Nipple, Cracked

Q: I am nursing my 4-week-old son, and my left nipple is cracked. It is very painful to nurse on that side. I've used both vitamin E oil and lanolin for 5 days, but neither seems effective. What can I do?

A: A cracked nipple usually is due to a problem with positioning and latch-on. Cracks are not normal. Where the crack (or cracks) is located often indicates the problem's source. You're smart to continue to nurse from the affected nipple: Studies show that a cracked nipple heals just as quickly if it's used for nursing as if it's left alone. Nursing may speed healing, since it increases the blood flow to your breasts.

To promote healing, apply breast milk to the nipple cracks, and let it air-dry. Breast milk not only will heal cracks better than lanolin, vitamin E, or other creams but also can prevent infections. You'll also need an all-purpose nipple ointment to heal a damaged nipple, and moist wounds require special care. Ask us or lactation consultant for help.

First, check your baby when she's off the breast, and see if she can extend her tongue beyond her gum line. If she can't extend her tongue, that might be the cause of your cracked nipple. Have your pediatrician look at her tongue to confirm this. It's possible to breastfeed in this case, but you'll need one-to-one help from a lactation consultant who's had experience with this situation. If your cracked nipple was caused by a positioning problem, here are some tips on establishing a good nursing position:

• Have several small pillows available to support your arms and your baby. Nurse in a comfortable chair, or surround yourself with pillows if you're nursing in bed. Put one pillow behind your back, another on your lap, and a third under the arm that you'll use to support the baby.
• Rest your feet on a low footstool (a cardboard box will work in a pinch), so your knees are raised.
• Hold the baby at breast level. The pillows should be supporting your upper body-arms and shoulders-and your lower back. If those areas feel strained, reposition yourself.
• Check the baby to make sure she also feels supported and secure. If she's tense, she can't concentrate on nursing.
• Hold your breast with one hand. Cup it with your thumb above-but not touching-the pink/brown areola, so your fingers and palm support the breast from below. Tickle your baby's lips with your nipple. If she doesn't open her lips, express a little milk and dab it on her mouth. When she opens her mouth, bring her quickly to your breast.
• Make sure she gets a big mouthful of breast. Your whole nipple should be inside her mouth, and a good measure (an inch) of areola as well. (If you're engorged, you may not be able to get much or any areola inside. Express some milk until the engorgement diminishes.)
• Support the baby, if necessary, at her shoulders, instead of her head. Make sure her body is in a straight line from ear to hip. Cuddle her close. Her chin and nose should be in contact with your breast throughout the session.
• Watch her as she suckles. Are her lips pulled in, or flanged out? If they're pulled in, fold the lip out. If you're having trouble envisioning this, watch yourself in the mirror while you're drinking a soda from a can or bottle. That's how the baby's lips should look, too.
• Listen as she nurses. If she clicks, slurps, or gasps, she may have a poor latch-on.