Sore nipples, full breasts and mastitis: what helps

Breastfeeding problems are common, and most can be fixed with the right help. Here’s what the NHS says about sore nipples, full breasts and mastitis.

Sore or cracked nipples

The NHS says sore nipples are usually caused by the baby not being positioned and attached properly at the breast. Some nipple pain is common in the first few days. Signs of a poor latch include flattened, wedged or white nipples at the end of a feed, and a baby who seems unsettled after feeds.

What the NHS suggests:

Get help with positioning first, because self-help tips won’t work well if attachment is poor.
Change breast pads at every feed, using ones without plastic backing if possible.
Wear a well-fitting bra without underwire.
Keep feeding for as long as your baby wants at each feed, and express if you need a break.
For cracked nipples, dab a little expressed milk on after feeds.
Avoid nipple shields and breast shells where possible, as they can affect attachment.

Get help early from your midwife, health visitor or breastfeeding supporter if one or both nipples hurt at every feed, or if they crack or bleed. Cracked or bleeding nipples raise the risk of infection. If the pain continues when your baby is well attached, there may be an underlying problem such as an infection.

Very full breasts

To ease very full breasts, feed your baby often. A cloth soaked in warm water, or a warm bath, just before hand expressing can help the milk flow. A cold compress between feeds can ease pain and swelling. Only express enough to relieve the discomfort, because expressing more makes more milk. Ask your midwife, health visitor or a breastfeeding specialist for advice if it doesn’t ease.

Mastitis

Mastitis is inflamed, painful breast tissue, sometimes with infection. The NHS lists these symptoms:

a swollen, hot, painful area on one breast, which may be red (harder to see on black or brown skin)
a wedge-shaped lump or hard area
burning pain, constant or only when feeding
white or blood-streaked nipple discharge
flu-like symptoms: aches, a high temperature, feeling hot, cold or shivery, and tiredness

What helps: keep feeding, because stopping can make a blockage worse. Hand express if feeding is too painful. Check your baby’s positioning and attachment and drink plenty of fluids. Rest, wear a comfortable, supportive bra and avoid tight clothing, and take paracetamol or ibuprofen. Do not take aspirin, and don’t put oils, soaks or creams on your breast.

See a GP, or call NHS 111, if you feel worse at any time or you’re no better 12 to 24 hours after treating it at home. If you’ve started antibiotics and aren’t improving after 48 hours, go back to your GP. Antibiotics should clear the infection in a few days. The NHS says a very small amount may pass into breast milk, which isn’t a risk to your baby, but may make them irritable or restless.

Could it be thrush?

The NHS lists these signs of thrush: burning nipple pain, especially after every feed, white patches or tiny blisters on the nipple or areola, or loss of colour in the nipple or areola. The treatment is an antifungal cream or tablets for you, and your baby may need treatment too. Carry on breastfeeding if you can. Book a GP appointment as soon as possible.

Support

The National Breastfeeding Helpline is on 0300 100 0212, open 24 hours a day.

Questions people ask

Is it safe to keep feeding with mastitis?

Yes. The NHS says breastfeeding won’t harm your baby, although the milk may taste a little salty if there is an infection.

Will antibiotics affect my baby?

The NHS says a very small amount may pass into breast milk. It isn’t a risk to your baby but may make them irritable or restless.

Do I need a nipple shield?

The NHS says to avoid them where possible, as they can affect attachment. Ask a breastfeeding supporter before you use one.