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Sore, inverted or flat nipples

The initial failure of breastfeeding may be associated with sore, inverted or flat nipples. Explore solutions to help yourself overcome these problems.
LOVI, content-related consultation, Danuta Chrzanowska-Liszewska MD, neonatologist; Aleksandra Łada, NDT SLT Senior Tutor; Agata Serwatowska-Bargieł Ph.D., International certified lactation consultant (IBCLC), neonatologist | 30 March 2014

Too shallow latch on the areola and nipple biting result in sore nipples, poor emptying and consequently milk stasis which might lead to breast inflammation. To avoid this, work on your latching on technique. However, not all problems can be avoided, as the breastfeeding skill must be mastered by both mother and child. The following tips will help you deal with possible problems.

Painful or sore nipples

Sore nipples may be initially related to hormonal changes and increased susceptibility to irritation. Breasts must get used to suckling, and pain should subside after a few days. You can also feel pain if your child does not cover the whole areola with his mouth, but only a small portion of it, and he bites and hurts the nipple with gums. 

The reasons may be as follows:

  • Poor latching on technique or incorrect feeding position

  • Incorrect latch on a hard and filled breast during high milk supply

  • Shortened lingual frenulum

  • Difficulty with latching on an inverted nipple

  • Pressing the breast with a finger during suckling makes the nipple move inside the baby's mouth

  • Incorrect way of removing the nipple from baby's mouth after feeding

  • Greedy and hard latching on the nipple by a hungry child

  • Milk let down reflex disorders

What can you do?

  • After attaching the child to the breast make sure he properly latched on the nipple, and that most of the areola is inside his mouth. His lips should be wide open and curled out like in a fish.

  • Take short breaks between feeding.

  • If you feel the breast is hard and difficult to latch on, express some milk before feeding with your hand or a breast pump.

  • To stimulate the let down reflex before feeding shower the breasts with warm water and express some milk.

  • Wash your breasts with water no more than twice a day. Do not use soap as it dries and irritates the nipple.

  • Air sore nipples. Wear loose, cotton and airy blouses at home, and put on a bra and breast pads before going out.

  • If your clothing hurts, you can put small handle-less strainers bought in a tea shop or protective shells into your bra between feedings. They ensure air access, and prevent the nipple contact with a material.

  • Manual breast pump Protect, salvia wraps, healing ointment and strainers may be helpful
     
     
     

    Between feedings use sage or calendula infusion to soak the sore nipples.

  • Rub the nipples with your own milk after feeding.

  • Between feedings use a healing ointment that needs not to be washed off. Before feeding make sure the ointment does not remain on the skin - slippery areola can make the child's lips slip and latch on will be incorrect.

  • Remove the nipple from baby's mouth by inserting a finger between the breast and a corner of his mouth. This way you can break the vacuum, and the suckling stops.

  • If the nipples are so cracked that pain prevents the breastfeeding, feed the baby using accessories that do not disturb the suckling reflex until the nipples are healed.

Inverted or flat nipples

Flat or inverted nipples may initially hinder breastfeeding, but they are not a reason to abandon it. Proper latching on technique is half the battle in overcoming this problem.

What can you do?

  • Feed as often as possible. Frequent suckling is the best nipple shaping exercise.

  • Express some milk with a breast pump before feeding to facilitate effective latch on the areola.

  • Shape your nipple with fingers between feedings. Hold the nipple between thumb and forefinger and rub it to and fro, and pull gently. You can also use a syringe to pull away the nipple, previously cutting the syringe needle tip and inverting the plunger.

  • Electronic breast pump and Prolactis syringe may be helpful
     

    Express milk with a breast pump after and between feedings - it is also an excellent exercise for nipples.

  • If, despite your attempts, the baby does not want to suckle, consult a lactation specialist or a speech therapist.

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