The problem: pain at every feed
In the first days after the birth there is a brief pull when the baby latches on, then it gets better. That much is common. But if one or both nipples hurt at every feed, crack or bleed, that is not something to put up with but a reason to get help early (NHS: Sore nipples).
Sore nipples are injured nipples, with or without infection. Typical signs are cracks, skin abrasions, pain especially when latching on, redness, swelling, scabs and pale or dark blotches on the nipple. With a bacterial infection, pus or a yellowish discharge can appear (Jacobs et al. 2013). A sign of a poor latch: after the feed the nipple looks flattened, wedge-shaped or white, and the baby seems unsettled after feeding (NHS: Sore nipples).
Many people also search for dry, flaky nipples in pregnancy, during the menopause or in men. That is a different picture, which the table also covers. It is based on specialist sources and does not replace a diagnosis; only a medical examination can give you certainty.
| What you notice | What is often behind it | What matters now |
|---|---|---|
| Pain when latching on, cracks, scabs, flattened nipple after feeding | baby not latched on deeply enough (NHS: Sore nipples) | have the latch checked |
| Pain despite a good latch, itching, changed skin on the nipple or areola | possible infection by bacteria, viruses or fungi (NHS: Breast pain) | midwife or doctor |
| Pus or yellowish discharge on the sore, red nipple | bacterial infection (Jacobs et al. 2013) | have it checked by a doctor |
| Dry, flaky, itchy areola, even without breastfeeding | nipple eczema, for example from soap, detergent, clothing, fragrances or a contact allergy (DermNet) | leave out irritants, see a doctor |
| One-sided, scaly or eczema-like area on the nipple that persists for months | must be checked by a doctor to rule out the rare Paget's disease, a form of breast cancer (DermNet), (NHS: Breast cancer) | see a doctor, do not wait |
Why nipples get sore
The latch. When the baby is well attached, the nipple rests at the back of the mouth against the soft palate. If the baby is poorly attached, the nipple sits further forward and is pinched against the hard palate (NHS: Sore nipples). Research has identified a poor latch as a common cause of sore nipples (Dennis et al. 2014).
Anatomy of mother and child. Flat or inverted nipples, and in the baby an unfavourable tongue position, a frenulum of the tongue or lip that is too short, an asymmetrical lower jaw or particular features of the palate can make latching on and sucking harder. The German guideline recommends checking for these before any treatment (Jacobs et al. 2013). Between 4 and 11 per cent of newborns have a tongue-tie; in studies, dividing it reduced mothers' pain in the short term, but the studies were small (O'Shea et al. 2017).
Pump and shields. A poorly fitting breast pump or incorrectly used nipple shields can put extra strain on the nipples (Jacobs et al. 2013). Nipple shields and breast shells can also affect how the baby attaches (NHS: Sore nipples).
Moisture and friction. Wet breast pads with a plastic backing keep the skin damp; a tight underwired bra presses (NHS: Sore nipples). In autumn and winter there is also the fact that under thick layers damp pads go unnoticed for longer and rough wool can rub on the delicate skin.
Infection and skin. Open or bleeding cracks increase the risk of germs getting in (NHS: Sore nipples). A fungal infection, skin inflammation or nipple eczema can look similar (Jacobs et al. 2013). Eczema can also be triggered by products applied for the sake of the sore nipple, such as lanolin, vitamin E, chamomile, aloe vera or tea tree oil (DermNet).
The solution step by step
| Step | What you do | Why |
|---|---|---|
| Get help early | Have a midwife, lactation consultant or breastfeeding group watch a whole feed. | Self-help does not work while the baby is poorly attached (NHS: Sore nipples); feeding technique and sucking should be checked before any treatment (Jacobs et al. 2013). |
| Latch | Bring the baby close to the breast with a wide-open mouth so that they take in plenty of the areola; if it hurts, break the suction with a clean finger in the corner of the mouth and latch again. | Only then does the nipple sit at the back against the soft palate (NHS: Sore nipples). |
| Change position | Feed sometimes sitting, sometimes lying down, sometimes on your side. | Different feeding positions help with sore nipples (Jacobs et al. 2013). |
| Encourage milk flow | Relax before latching, massage the breast carefully or prepare it with moist warmth. | This supports the let-down reflex and is mentioned in the guideline (Jacobs et al. 2013). |
| After feeding | Spread a few drops of breast milk on the nipple and let it air-dry; alternatively, highly purified lanolin from the pharmacy. | Both are used in practice and well accepted, even though studies show no clear benefit (Jacobs et al. 2013). |
| Pads and bra | Change breast pads at every feed, ideally breathable and without a plastic backing; wear a well-fitting bra without underwire. | This keeps the skin drier and free of pressure (NHS: Sore nipples), (Jacobs et al. 2013). |
| Hygiene | Wash your hands before feeding and before touching the nipples. | The general rules on hand hygiene apply here too (Jacobs et al. 2013). |
| If it hurts too much | Keep breastfeeding as best you can, or express milk by hand for a while; a breast pump must fit properly. | It is important not to stop breastfeeding (NHS: Sore nipples); poorly fitting pumps make things worse (Jacobs et al. 2013). |
The German guideline, developed on the initiative of the National Breastfeeding Committee, involved the German Association of Midwives, the Professional Association of German Lactation Consultants and La Leche League, among others (Jacobs et al. 2013). It stresses: if the skin is intact, nothing needs to be applied to the nipple.
