Coping with cracked, bleeding, or scabbed nipples while breastfeeding

What is nipple fissure?

Nipple fissures are painful cracks on the skin of the nipple. They often affect breastfeeding moms as their babies learn to nurse. Athletes – especially long-distance runners, as well as surfers and cyclists – also get nipple fissures.

A nipple fissure can happen to one or both breasts, and it may cause the nipple to be red, sore, dry, and chafed. The condition is often temporary and not severe, but it can make breastfeeding very uncomfortable as your baby latches on and sucks.

If it gets worse, your nipples may bleed or develop sores or scabbing. If you become reluctant to nurse or pump because of the pain, you may develop engorgement or mastitis, and the condition may affect your milk supply.

Are cracked or bleeding nipples common when breastfeeding?

Yes. Cracked or bleeding nipples are a common problem for breastfeeding moms. In fact, about 80 to 90 percent of breastfeeding women develop nipple fissures.

If it hurts when your baby latches on, work on getting a better breastfeeding latch right away. Sometimes a simple change in breastfeeding position or method is all you need to prevent nipple fissures from worsening. Your healthcare practitioner or a lactation consultant can help you figure out good adjustments to make.

They can also help you figure out how to continue breastfeeding as you cope with this challenge. You may be able to breastfeed with cracked or bleeding nipples – but if this becomes too painful, you may need to stop breastfeeding and pump for a few days (or possibly longer) to let your nipples heal. Exclusive pumping is one way to give yourself a break.

Sometimes frequent pumping can make your nipples more sore, but a lactation consultant can show you how to pump so you can preserve your milk supply and avoid further nipple damage.

What causes nipple fissure?

The most common cause of nipple fissure in breastfeeding moms is a bad latch. When your baby doesn't get your nipple and areola far enough into their mouth, it can irritate your nipples, causing them to become painful and crack, bleed, or scab.

Ideally, your baby should have the whole nipple and part of the areola in their mouth. Especially when first learning to breastfeed, a baby might suck on just the nipple, which can cause damage.

Sometimes babies have a physical trait that makes latching correctly difficult for them. If your baby is tongue-tied, for example, they may have difficulty latching on and chomp and bite rather than suck in an effort to access your milk. Tongue-tie happens when the tissue connecting the tongue to the floor of the mouth is short or extends too far to the front of the tongue. If your baby's tongue appears heart-shaped when they cry, they may have a tongue-tie.

If you suspect your baby has a tongue-tie, work with a lactation consultant who can assess the situation and, if needed, help you find a specialist who can properly diagnose and treat the condition.

Babies with a high palate or the inability to open their mouths wide also sometimes have difficulty getting a deep latch and sucking effectively. Your baby's doctor or a lactation consultant can help you determine if this is the case for your baby.

Other common causes of nipple fissure in breastfeeding moms are:

• Nipple or breast problems: Flat or inverted nipples, swollen breasts and nipples (edema), and engorged breasts can all make it difficult for your baby to latch on properly. This can irritate your skin and cause your nipples to crack or bleed. If your breasts are very engorged, nipple tissue may stretch and crack, contributing to the problem.
• Breast pumps: Using a breast pump incorrectly (by setting the suction too high, for example) can hurt or damage your nipples, causing cracks or bleeding. Flanges that don't fit properly can also cause nipple irritation. Ask a lactation consultant to check that you're using your pump correctly and have the correct size of flanges.
• Thrush (yeast infection): Thrush can cause nipple pain and damage. Signs of thrush in breastfeeding moms include itchy, red, shiny, painful nipples (they may also be cracked) and shooting and/or burning pains in the breast during or after a feeding.
• Eczema: Your nipples can crack or bleed because of severe dry skin or eczema. Eczema can show up as scaly red patches of skin that may be itchy or painful. Some women develop eczema for the first time while pregnant.

Keep in mind that it's possible to suffer from more than one of these conditions at the same time.

What should I do if I have nipple fissures?

There are many at-home treatments for nipple fissures. Prompt treatment can reduce the pain, prevent more severe skin damage, and help you start healing.

While breastfeeding

• Check your baby's latch. The best latch position is off-center, with more of the areola below the nipple in your baby's mouth. One way to achieve this is to line up their nose with your nipple so their bottom gum is far away from the base of your nipple when they open their mouth. Once their mouth is open, hug them on quickly. (Bring your baby to your breast, not your breast to them.) Your nipple should be far back in your baby's mouth.
• Try different nursing positions. You may find that certain positions make it easier for your baby to latch on correctly and are much more comfortable. One analysis of a dozen studies concluded that women experienced less nipple pain and nipple trauma – and better latch position – in the laid-back position. Watch our breastfeeding positions video to see how it's done.
• Briefly apply a cold pack to numb the injured nipple area before nursing. Cold can help dull the pain, particularly during the initial latch, which tends to hurt the most.
• Breastfeed frequently. Nursing every two to three hours can help prevent engorged breasts. An engorged breast is harder for your baby to latch on to. This can result in a shallow latch, which can lead to nipple soreness, irritation, and cracking.
• Pump before nursing when engorged. If you have trouble with engorgement causing a shallow latch, it may help to pump for a minute or two (preferably using a hand pump, which is more gentle than an electric pump) before nursing to prepare the nipple for easier latching.
• If your breasts are engorged or your nipples are flat or inverted, try "reverse pressure softening." This involves applying gentle pressure with your fingers around the base of the nipple, which can help create a softer nipple and areola for your baby to grasp. Ask your lactation consultant to show you how to do this.
• Nurse on the less-injured side first, if you have one. Babies often nurse more gently on the second side since they're less hungry.
• Consider pumping on the injured side and breastfeeding on the other, if pumping is more comfortable than breastfeeding. You can give your breastfed baby a bottle with your pumped milk after they've finished nursing on one side.
• Exclusively pump until your nipples are healed. If it's too painful to nurse, but pumping is bearable, you can pump exclusively and bottle-feed your baby.
• Limit the duration of breastfeeding. Some babies will continue to suck even when they're not getting milk, which can irritate your nipples. Listen for your baby swallowing, and when they're no longer swallowing, gently detach them from your breast.

