The Complete Guide to Treating Sore Nipples While Breastfeeding

(An Evidence-Based, Wound-Care Approach)

Have you ever been told to “rough up” your nipples before baby comes?

Or that cracked nipples are “just part of it”?

Or that if you’re not crying in the shower, are you even breastfeeding?

Let me say this clearly:

Nipple pain has been normalized — but it is NOT normal.

Breastfeeding should not inherently cause ongoing pain. And when pain shows up, it is information. It is a signal that something needs adjusting.

Let’s unpack what’s actually happening when nipples become sore, cracked, or damaged — and how to heal them properly.

First: 3 Important Facts

1. Pain is a warning sign.
   Tongue tie, shallow latch, body tension, oversupply clamping, engorgement, pump trauma — these are root causes. Pain is the symptom.
2. Nipple wounds are real wounds.
   They should be treated using actual wound-healing principles — not internet folklore.
3. Early treatment matters.
   When wounds are treated correctly in the first few days, chronic nipple trauma is far less likely.

What Is Normal vs. Not Normal

Mild & Temporary (Normal)

• 10–15 seconds of tenderness with initial latch that fades (this is likely from baby not opening wide enough and should resolve as latch improves)
• Nipple comes out round — not pinched

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Not Normal

• Toe-curling pain every latch
• Lipstick-shaped nipple after feeds
• Cracks, bleeding, or open fissures
• Blistering or blebs with severe pain

If your body is bracing every time baby opens their mouth — we need to change something.

Why Nipples Become Damaged

1. Shallow Latch

Compression of nipple tissue = trauma.
This is the most common cause.

2. Engorgement

When breasts are overly full, baby cannot latch deeply. Reverse pressure softening can help.

3. Oversupply

Some babies clamp to slow heavy milk flow. That repeated clamping injures tissue.

5. Pump Trauma

• Flanges too small or too large
• Suction too high
• Elastic tissue being over-pulled
  Pump injuries are incredibly common and under-recognized.

6. Dermatitis

Soaps, alcohol wipes, hypochlorous acid sprays, APNO overuse, antifungals, essential oils — these strip the skin barrier and cause breakdown.

Nipple Wound Care 101

Core Concept: Moist Wound Healing

Nipple wounds should be:

• Lubricated
• Covered
• Protected
• Allowed to heal in a stable environment

Just like burns or other open wounds.

How to Heal Sore & Cracked Nipples Properly

1. Keep the Wound Covered (24/7 in Early Healing)

Open-to-air drying is outdated wound care advice.

Covered wounds heal faster.

Options:

Hydrogel Pads _{(Best for Dry, Superficial Wounds)}

• Provide cooling relief
• Maintain moisture balance
• Can be combined with balm if extremely dry
• If using alone → better than balm alone

Polyurethane Matrix Pads (e.g., Nursicare/Polymem)

Best for:

• Moist wounds
• Cratered wounds
• Wounds with seepage

These provide both absorptive capacity and closed healing.

Important:
Do NOT combine polyurethane pads with balm.
The absorptive surface needs direct contact with skin.

2. Silverettes- Yes, but wisely

Silverettes can:

• Provide a protective barrier
• Maintain a moist environment
• Offer soothing relief

But here’s the nuance:

They are not meant to be worn indefinitely.

Overuse can:

• Oversaturate tissue
• Create a “24/7 milk bath” effect
• Lead to skin maceration
• Worsen breakdown

Think: short-term tool,on for an hour - off for an hour -not a permanent solution.

If tissue looks overly white, swollen, or soggy → scale back.

3. Medical-Grade Honey (MediHoney)

Some wounds respond beautifully to medical-grade honey.

Important:

• It is irradiated
• Safe if infant ingests trace amounts
• Promotes healing via osmotic and anti-inflammatory properties

This is different from raw honey (which is not safe for infants).

What NOT To Do

❌ Avoid APNO (All Purpose Nipple Ointment)

APNO contains:

• Antifungal
• Antibiotic
• Steroid

The relief comes from the steroid.

The other components:

• Are often unnecessary
• Can cause dermatitis
• Increase cost
• Disrupt skin balance

If steroid is indicated → prescribe the steroid alone.

❌ Avoid Salt Soaks

They dry and irritate tissue.

❌ Avoid Alcohol, Harsh Soaps

They strip natural oils and delay healing.

❌ Avoid Breast Shells Designed to “Keep Nipples Dry”

They:

• Increase swelling
• Compress areola
• Worsen pain

How Long Should Healing Take?

A simple superficial wound:
8–10 days with proper care.

Deeper wounds may take longer.

Yes — they can heal while you continue breastfeeding.

The nipple-areolar complex is highly vascular and heals well.

Infant saliva also contains enzymatic components that support healing.

Should You Keep Breastfeeding?

In most cases: yes.

However, if pain is severe:

A 24-hour break while pumping and bottle feeding can:

• Protect your supply
• Interrupt trauma cycle
• Preserve your breastfeeding relationship

Taking a break is not failure.

It is strategy.

But for taking a break to be effective and complicate things further you need to make sure you are pumping with a good quality pump and well fitting flanges - check out this guide from Babies in Common.

You also need to making sure you are supplementing with the correct bottle, pacing well and positing baby in a sidelying position. More on bottle feeding here. You can also check out my Amazon store front for my favorite, breastfeeding friendly bottles.

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When to Seek Help

Reach out if:

• Pain is worsening
• Wounds are not improving after 7–10 days
• Fever or spreading redness develops
• Pain persists despite latch correction

And please — do not go it alone.

The number of moms who tell me,
“I just wish I reached out sooner…”

It’s heartbreaking.

Small adjustments in latch biomechanics can change everything.

The Root Cause Still Matters

Wound care heals the tissue.

But you must still address:

• Shallow latch
  • Click here, for my top tips on fixing a shallow latch.
• Tongue tie
  
  • This blog post explains how tongue ties can affect both parent and child—and what practical, supportive steps you can take to address them.
• Body tension
  • If your baby has a lot of body tension, it can make latching deeply difficult leading to a shallow latch that causes nipple damage. Many babies can be helped by working with a tension-informed provider like a Craniosacral Therapist and/or Chiropractor.  

• Pump fit
  
  • ‍Download my free pumping guide-a mini-guide to flange fit, elastic nipples, and getting more milk.
• Oversupply
  
  • Learn why it happens, how it affects baby (hello, reflux & gas), and how to manage it without losing your mind, click here.
• Engorgement
  
  • When the breasts become overly full, it can contribute to your baby having a shallow latch. Try reverse pressure softening to soften the breast tissue to make it easier for the baby to latch. Click here for my hand expression blog.‍

In Boob School, we walk through:

• Latching step-by-step
• Latch troubleshooting checklist
• Pump flange fitting
• Managing oversupply
• When to suspect tension or ties
• What to do next

One mom shared:

“I was ready to keep feeding my baby while dying inside… and today’s class changed everything. I fed twice in a reclined position and didn’t feel pain for the first time.”

Breastfeeding comfortably is possible.

Not by gritting your teeth.

By understanding what your body is telling you.

Final Thoughts

Pain is common.

Pain is not normal.

Your nipples are not meant to be “toughened up.”

They are meant to be supported.

If you’re in the thick of it right now — I see you

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Even mild soreness can be helped and you can find adjustments with an IBCLC. If you are having any signs of nipple damage, it is vital to reach out for help and address the root cause of what is causing it. Support and guidance can make or break your journey. 

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Cheering you on, always!

XOXO

Kelly

Boob School Founder and CEO

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