Nipple TLC: Essential Care for Breastfeeding Moms

So, you’re beginning your breastfeeding journey. How exciting! This is such a special time for you and your baby. While there are many proven benefits of breastfeeding for both mama and baby, the experience for mom may come with some uncomfortable side effects, including nipple pain or soreness.

But don’t worry, you’ve come to the right place! Sore nipples are very common, and luckily, there are treatment options available to help you heal quickly. Here’s our guide to addressing nipple soreness, care, and confusion, along with some of our breastfeeding essentials to help you continue on your breastfeeding journey pain-free.

• Pay attention to the latch. Make sure that baby is opening his mouth wide before you latch him to your breast. To get your little one to open wide, hold your baby close to your breast and let their bottom lip brush against the bottom of your areola. This will trigger the “rooting” response, which will prompt your little one to open their mouth. With a wide-open mouth, you can hold your baby to your breast, ensuring their mouth covers your areola. For some mama-baby duos, an asymmetrical latch works best. With an asymmetrical latch, baby’s mouth is slightly further down on the breast, with their top lip not fully covering the top of the areola and their bottom lip reaching past the bottom of the areola. If you attempt a latch and it hurts, don’t be afraid to break the suction and try again. Sometimes it takes a couple attempts to get it right, but it’s worth the extra effort. Need more advice on latching? Read more.
• Experiment with positioning. Sometimes sore nipples can be caused by improper positioning at the breast. If you’re experiencing pain, try adjusting your baby's alignment to ensure that baby's ears, shoulders, and hips are in a row. Your baby should be facing you, tummy to tummy.
• Talk to a lactation consultant. A lactation consultant can help improve your baby’s latch, offer additional tips to maintain healthy skin around the breast and support you in reaching your breastfeeding goals.
• Keep things clean. Wash your hands before you apply nipple cream, especially if the skin is broken. Be sure to change your nursing pads frequently so that your breasts don’t remain wet for an extended period of time.
• Support your breasts when you aren’t feeding. Some mamas love using hydrogel breast pads that can be placed inside the bra, offering extra protection from friction.
• Use nipple cream. Many mamas find that using nipple cream made specifically for nursing moms helps protect their skin. Many popular nipple creams use lanolin—an emollient moisturizer—-to help soothe sore, chapped, or cracked nipples. You can also experiment with nipple creams that contain calendula when you are feeling sore or are concerned about infection. Normally, you do not have to wash off nipple creams. Wiping the cream off gently before the next feeding is enough.

While some babies whose mothers have flat or inverted nipples have no problems latching, some may have a harder time. When a mom has flat and inverted nipples, they may experience some difficulty getting a deep, comfortable latch. Flat nipples are typically those that are level with the areola, while inverted nipples retract inward as opposed to outward. It’s important to know that some nipples look flat or inverted, but with compression they will evert.

To check to see if you have flat or inverted nipples, consult with a lactation specialist who can help determine if one or both nipples are inverted. With the proper support from a lactation consultant, inverted nipples shouldn’t prevent you from breastfeeding or pumping. 

To get a good latch, babies need to open wide and take in a mouthful of breast tissue, not just the nipple. Moms with flat or inverted nipples may struggle to get their babies to latch deeply. Again, babies shouldn’t just be nipple feeding. Your little one should latch well beyond the nipple, placing their mouth onto the areola and drawing the breast deeply into their mouth.

If you have flat or inverted nipples, you’re not alone! Between 3-10% of mamas struggle with them. Over time, with the use of the breast pump and/or breastfeeding, many new mothers find that their nipples begin to take on more shape.

If the problems do persist, there are a handful of solutions for flat and inverted nipples. Try these tips:

Reverse pressure softening can help displace extra fluid from engorgement and draw your nipple out. Use the tips of your three middle fingers to apply gentle pressure at the base of your nipple. Hold continuous pressure in the same location for about five seconds, then rotate your hands to the left and right. Continue applying pressure for about 30-60 seconds total. This should soften the area around the nipple, possibly drawing your nipple out a bit. You may even see breast milk begin to leak.

