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How do I prevent sore nipples?

Pregnant women at a recent Maternity Fair were heard to ask La Leche League Leaders, "I want to breastfeed my baby but I heard you will get sore nipples. Is that true?" Breastfeeding is not supposed to hurt. It is intended to be an enjoyable experience for you and your baby.

Visiting this Web site is an excellent step in the prevention of sore nipples. Learning all you can about breastfeeding will help you breastfeed your new baby. Attending an LLL meeting is also very helpful. You will be able to observe mothers breastfeeding their babies. Common concerns, as well as the joys of breastfeeding are discussed at meetings so you can learn how to get off to a good start with your baby.

Sore nipples are most frequently caused by improper positioning of the baby at the breast. See our Positioning Your Baby at the Breast for complete details. These basic steps will help to prevent sore nipples:

  1. Position yourself comfortably with back support, pillows supporting your arms and in your lap and your feet supported by a footrest or a telephone book.
  2. Position baby close to you, with his hips flexed, so that he does not have to turn his head to reach your breast. His mouth and nose should be facing your nipple. If possible, ask your helper to hand you the baby once you are comfortable. (See "Going Beyond the Basics" for details.)
  3. Support your breast so it is not pressing on your baby's chin. Your baby's chin should drive into your breast. (See "Breast Support Techniques" for descriptions.)
  4. Attach or latch baby onto your breast. Encourage him to open his mouth wide by tickling his lips with your nipple and saying, "Open". Pull him close by supporting his back (rather than the back of his head) so that his chin drives into your breast. His nose will be touching your breast. Your hand forms a "second neck" for your baby. (See "Is My Baby Latched on Well" for further information.)
  5. Enjoy! If it does not feel comfortable, detach and gently reposition the baby

These steps may need to be repeated frequently during the early weeks. You and your baby will find a technique that works for you after some practice.

Sore nipples can have other causes such as:

Flat or inverted nipples: Mothers with nipples in this category have successfully breastfed their babies without pain. Flat nipples do not become erect when stimulated or cold. Inverted nipples actually retract rather than protrude when the area around the nipple is compressed. Wearing breast shells during pregnancy may help to draw out your nipples. Once your baby is born, it may help to use a breast pump to pull out your nipple immediately before latching your baby on to your breast. See our FAQ on flat nipples for additional help.

Engorgement: Full, hard breasts can occur in the early days of breastfeeding. This may result in flat nipples which make it difficult for your baby to latch on. To avoid this condition be sure your milk is being removed frequently from your breasts. If your newborn is not breastfeeding every 2 hours or so, hand-expressing or using a breast pump may help you avoid engorgement. (As your baby grows he will go longer between feedings without you becoming engorged.) Our FAQ on engorgement is an excellent source of information on dealing with this painful condition and contains information on reverse pressure softening, which may quickly help with engorgement.

Using a Breast Pump: Just as breastfeeding is not supposed to hurt, neither should it be painful to use a breast pump. You may need to experiment to find a breast pump that is comfortable for you. Generally, when your nipple is centered in the flange's walls and the suction is gentle you can avoid injury. Pumps may be available from your local Leader.

Removing Baby from Your Breast: Very gently! Many mothers find that once their baby is satiated, he or she will release the breast. If baby must be moved before this happens, try inserting a finger into the corner of your baby's mouth, pulling down on baby's chin, or pressing down on your breast near baby's mouth to break the seal.

Use of Pacifiers (Dummies) or Bottles: If your baby receives any nipple other than your own, including pacifiers or bottles, a condition known as nipple confusion can result. This is because an entirely different technique is used by your baby to breastfeed rather than suck on an artificial nipple. This may cause your baby to breastfeed improperly and cause soreness. If this occurs, your baby can learn to breastfeed properly. Be sure to consult with your local Leader. See also Myth 15 in this article.

Thrush: If your baby is no longer a newborn and you suddenly find yourself with sore nipples or deep breast pain, you may have thrush. See our FAQ on Thrush for further identification information and treatment options.

By educating yourself during pregnancy you will enhance your breastfeeding experience. If your baby has already been born, determining the cause of your sore nipples is the first step toward healing your nipples and resuming a pain-free breastfeeding experience. See our FAQ How Do I Heal Sore Nipples? for further information.

Resources for Additional Information

Contact a local La Leche League Leader for more information and support during this challenging time. For help in finding a local Leader, check out Finding a Local LLL Group

Our Web resources collections have many articles, podcasts and other resources with further information on these relevant topics:

These pamphlets may be available from a local LLL Leader or Group:

  • Positioning Your Baby at the Breast is a step-by-step guide to positioning the baby correctly to ensure that baby sucks well and gets plenty of milk, and mother avoids nipple soreness and pain.
  • Sore Nipples includes step-by-step illustrations of latch-on and emphasizes the importance of correct positioning; also features recommendations about treatment of sore and cracked nipples reflecting current research on moist wound healing.
THE WOMANLY ART OF BREASTFEEDING, NEW 8th Edition, published by La Leche League International, is the most complete resource available for the breastfeeding mother.

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