About 80-90% of breastfeeding women seem to experience some degree of nipple soreness on account of nipple trauma and infection.1 Nipple pain is commonly encountered during the first 10 days of breastfeeding and when the infant is teething.2

Abrasions from feeding often cause sore nipples. Psoriasis, eczema and contact dermatitis can also cause sore nipples. The breaks in the skin heighten the chances of infections of the nipple, as well as mastitis.2

Sore nipples are a common cause of mastitis. Nipple fissures can cause pain and may promote the entry for bacteria, leading to mastitis.3 Improper latching to the breast has been shown to be associated with sore and traumatized nipples.4 A study found the most common attributed cause of nipple pain to be incorrect positioning and attachment.5

Correct positioning and latch; therefore, is a potential treatment option for cracked, sore and painful nipples. Simple improvement of the infant’s latch can often relieve the condition.4 Correction of positioning and attachment is an experience-based recommendation for the treatment of nipple pain. When performed within the first week of birth, it has been associated with a longer duration of breastfeeding and fewer breastfeeding problems, including sore nipples.5

Mothers can choose from various breastfeeding positions to breastfeed their babies. These include laid back breastfeeding or biological nurturing, cross cradle hold, cradle hold, rugby or football hold and side lying position.6

Effective positioning and attachment while breastfeeding have been recommended as potential measures for preventing mastitis. Prevention of nipple trauma through good position and attachment can help prevent the development of mastitis.7

Appropriate positioning involves the following: 7

• The baby’s head and body should be in alignment and the neck should not be twisted
• The baby’s tummy should be turned towards the mother’s tummy
• The baby’s head should not be held but the neck and shoulders should be supported allowing the baby’s head to tilt backwards
• The woman may shape her breast to enable a deeper latch
• The baby must start a breastfeed with the nose opposite the nipple
• When the mouth is wide open, the baby should be brought to the breast with the chin leading
• The nipple should point towards the roof of the baby’s mouth
• The baby’s body should be held close to the mothers’ body.

References

1. Saeidi R, Robatsangi MG, Tafazol M. Effect of aloe vera gel on nipple sores. Iranian Journal of Neonatology 2010;1(1):13-4.
2. Khan T. Common Breastfeeding Problems, Part 3 of 3: Nipple Pain + Infection. Available from: http://www.familydocs.org/f/14.CME_.Spotlight.JAN_.Breastfeeding.pdf.
3. Spencer JP. Management of Mastitis in Breastfeeding Women. Am Fam Physician. 2008 Sep 15;78(6):727-731.
4. Walker M. Are There Any Cures for Sore Nipples? Clinical Lactation 2013;4(3), http://dx.doi.org/10.1891/2158-0782.4.3.106.
5. Kent JC, Ashton E, Hardwick CM, et al. Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments. Int J Environ Res Public Health. 2015 Oct; 12(10): 12247–12263.
6. Positioning and Attachment of Baby to the Breast - Fact sheet for Health Care Professionals. Available from: https://www.breastfeeding.ie/Uploads/Positioning-and-attachment-of-baby-to-the-breast.pdf.
7. Mastitis Prevention and Treatment. Available from: http://nationalwomenshealth.adhb.govt.nz/Portals/0/Documents/Policies/Mastitis%20Prevention%20and%20Treatment_.pdf.