Moms with “shy” nipples—when the nipple looks flat but becomes erect after stimulation—may find that using their fingers to “roll” the nipple before breastfeeding helps. Place your hand about a half inch away from the nipple with your thumb above and your fingers below the nipple. Move your thumb and fingers back and forth along the areola as if you were rubbing a piece of fabric between your fingers.

A nipple everter is used just before latching to gently add shape and help the nipple protrude. The nice thing about this tool is that it does not need to be plugged in or set up! It’s a quick and simple solution to flat or inverted nipples.

Another way to prime the nipple for breastfeeding and give it instant shape is to pump for about one minute before bringing the baby to the breast. The vacuum pressure from a manual or electric breast pump applies just enough suction to draw the nipple out, helping your baby latch on more easily.

Nipple shields can also help babies latch onto flat or inverted nipples. They are thin, flexible silicone devices worn over your nipple. If your baby uses a nipple shield but does not totally empty the breasts while nursing, it’s recommended to pump for a few minutes after feedings to remove any residual milk. 

Unlike the nipple shield, breast shells are worn in your bra in between feedings. They provide continuous reverse pressure around the base of the nipple, with the intent of drawing out the nipple. The idea behind breast shells is that they continuously draw out your nipple, so you can feed any time without needing to pump, use a nipple everter, or use reverse pressure softening.

For more personalized help or troubleshooting, reach out to a lactation consultant or IBCLC, especially if these issues cause soreness or milk supply concerns. 

Moms don’t always have the ability to be there for every feeding, especially if they’re returning to work, and often need to turn to bottle feeding. While many babies can go back and forth between breast and bottle without trouble, some babies may seem to prefer the bottle even if you still want to breastfeed.

Nipple confusion can be a frustrating part of breastfeeding for nursing moms. If bottles are introduced before breastfeeding is well established, babies may develop a preference for the bottle and have a harder time breastfeeding. Experts recommend waiting to offer bottles until breastfeeding has been well established. Of course, this is not always possible, especially if you are having problems breastfeeding. In this case, we recommend reaching out to a lactation consultant who can help you develop a plan that ensures your baby is well-fed while you are working on your breastfeeding issues. 

Babies might also have trouble going back and forth between breast and bottle when mom’s milk supply is low. Baby gets used to the faster, more consistent flow from the bottle and may show signs of frustration during breastfeeding. This can be a vicious cycle. The more bottles a baby gets and the less time they spend breastfeeding, the more likely mama will have a reduced milk supply. It is important that moms who are regularly supplementing with bottles maintain a consistent pumping schedule to maintain or increase milk supply. Your lactation consultant is a great resource for you to rely on for guidance in this situation.

Some babies won’t take the bottle unless it feels completely different. It’s ok to experiment with different bottles, milk temperatures (some babies prefer cold milk), and nursing positions (cradled, upright, or facing forward). Many babies (and their caregivers) find motion to be soothing. This may help everyone relax and a resistant baby to take a bottle. Rocking, gentle bouncing, standing and walking or swaying, even a change of scenery (go outside!) may all help. 

Some babies will take to the bottle better when introduced by someone other than the breastfeeding mom, such as dad, grandma, or babysitter. This can be a great way to introduce the bottle and give mom a little break, as well. Remember to be patient and try different things, if what you are doing isn’t working. This isn’t a race and may not happen overnight. Introducing your baby to the bottle will take some time and patience!

There are plenty of resources for moms who are dealing with sore nipples, shallow latches, inverted nipples, and more. If you need help, reach out to your doctor or one of our lactation consultants to find a strategy to improve the breastfeeding experience in a way that works for you and your baby! Your insurance plan may even cover these courses or one-on-one training.

You can also join our Facebook group, Aeroflow Breastpumps: The Pumping Room, whether you exclusively pump, breastfeed, formula feed, or fall somewhere in between. The Pumping Room is a safe space where mothers and their support partners can exchange stories, offer mutual support, receive expert guidance from our clinicians, and share all your little one’s milestones and your parenting wins. We hope to see you there!