What is actually causing it

The NHS is unambiguous: "If you get sore nipples when breastfeeding, it's usually because your baby is not positioned and attached properly at the breast." When attachment is shallow, the nipple is drawn against the hard palate and pinched with every suck. Deep attachment places it against the soft palate, where nothing compresses it.

That single fact reorganises everything else on this page. Nipple pain is a mechanical problem with a mechanical fix. Creams, gels and shields treat the damage; only attachment treats the cause. The NHS says it plainly — self-help measures will not work if the attachment problem is not addressed.

What is normal, and for how long

The HSE draws the line clearly. Some tenderness at the start of a feed is common in the early days, because your nipples are not used to it, and it "lasts for a short time, usually around 1 week." Soreness that continues throughout a feed, or that lasts more than a week, is not normal.

There is trial data on the timeline too. The Cochrane review of interventions for painful nipples, covering four good-quality trials and 656 women, found that regardless of which treatment was used, "for most women nipple pain reduced to mild levels after approximately seven to 10 days' postpartum" — and suggested that simply telling women this is a useful intervention in itself.

What the evidence says about creams and dressings

This is where most advice overstates its case. The same Cochrane review compared glycerine gel dressings, lanolin with breast shells, lanolin alone, expressed breast milk and an all-purpose nipple ointment. Its conclusions:

There was insufficient evidence that glycerine gel dressings, breast shells with lanolin, lanolin alone or all-purpose nipple ointment improved perceptions of nipple pain.
In one trial, women who applied expressed breast milk reported lower pain at four to five days than women who applied lanolin — but the benefit was not maintained at six to seven days.
The reviewers concluded that "applying nothing or just expressed breast milk may be equally or more beneficial in the short-term experience of nipple pain than the application of an ointment such as lanolin."
Overall quality of evidence for the primary outcome was low.

The NHS itself suggests applying expressed breast milk to cracked nipples after feeds, and mentions silver nipple cups between feeds. None of this is a substitute for correcting the latch; it is wound care while the cause is fixed.

What to do

Get a feed watched. The fastest route to less pain is someone experienced observing an actual feed and adjusting position and attachment.
Reset a bad latch mid-feed. Break the suction with a clean finger in the corner of the mouth rather than pulling off.
Soften a full breast first. The HSE advises hand expressing a little milk if your breasts are engorged, so your baby can get a deeper latch.
Keep milk moving. The NHS advises continuing to breastfeed or expressing by hand. The HSE says that if feeding is too painful, expressing for a day or two gives nipples time to heal while your baby still gets your milk — and that hand expressing may be more comfortable than a pump. If you do use a pump, start on the lowest setting.
Change breast pads at each feed, ideally without plastic backing, and wear a well-fitting bra without underwire (NHS).

What to avoid

The NHS advises against nipple shields and breast shells, because "these can affect how your baby attaches to the breast." The Academy of Breastfeeding Medicine goes further in its 2022 mastitis protocol: available evidence does not support nipple shields, neither safety nor effectiveness has been demonstrated, and infants often passively drink from the shield reservoir rather than latching to the breast itself.

The same protocol advises against saline soaks and topical products such as castor oil, noting that published evidence and best practice in wound care do not support saline soaking for pain or nipple trauma, and that some topical products may cause tissue damage. It also advises against routine cleaning of the nipple, which can macerate skin and cause pain.

And do not stop breastfeeding as a first response to pain. Both the NHS and HSE treat pain as a prompt to get help, not a reason to wean.

When soreness is something else

If your latch has been checked and pain persists, other causes are worth investigating. The HSE describes thrush as burning nipple pain that can last through and after a feed, sometimes with pink, shiny or flaky nipples and shooting pain deep in the breast, often after a period of pain-free feeding. Restricted tongue movement is another possibility: La Leche League GB notes a nipple compressed into a wedge shape "like that of a new lipstick" immediately after feeding, often with a stripe at the tip, as a sign of poor attachment that may be caused by tongue tie. Vasospasm, eczema and bacterial infection also occur.

When to get help

Ask your midwife, health visitor, public health nurse or a breastfeeding specialist as soon as you can if:

One or both nipples hurt at every feed (NHS).
Your nipples crack or bleed. The NHS notes this "increases your risk of getting an infection in your nipple."
Soreness lasts beyond the first week, or continues right through a feed (HSE).

Contact your GP or NHS 111 (or your local equivalent) if you develop a fever or flu-like symptoms, a hot, red, painful area on the breast, or a nipple wound that looks crusty, oozes or is spreading — these point to infection rather than friction.

Where to get real help

Most breastfeeding problems are solved faster by someone watching a feed than by reading about them. In the UK the National Breastfeeding Helpline is 0300 100 0212 and, as its operators the Breastfeeding Network and the Association of Breastfeeding Mothers state, it is open "24 hours a day, 365 days a year", with support also available in Welsh, Polish, Bengali and Sylheti (nationalbreastfeedinghelpline.org.uk). La Leche League GB runs local groups and a helpline; in Ireland the HSE offers an "Ask our breastfeeding expert" live chat and email service. An IBCLC is an International Board Certified Lactation Consultant, the only internationally accredited lactation qualification — you can check credentials through IBLCE. Your midwife, health visitor or public health nurse can also refer you.

Sore and Cracked Nipples When Breastfeeding