Managing painful and sore nipples - Improving the breastfeeding experience


eMediNexus    18 May 2018

Many women experience painful sore nipples that prevents them from breastfeeding their infant for a sufficient period of time.1 Common causes of nipple pain in the absence of an infection include improper latch or flat/inverted nipples.2

A study evaluated the relationship between various aspects of optimal breastfeeding such as the positioning of the baby at the mothers breast, the positioning of the babys head and mouth, the breastfeeding dynamic and the latching process, using a guided assessment and documentation tool and the breastfeeding mothers level of reported pain on a five-point verbal descriptor scale. In all, 95 healthy postpartum breastfeeding mothers who sequentially reported sore nipples within ten days of giving birth to healthy, term babies were recruited in the study. Each mothers midwife observed, assessed and documented a breastfeed using a guidance assessment form, the Lactation Assessment Tool (LAT). Pain during breastfeeding was scored by each mother. Four attribute categories were scored and examined as related to the pain levels of the mother: the babys face position (chin and nose and head position, cheek line, lip flange and angle of mouth opening); the babys body position (height at the breast, body rotation and body in relation to mothers body); the breastfeeding dynamic (change in breastfeeding pattern (suck vs. swallow) and movement of mothers breast) and the latching process of the baby (root, gape, seal and suck). No significant difference was found between the mothers level of reported pain and the assessed head position, body position or breastfeeding dynamic attributes of the baby. However, more optimal latching process behavior of the baby (rooting, gaping, sealing, and sucking behaviour) was noted to be related to lower levels of reported pain.1 Correction of positioning and latch is often the initial approach to manage sore nipples. Improvement is often seen by the simple improvement of the infant’s latch.3

Besides assessment of latch, suck, and swallowing and correct positioning as measures to prevent nipple soreness,3 topical preparations can also be used to manage traumatized nipples. Virgin coconut oil and kokum butter are beneficial therapeutic options to manage dry, cracked and sore nipples. Virgin coconut oil has long been used in Ayurvedic medicine for skin disorders. Positive results have been reported by lactation consultants with the use of virgin coconut oil on sore nipples. This oil has a broad spectrum of activity against bacteria, fungi, and viruses. A wide range of biologically active ingredients are found in coconut oil that can explain its wound healing properties. Virgin coconut oil has also been found to be better than olive oil in its ability to eliminate S. aureus from adult skin with atopic dermatitis.3

Kokum oil, or kokum butter, is useful in certain skin conditions. It has been used successfully as an application for ulcerations, fissures of lips, hands, chapped skin, as well as wounds and sores associated with inflammation.4 Kokum, or Garcinia indica, contains anthocyanin pigments, tannins, pectin, omega oils, hydroxycitric acid, garcinol, citric acid, oxalic acid and ascorbic acid. An infusion prepared from kokum can be directly applied to skin rashes, burns and dry skin on account of its cooling effects. Kokum butter has soothing properties and is an astringent and is often used in ointments to treat fissures and cracked skin.5 Kokum butter is an excellent emollient and therefore, can be used as a natural moisturizer to keep the skin supple. It is effective for treatment for severely dry skin, ulceration and fissures.6


  1. Blair A, Cadwell K, Turner-Maffei C, Brimdyr K. The relationship between positioning, the breastfeeding dynamic, the latching process and pain in breastfeeding mothers with sore nipples. Breastfeed Rev. 2003 Jul;11(2):5-10.
  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. 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.
  4. In: Dr. K. M. Nadkarnis Indian materia Volume 1.
  5. In: Healing Spices: 50 Wonderful Spices, and How to Use Them in Health-giving Foods and Drinks. Hartvig K (ed.).
  6. Swami SB, Thakor NJ, Patil SC. Kokum (Garcinia Indica) and its Many Functional Components as Related to the Human Health: A Review. Journal of Food Research and Technology 2014;2(4):130-42.

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