Painful Nipples

Painful nipple trauma (cracks, blisters, scabs, bleeding)

    Use moist wound healing

• Apply nipple balm (without lanolin), an antibiotic ointment (Bacitracin OTC), or pasteurized medical grade honey (Medihoney).
  • Use a small amount, and you don't need to wipe it off when your baby nurses again.
  • Don't ask for Triple Nipple Ointment.
    • 2 of the 3 ingredients are unecessary, and it's expensive to compound. 
• Cover the ointment with a non-stick pad, like hydrogel pads  or parchment paper.
  • If the wound sticks to your bra or breastpad, trauma recurs with each feeding. 
• Deep cracked wounds must fill in and heal from the inside outward, because we can't close a nipple wound with a suture.
  • Apply a hydrocolloid bandage, which needs to be removed and replaced for every nursing or pumping session.
  • If the wound is at the base of the nipple, consider wearing a breast shell (used for inverted nipples) to hold the edges apart so the wound can fill in and heal from inside out. 

    Consider using a nipple shield

• Temporary use of a nipple shield will create a barrier between your nipple and your baby’s tongue, to lessen pain until the wound heals. Don’t let your baby’s mouth slide on and off the shield while nursing. 

    Pump exclusively for a bit

• If the latch is intolerable, in place of nursing until the trauma heals. 
• Click here  to view a video on pumping. It's important to use the correct size flange and don't pump for too long.

Vasospasm

Intermittent or persistent burning pain of the nipples, with stabbing or shooting pain into the breast is likely from vasospasm. It is caused by constriction of blood vessels, and can be random, but it usually occurs with exposure to cold. Typical spells occur right after nursing, when getting out of a shower, or during pumping. The nipples turn purple or pale, which can be hard to see in dark skin. It's more common in women with a history of "Raynaud's Syndrome," which causes similar symptoms in the hands and feet. 

To manage this:

• Vasospasm is more common if there is an over-supply of milk. If that's case, you'll need to down-regulate your milk supply.
• Resolve nipple trauma. Click here to view latching videos.
• Keep your nipples warm.
  • Apply dry heat over your bra immediately after nursing (heating pad, hand warmers).
  • Wear wool or fleece breast pads between feedings.
• Avoid caffeine and nicotine, which constrict blood vessels.
• If symtpoms are severe, consider medications that dilate blood vessels to increase blood flow. 
  • Side effects of these meds include headache, dizziness, low blood pressure, flushing and fast heart rate.

Nipple bleb

A very painful white pimple can plug the opening of a milk duct on the face of your nipple.
“Stuck” milk might pool deep in the breast tissue and ducts, and then get infected.
Milk supply may decrease, since the milk can’t get out.

To mange this

• Leave a new bleb  alone if it is not painful and doesn't seem to block any flow of milk. If it is a problem, soften it with a warm compress. Consider trying to open it with a sterile needle. Gently massage the breast to empty the pooled milk, which may squirt out under pressure.
• If you have recurrent blebs, seek expert help, as a steroid cream may help treat this and prevent recurrences. Also, decrease your pump’s suction strength.
• Consider sunflower lecithin supplements to prevent plugs (not proven). 

Eczema or Contact Dermatitis

Dermatitis is inflammation of the skin.
Mothers with underlying eczema or psoriasis are prone to outbreaks on their nipples during breastfeeding.
Contact dermatitis happens when something touches the nipples, such as creams, pads, pump cleaning solutions, or substances in the baby's mouth, like meds or food that Mom is allergic to. 
Eczema and contact dermatitis will make your nipples itch and burn.
They’ll look inflamed, possibly with red bumps. They may get dry and scaly.

To manage this

• Avoid irritants and triggers. 
• Moisturize the nipples after nursing with a hypoallergenic balm, or coconut or olive oil
• Apply a steroid cream if prescribed. You don't need to wipe it off. 
• Sometimes an antibiotic cream is needed to treat a secondary bacterial infection that causes oozing, crusting, and open sores. 

Yeast infection

Nipple yeast infection is rare, according to breastfeeding experts recently. Therefore, antifungal cream on the nipple is unnecessary, unless perhaps, the baby is diagnosed with thrush.