After breastfeeding

• Detach your baby gently. Normally, a baby will let go of a breast when they're finished feeding and no longer getting any milk. If they don't, or if you need to detach them yourself, insert your pinky into the corner of their mouth to break the suction, so you can pull them off your breast more easily.
• Clean your nipples gently. When you have a cracked or bleeding nipple, rinse the breast after each feeding with warm water, pat with a clean towel, and air dry. Once a day, use a gentle, mild soap to clean the wound, rinse well with water, and air dry. Don't use antibacterial soap or skincare products with alcohol or fragrances on your nipples, as these can be drying.
• Use a warm compress. You may find it soothing to hold a washcloth that's been dipped in warm water (and wrung out) on your sore nipples for a few minutes. Pat your nipples dry afterwards.
• Use an antibacterial cream as prescribed. If you have an open wound, see your healthcare provider. They may recommend an over-the-counter antibacterial cream or give you a prescription. Some of these products need to be removed before nursing, but many don't unless your baby objects to the taste or odor.
• Try lanolin. Many nursing moms use lanolin for sore, cracked nipples. It's a fat made from sheep's wool, so don't use it if you have a sensitivity to wool. Also don't use it if you have a yeast infection (thrush) on your breast, as it can trap moisture and encourage yeast growth. Otherwise, commercial lanolin products made for nursing mothers (ultrapure modified lanolin) are perfectly safe to try. Use a small, pea-size amount, and apply with clean fingertips to the sore, injured area after each feeding and after taking a shower or bath. Gently pat it on: Don't rub it in. Lanolin doesn't need to be removed before you breastfeed your baby.
• Apply expressed milk to your nipples. Breast milk has healing properties that can ease irritation, and it doesn't need to be washed off before nursing. However, don't do this if your nipple soreness is due to thrush, because applying breast milk can encourage yeast growth.
• Try hydrogel dressings designed for nipple healing. These pads are soothing and speed healing. Try to avoid touching your nipple or areola before applying the pad (bacteria from your fingers can get trapped under the pad). Also, don't use them if you have a yeast infection or with other topical products, such as lanolin. For an added cooling effect, store the hydrogel pads in the refrigerator.
• Take painkillers. Take ibuprofen or acetaminophen about 30 minutes before nursing to help lessen pain. These medications are safe for breastfeeding moms to take in standard doses.
• Wear breast shells. Sometimes your nipples can become so sore that you can't bear the pressure of wearing a bra, or a scab sticks to your bra and is painfully yanked off. In this case, try wearing a plastic breast shell inside your bra to create a space between your breast and the bra. Don't use breast shells if your breasts are engorged, however. Wearing them against an engorged breast could impede milk flow and lead to plugged ducts. Also, be sure to wash breast shells between wearings.
• Pay attention to your nursing bras. To prevent skin irritation from your nursing bras, buy ones that are comfortable, made from natural fabrics, and fit well. Make sure they're not too tight and they don't have seams that rub. Avoid underwire bras. Wash your nursing bras frequently with unscented laundry detergent and rinse well.
• Change nursing pads often if you use them, since damp nipples can invite infection. Use nursing pads that are 100-percent cotton.
• Avoid soaps and detergents with fragrances and chemicals. These can be irritating, so choose fragrance-free products.
• Consider LED therapy. There's some evidence that light-emitting diode therapy is useful in treating nipple fissures. It has anti-inflammatory properties and helps with tissue healing and pain control. LED therapy isn't painful or invasive and has no side effects. If you're interested, ask your healthcare provider for a referral to a practitioner who offers this.
• Keep things clean. Bacteria can easily enter cracked, delicate skin. To prevent infection, be diligent about washing your hands before touching your cracked or bleeding nipples. Scrub your hands for 20 seconds with soap and warm water before expressing milk or applying expressed milk, lanolin, creams, or hydrogel pads to your breasts.

When should I call the doctor for cracked or bleeding nipples?

Cracked or bleeding nipples can lead to infection, and painful breastfeeding is often associated with both early weaning and postpartum depression. Don't hesitate to check with your healthcare practitioner if:

• A cracked nipple is still painful and/or has a bloody discharge after 24 hours
• You notice fever, inflammation, oozing, pus, a very tender blister, or other signs of infection
• Your nipple and/or areola is shiny or flaky, or your nipple is burning
• You have nipple pain that radiates to the breast
• Cracked or bleeding nipples – and the accompanying pain – are interfering with breastfeeding.

Is it safe for my baby to breastfeed if my nipples are cracked or bleeding?

Yes. Your baby may swallow some blood and you may see it come out in their diaper, but it won't do them any harm. If you pump, you may notice that your breast milk has a pink tinge to it. This is due to blood from your cracked nipples, and it won't harm your baby.

Don't nurse until your nipples heal, though, if you have:

• Hepatitis C: If you have cracked or bleeding nipples, stop nursing temporarily, because until you receive treatment the virus can be passed through infected blood.
• Toxoplasmosis: Theoretically it's possible the parasite could pass to your baby through breastfeeding if you have cracked or bleeding nipples during the week or two after you get infected.

To keep your milk supply up in these cases, you can "pump and dump" – pump and discard the expressed milk.

Painful nipples are only one of the glitches you may encounter while breastfeeding. Read more about other nursing problems and solutions, from leaking breasts to an overabundant or dwindling milk supply.