What helps – and what doesn't
| Remedy or habit | Assessment |
|---|---|
| Breast milk on the nipple | tried and tested in practice (Jacobs et al. 2013); in one study at least as good as lanolin in the short term (Dennis et al. 2014) |
| Highly purified lanolin | widely used in practice (Jacobs et al. 2013); no clear advantage over nothing (Dennis et al. 2014); wool wax can trigger a contact allergy (DermNet) |
| Glycerine gel pads, breast shells, all-purpose nipple ointments | no clear benefit in studies (Dennis et al. 2014) |
| Black tea as a tea-bag compress | in a small study no better than a warm water compress; both were better than nothing (Lavergne 1997). So warm water is enough |
| Quark on the nipple | rather not: we have not found any studies, and a food does not belong on open cracks |
| Nipple ointments with active ingredients, essential oils, tea tree oil, propolis, chamomile | only after consultation: whatever stays on the nipple, the baby takes into their mouth at the next feed; some of these substances are also known triggers of contact allergies on the nipple (DermNet) |
| Nipple shields long term | rather not without advice: they can change how the baby attaches (NHS: Sore nipples) |
| Laser light therapy (photobiomodulation) | an analysis of small studies found less pain, but the evidence is weak (de Oliveira Alves et al. 2025) |
| Stopping breastfeeding because of blood in the milk | not necessary: blood in the milk alone is no reason to stop breastfeeding (Jacobs et al. 2013) |
Common mistakes
The most common mistake is putting up with the pain for weeks because "that's just how it is at the start", instead of having the latch checked early. Second, ointments are switched and layered while the cause, the latch, stays the same. Third, all sorts of things are put on cracks, from quark to ointments with essential oils, which the baby then drinks along with the milk. Fourth, damp breast pads stay in the bra for hours. Fifth, an area that does not get better despite good technique is not seen by a doctor. And sixth, breastfeeding is stopped suddenly because of a painful, red area in the breast; that can make things worse.
When to seek medical advice?
The same day, see your gynaecologist or the out-of-hours medical service (116 117 in Germany) if
- an area of the breast is red, hot, swollen and very painful and you feel ill or have a fever above 38.4 °C; these are signs of breast inflammation (mastitis) (Jacobs et al. 2013), (NHS: Mastitis),
- mastitis does not improve after 12 to 24 hours of self-help (NHS: Mastitis); according to the guideline, a bacterial inflammation must be assumed if there is no improvement within 24 to 48 hours (Jacobs et al. 2013),
- the nipple shows pus or a yellowish discharge (Jacobs et al. 2013).
Do not stop breastfeeding abruptly: stopping suddenly can make mastitis worse and lead to an abscess (NHS: Breast pain). If you feel very ill with a fever, become drowsy or confused, call 112.
In the next few days, see your midwife, a breastfeeding counsellor or a doctor if
- the nipples are cracked or bleeding; this increases the risk of infection (NHS: Sore nipples),
- the pain persists despite a good latch (NHS: Sore nipples), or the skin itches or changes (NHS: Breast pain),
- the baby attaches poorly or is not gaining weight well; then the tongue and lip frenulum should be checked too (Jacobs et al. 2013).
See a doctor regardless of breastfeeding if a nipple turns inwards, a rash or scaly area on the nipple does not go away, fluid leaks outside pregnancy and breastfeeding, or you feel a lump in your breast or armpit (NHS: Breast cancer). Often something harmless is behind it, but it needs to be checked.
Frequently asked questions
How long do sore nipples from breastfeeding last?
