Breast/chestfeeding is not biologically designed to hurt. While it’s true that nipples can be extra sensitive in the first few days after childbirth, this is due to hormonal changes in the body. Pain when feeding should not persist beyond the first week after birth. Pain is our body’s way of asking us to pay attention to something, and this isn’t different with nipples. If you are having nipple pain that isn’t getting better, it’s time to investigate why.

The most common cause of nipple pain is nipple compression when latching. When a baby chews the nipple into the mouth, instead of gaping widely to come up and over the nipple, this causes pain, because compressing the nipple is painful. It would be painful if I walked up to you and pinched your nipple with my finger, and your baby’s jaws have much more force than my fingers do. If your baby is chewing or sucking your nipple into their mouth, then the most important thing you can do to help your nipples feel better is to work on your latch mechanics to make sure you get a deeper latch.

The second most common cause of nipple pain is caused by a pump flange that is too large. While pump flanges can also be too small, the vast majority of women are pumping with flanges that are too large, and pull the areola into the space designed for the nipple. This often results in needing to turn the suction up higher on the pump because it's harder to stretch the areola than the nipple, and this can cause damage. If you are having nipple pain, make sure your pump is the right fit for you.

If your nipples are already damaged, please seek out help with an experienced IBCLC who can help make sure you are solving the root of your feeding problems. Nipple damage can get worse quickly, and sometimes can get damaged to the point of needing to take a feeding break in order to heal. The more quickly you can solve the WHY the more quickly you can help to make sure the damage gets healed too.

Now that you understand the most common causes of sore nipples, let’s talk about some different options you can use to help them feel better.

If you go to your health care provider and tell them that you have sore nipples, the most likely outcome is that they will give you a prescription for All-Purpose Nipple Ointment (APNO). And while this ointment definitely does make nipples feel better due to the steroid, there is a trade-off. APNO is first quite expensive and often has to be made by a compounding pharmacy. It’s called “All Purpose” because it contains an anti-fungal, anti-bacterial and a steroid, all together, in one. APNO is designed to be used as a short-term option because steroids can thin out the skin, and when used over time, APNO can end up exacerbating the pain and damage they were intended to solve. 

Since most latch pain is caused by shallow latch and nipple compression, the anti-fungal and anti-bacterial aspects of the cream is usually not necessary. And if you have an open wound, Medihoney (described below) is an alternative to APNO that have less cost and fewer potential negative consequences. My recommendation for my clients is to skip the APNO altogether because it’s simply not necessary

Here are 4 other alternatives to APNO to help you make your sore nipples feel better.

Saline Soaks

Saline soaks are one of my favorite ways to help nipples feel better. A saline soak is made by adding ¼-½ teaspoon to a cup of warm water, and mixing together. This ends up with a saline content close to your tears, so it won’t sting at all. Once you have made up a solution, you can put it into a small shot glass or medicine glass and then soak your nipples over it. You can also make an extra cup of liquid and fill up your hakaa (if you have one), and use that as a saline soak as well. Soak for 3-5 min a few times per day. Saline soaks are inexpensive, effective and easy.

Medihoney

I love Medihoney. Medihoney is a medical-grade honey that is appropriate and safe to use on wounds. Honey actually also has antimicrobial properties, so I think it eliminates the need for APNO. Because Medihoney is a medical-grade product, it is also safe for ingestion by babies, because it has been irradiated to kill all of the potential botulism spores. The only drawback of Medihoney is that it’s messy and sticky (because it's honey). Medihoney comes in two general forms - paste and gel. I find that the paste is thicker and easier to use, and it’s also more expensive.

Medihoney can be put on your nipples after feeding and left on until the next feeding, when you can wipe the honey off before latching. Again, its totally safe if there are some remnants of medihoney on your nipples when feeding. I recommend putting the honey on your nipples directly, and then putting a non-stick wound pad on top of that, to keep the honey from getting on your clothes.

Speaking of leaving the honey on, did you know that when it comes to your nipples, keeping them moist while healing is better than allowing your nipples to air dry. Moisture prevents scabs from forming and then being pulled off each time your baby feeds.

Calendula

Calendula is an herb with lots of documented healing properties and comes in a variety of formats. It is really helpful for soothing sore nipples and healing damaged nipples. You can find calendula online from a grocery store like Sprouts or Whole Foods.  You can get a spray, which is usually the calendula mixed with oil and placed into a spray container, or as a tincture, which is calendula mixed in alcohol. I find the spray easier to put on directly, or you can add the tincture to a saline soak. Calendula can also be found in creams or ointment (which I’ll get to in a second) and applied on the nipples topically.

Herbal Ointments

You were likely given some Lansinoh ointment if you delivered in a hospital, and if you haven’t felt like it helped much, you aren’t alone. This research doesn’t show that Lansinoh works particularly well to heal nipples, because it’s really just a cream with few actual healing properties.

Luckily, there are now lots of other ointments on the market that combine some of the ingredients above with some other herbs that have been shown to help with healing. The bonus of these ointments is that you can also use them on scrapes and cuts on your baby too.

Some of my favorites are Mother Love, which contains calendula and marshmallow, Tiny Human Nipple Crack because it contains aloe and calendula, and Green Forest Lady which also contains calendula and marshmallow.

All of these options are safe for your baby, and while you want to wipe them off before latching because it may make latching harder for your baby, you don’t need to scrub your nipples before you feed your baby. You can just sit down, make sure you get that wide gape, and worry about all the other things new parents have to do.