursing positions to try.
3. Ice your nipple for a few seconds before latch to take the edge off the pain.
4. Ibuprofen about twenty minutes before latching can also help, and is compatible with breastfeeding.
5. If you need to take the baby off the breast, break the seal by gently inserting a finger in the corner of the baby's mouth first.
6. If your baby wants to comfort nurse at the end of the feed, use the least sore breast, or let a partner or helper tend to them.

Nipple care while you heal

1. Right after breastfeeding, bathe your nipples in normal saline solution. It sounds like it would sting, but it doesn't, it's gentle, prevents infection, and speeds healing. Mix ½ tsp salt in 8oz of warm water. Hold a burp cloth under your breast and dribble the solution from a squirt bottle onto the cracks. Do this after every feed or pump session until the cracks are gone, then air dry or pat dry with a clean, soft cloth.
2. Moist wound healing. It's not about keeping your breasts wet, it's about a barrier that maintains internal moisture and promotes healing. Use a pure lanolin nipple ointment or try hydrogel pads. Both are soothing and hypoallergenic for mom and baby.
3. Your own breastmilk can help. If you leak between feeds, rub a little onto your nipples with clean fingers and let it air dry.
4. Skip the nursing pads for now. If you must wear them, change them frequently.
5. Try going topless between feeds to expose your nipples to room air.
6. It's okay, and helpful, to wash cracked nipples with mild soap once a day in the shower.
7. If wearing a bra is painful, try breast shells to keep the fabric off the crack.

When to get help? Probably now

There's a lot of quality information out there for hurdles like cracked nipples, but sometimes nothing beats a consultation with an expert, and this is likely one of those times. Consider a visit with a lactation consultant, a qualified helper like a La Leche League leader, or your OB-GYN. Eyes on the problem now can only help you heal faster and get to the root of it.

Getting to the cause

So far we've covered minimizing pain and basic wound care, but not the cause of the damage. Breastfeeding is not supposed to hurt or cause injury, so what's going on? There are two general places to look:

1. Technique-related problems
2. Anatomical considerations (either baby-sided or mom-sided)

We'll look at both, but first an important caveat.

Some nipple wounds should be treated with prescription medication.

When infection is present, fungal or bacterial, the self-care above is soothing and promotes healing, but should be paired with targeted topicals or even oral medications. Oozing, or greenish or yellow coloration in an open crack, warrants a doctor's visit. Short of that it isn't always clear. The key is whether your self-care is moving the needle. If pain isn't improving and your nipples aren't showing signs of healing within a day or so, please seek help.

Technique: a shallow latch

Breastfeeding is not nipple feeding. To feed effectively, baby opens wide and latches deeply onto the breast, with the nipple far back in the mouth, making gentle, painless contact with the soft palate. Baby forms a seal, and tongue and jaw action draws milk from deep in the milk-making tissue, through the ducts, into the mouth. For most mothers, this is a mild sensation that many find comfortable.

With a shallow latch, the nipple is clamped against the hard palate at the front of the mouth, and the baby's tongue and jaw cause painful friction on sensitive nipple tissue. Over time that friction and pressure leads to abrasions. Abrasions sting but are bearable for most, but if not corrected promptly, they worsen with continued friction or become host to yeast or bacteria.

Here is a great post on how to achieve a deep, comfortable latch.

Anatomy: baby's side

In a word, tongue-tie. This is where a tight lingual frenulum restricts the baby's tongue movement, causing painful friction on the nipple and often ineffective milk removal. If you suspect it, see a lactation consultant or your baby's pediatrician. In most cases tongue-ties are released quickly and painlessly, with notable pain relief for mom and a more satisfied, less frustrated feeder.

There can be other baby-sided causes too. Torticollis, a temporary condition from the baby's positioning in the womb, can impede a comfortable, effective latch. A lactation consultant can help with positioning ideas, and your pediatrician will have further resources.

Anatomy: mom's side

Mom-sided issues can be as simple as large nipples (lactation consultants sometimes jokingly call this an "oral-boobular disproportion"). This typically improves over time as the baby grows.

A tool, but use with caution.

We'd be remiss not to mention that some moms with cracked nipples benefit from a properly fitted nipple shield, a soft, silicone device worn over the nipple with holes that allow milk transfer. You can pick one up at your local pharmacy. It can provide temporary relief and keep mom and baby breastfeeding through healing. But nipple shields can slow milk transfer, and some babies become dependent on them, so use this tool with caution.

Wishing you a speedy recovery from nipple damage, and much joy along your breastfeeding journey.