by Jack Newman, MD, FRCPC

Here's What You'll Find Below:Proper positioning and latching
Getting your baby positioned
Helping your baby latch
Improving baby's suck
Vasospasm: My nipple turns white!
General Measures for Nipple Soreness

Introduction

The best treatment of sore nipples is prevention. The best prevention is getting the baby to latch on properly from the first day.

Mother and baby skin to skin contact immediately after birth for at least the first hour or two will frequently result in a baby latching on all by himself with a good latch. See the information sheets Breastfeeding -- Starting Out Right and The Importance of Skin to Skin Contact.

Early onset nipple pain is usually due to one or both of two causes. Either the baby is not positioned and latched properly, or the baby is not suckling properly, or both. However, babies learn to suck properly by getting milk from the breast when they are latched on well. (They learn by doing). Thus, "suck" problems are often caused by poor latching on.

Fungal infections of the nipple (due to Candida albicans) may also cause sore nipples. Vasospasm (which is due to irritation of the blood vessels in the nipple from poor latching and/or a fungal infection) may also cause sore nipples (see the information sheet Vasospasm and Raynaud's Phenomenon).

The soreness caused by poor latching and ineffective suckling hurts most as you latch the baby on and usually improves as the baby breastfeeds. However, if damage is severe, the soreness of a poor latch and/or ineffective suckling may go on throughout the feeding. Women describe knifelike pain from the a poor latch or ineffective sucking. The pain of the fungal infection is often described as burning but it does not have to be burning in nature. A new onset of nipple pain when feedings had previously been painless is a tip off that the pain may be due to a Candidal infection, but a Candidal infection may also be superimposed on other causes of nipple pain, so there was never a pain free period. Cracks may be due to a yeast infection. Dermatologic conditions may also cause late onset nipple pain. There are several other causes of sore nipples.

Proper Positioning and Latching

(See information sheet When Latching)

It is not uncommon for women to experience difficulty positioning and latching the baby on. If the mother positions the baby well, she facilitates the baby's getting a good latch and a good latch not only decreases the risk of the mother becoming sore, but also reduces the baby's chances of becoming "gassy" because a good latch allows the baby to control the flow of milk better. Thus, poor latching may also result in the baby not gaining adequately, or feeding frequently, or being colicky (see the information sheet Colic in the Breastfed Baby). See also nbci.ca for videos that show how to latch a baby on, how to know a baby is getting milk and how to use compression.

Positioning

For the purposes of explanation, let us assume you are feeding on the left breast
(See information sheet When Latching and the videos at nbci.ca)

Good positioning facilitates a good latch. A lot of what follows under latching comes automatically if the baby is well positioned in the first place.

At first, it may be easiest for many mothers to use the cross cradle hold to position your baby for latching on. Hold the baby in your right arm, pushing in the baby's bottom with the side of your forearm so that your hand turns palm upwards (towards the ceiling). This will help you support his body more easily as the baby's weight is on your forearm rather than your wrist or hand.

Holding the baby like this also will bring the baby in from the correct direction so that he gets a good latch. Your hand will be palm up under the baby's face (not shoulder or under his neck). The web between your thumb and index finger should be behind the nape of his neck (not behind his head). The baby will be almost horizontal across your body, with his head slight tilted backward, and should be turned so that his chest, belly and thighs are against you with a slight tilt upwards so the baby can look at you. Hold the breast with your left hand, with the thumb on top and the other fingers underneath, fairly far back from the nipple and areola.

The baby should be approaching the breast with the head just slightly tilted backwards. The nipple then automatically points to the roof of the baby's mouth.