For most women the pain eases noticeably about seven to ten days after the birth, regardless of what they apply (Dennis et al. 2014). If it does not get better or cracks appear, have the latch checked.
Which cream helps with sore nipples?
The German guideline names breast milk or highly purified lanolin, based on experience rather than studies (Jacobs et al. 2013). According to a Cochrane review, other ointments bring no clear advantage (Dennis et al. 2014). Ointments with active ingredients only after consultation.
Do black tea or quark help?
Tea-bag compresses were no better than warm water in one study (Lavergne 1997). We have not found any studies on quark on sore nipples; it does not belong on open cracks.
Can I keep breastfeeding with bleeding nipples?
Yes. Blood in the milk alone is no reason to stop breastfeeding (Jacobs et al. 2013). But get help early, because open cracks become inflamed more easily.
What if the baby is getting teeth?
If new pain comes with the first teeth, have the latch checked again. If the baby bites, you can break the suction with a clean finger in the corner of their mouth.
Dry, flaky nipples in pregnancy: what helps?
Eczema may be behind it, triggered for example by soap, detergent, clothing or fragrances (DermNet). Wash with lukewarm water, no perfumed products on the breast, soft cotton, fragrance-free care. If it persists or only one side is affected, have it looked at.
Dry nipples in men or during the menopause?
Nipple eczema can occur at any age and in men (DermNet). A one-sided, scaly area that does not go away should always be checked by a doctor.
At forpeople
We do not recommend any of our own products for sore nipples while breastfeeding. Whatever stays on the nipple, your baby takes in at the next feed. Our SOS Pitch Salve contains larch resin, our Beeswax Salve contains larch resin, propolis and essential oils, and our almond oil is a nut oil; none of these belongs on the breastfeeding breast. Breast milk or highly purified lanolin from the pharmacy are tried and tested, along with help with the latch.
If other areas of skin are troubling you during pregnancy or breastfeeding, you will find more in Itchy skin in pregnancy and Sore skin under the breast (intertrigo).
More on this: Lanolin or beeswax · Colophony allergy, propolis, beeswax · Essential oils and fragrance allergens · Nappy rash in babies · Dry skin in babies · Rash from laundry detergent
Sources
- Jacobs A, Abou-Dakn M, Becker K, Both D, Gatermann S, Gresens R et al. (2013): S3-Guidelines for the Treatment of Inflammatory Breast Disease during the Lactation Period. AWMF Guidelines, Registry No. 015/071 (short version). Geburtshilfe und Frauenheilkunde 73(12): 1202–1208. https://doi.org/10.1055/s-0033-1360115
- Dennis CL, Jackson K, Watson J (2014): Interventions for treating painful nipples among breastfeeding women. Cochrane Database of Systematic Reviews 2014(12): CD007366. https://doi.org/10.1002/14651858.CD007366.pub2
- NHS: Sore or cracked nipples when breastfeeding. Last reviewed 16 Jun 2026. Accessed 30 Oct 2026. nhs.uk
- NHS: Breast pain and breastfeeding. Last reviewed 11 Mar 2026. Accessed 30 Oct 2026. nhs.uk
- NHS: Mastitis. Last reviewed 17 Mar 2023. Accessed 30 Oct 2026. nhs.uk/conditions/mastitis
- O'Shea JE, Foster JP, O'Donnell CP, Breathnach D, Jacobs SE, Todd DA, Davis PG (2017): Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews 3: CD011065. https://doi.org/10.1002/14651858.CD011065.pub2
- Lavergne NA (1997): Does application of tea bags to sore nipples while breastfeeding provide effective relief? Journal of Obstetric, Gynecologic, and Neonatal Nursing 26(1): 53–58. https://doi.org/10.1111/j.1552-6909.1997.tb01507.x
- DermNet: Nipple eczema. Kim NS, Velykoredko Y, September 2018. Accessed 30 Oct 2026. dermnetnz.org/topics/nipple-eczema
- NHS: Symptoms of breast cancer in women. Last reviewed 4 Mar 2024. Accessed 30 Oct 2026. nhs.uk
- de Oliveira Alves R, Faccioli Ragghianti MH, Nunes LP, Ferreira MF, Alves de Toledo PT, Ferrisse TM et al. (2025): Photobiomodulation as a promising approach in the management of nipple lesions during breastfeeding: a systematic review and meta-analysis of randomized clinical trials. Lasers in Medical Science 40(1): 276. https://doi.org/10.1007/s10103-025-04531-7
