Under normal circumstances breastfeeding doesn't hurt. In the first days after birth you may experience some nipple tenderness, but this usually subsides in a few days and after that breastfeeding shouldn't hurt. If it does, it is a sign that something is wrong.

THE PRIMARY CAUSE of nipple soreness in the early weeks is poor positioning and latch on of the baby. Please go back to the section HOW TO POSITION YOUR BABY and check every step carefully. You may experience immediate relief from nipple soreness when you begin positioning your baby correctly. If you are sure that your baby is positioned and latched on correctly, have a look at some other possible causes of sore nipples described below.

SOME OTHER CAUSES OF NIPPLE SORENESS

* Sometimes engorgement can cause sore nipples. If the breast is overfull the nipple may flatten, making it difficult for the baby to latch on to the breast properly. In this case you can pump or hand express some milk prior to nursing to soften the areola and bring out the nipple so your baby can latch on easier. (See also section ENGORGEMENT).

* Giving bottles or pacifiers in the early weeks of breastfeeding can cause your baby to become nipple confused. Sucking from a bottle nipple is different than from a breast and some babies start sucking incorrectly from the breast, causing the nipples to become sore. (See also section NIPPLE CONFUSION). If you suspect your baby is nipple confused consider stopping the use of pacifiers until the baby is older. If you're giving supplemental bottles to your baby consider reducing them gradually and start increasing your milk supply by nursing more often. Supplements can also be given to your baby by cup, spoon, plastic eyedropper, feeding syringe or baby cup. These feeding methods will take some practice but they don't cause nipple confusion.

* The use of soaps, alcohol, deodorant, body lotion or certain nipple creams can cause irritation to the skin of your nipples and result in sore nipples. If you suspect this can be the cause of your sore nipples, for example if you have a history of sensitive skin, eliminate these products or choose hypo-allergic ones. It is best to avoid using soap or alcohol on your breasts because they can dry your skin and remove the natural protective oils and can also cause irritation.

* Damp breastpads, especially the ones with a plastic lining, can cause the nipples to become sore because they create a moist environment with no air circulation. Use breastpads without plastic lining and change them very often, alternately you can use folded cotton handkerchiefs.

* Taking the baby from the breast without breaking the suction can cause sore nipples. When your baby is finished nursing and you want to take him from the breast, insert your finger in the corner of baby's mouth to break the suction, this way your nipples will not be hurt.

* A tight bra can cause your nipples to become sore. Make sure you are wearing a well fitting bra with some room for expansion for when your breasts become full.

* Improper use of a breastpump can cause sore nipples. Check the instructions of your breastpump carefully and try a lower setting, make sure your nipple doesn't touch the inside of the flange when you pump.

* When your baby is older and eating solids your nipple soreness may be caused by irritation from food particles in baby's mouth. In this case wipe baby's mouth with a moist cloth or give him a sip of water before nursing.

* If you have sore or cracked nipples that don't respond to standard sore nipple treatment (see below) while your baby is positioned and latched on correctly you may have contracted thrush on your nipples (please check out section THRUSH for further information and treatment).

Below you will find some suggestions that will make nursing more comfortable while your nipples are healing.

* Pay extra attention to the positioning and latch on of your baby especially in the period that your nipples are sore. Make sure your nipple goes deeply in baby's mouth, this will protect the nipple from further damage.

* Before every feeding you can pump or hand express some milk to start the letdown, this way your baby doesn't have to suck too vigorously.

* Apply some ice, wrapped in a wet cloth, on your nipple immediately before nursing to numb the nipple.

* Nurse on the least sore side first as baby usually nurses more vigorously on the first breast.

* Breastfeed often, don't hold feedings off for fear of pain because this will make your baby more hungry and he will nurse more aggressively.

* Try different nursing positions, so the pressure of baby's gums and tongue are not constantly on the sore spot. (see section HOW TO POSITION YOUR BABY for details on different nursing positions)

* Change breastpads frequently, avoid the ones with plastic lining. Wear a cotton bra. If dried milk causes your nipple to stick to your bra or breastpad, moisten it with some water before taking it off.

* If your nipples are so sore that you can not tolerate wearing your bra or clothes, you may want to consider wearing breast shells. Breast shells are two piece plastic or silicone devices worn inside your bra over the nipple and areola during the day to protect your nipples and promote healing by allowing air circulation.

* Be careful when choosing a cream or ointment for the treatment of sore nipples. Some may not be safe for your baby to ingest; others may be drying to the skin or cause irritation. Modified lanolin reportedly has excellent healing properties, maintains internal moisture, which hastens the healing process and does not need to be removed before feeding. Apply the lanolin before every feeding.

* If your nipples are so sore that you can not tolerate your baby nursing at your breast you may want to choose to temporarily pump your milk and feed it to your baby. If your baby is younger than 6 weeks it is better to avoid the use of bottles because your baby can become nipple confused at such an early stage, in this case it is better to feed him with a cup, spoon, plastic eye dropper or feeding syringe. As soon as your nipples have healed you can put your baby back to the breast.

Most sore or cracked nipples will heal quickly in a few days with the ideas given above and you'll be back to problem free nursing your baby!

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