Updated December 2025
Sore Nipples
Signs and Symptoms
- nipples feel sore, painful, burn and/or are itchy
- nipples appear to be abnormally pink or red, bruised, blistered, cracked, shiny, flaky and/or bleeding
- discharge from cracks or sores on the mother’s nipple
Assessment
- assess positions and latch
- assess for ankloglossia
- assess for candidiasis (thrush)
Treatment
- correct position and latch
- after breastfeeding
- if no nipple trauma, apply expressed breast milk onto nipples and air dry (if no nipple trauma)
- for nipple trauma, apply saline compresses to nipple and air dry
- with nipple trauma, a compounded all-purpose nipple ointment (APNO), containing an antibiotic, steroid, and antifungal agent is commonly recommended but not yet researched. Note: prescription not available at TPH BF support services
- refer to the clinic (NOTE: Procedure(s) to address ankloglossia may not be available at all Breastfeeding Clinics)
Nipple Bleb
Signs and Symptoms
- nipple pain
- white or yellow dot on the nipple
Treatment
- frequent breastfeeding (at least 8 times in 24 hours) and hand expression
- sterile lancing (not available at the clinic)
- before breastfeeding
- apply warm compresses
- gently massage affected area
- after breastfeeding
- analgesics as needed (not available at the clinic)
Engorgement
Signs and Symptoms
- generalized breast tightness and pain
- breasts are not compressible
- usually begins 3-6 days after birth
- breasts appear flush
- low-grade fever
- difficulty latching
- hands and arms may be numb and tingling if engorgement is severe
Treatment
- breastfeed early, frequent and without restrictions
- before breastfeeding
- hold baby skin-to-skin
- warm compresses to breast of warm shower
- gentle massage to the breast
- hand expression
- After breastfeeding
- hand expression
- cool compress to breast
- analgesics as needed (not available at the clinic)
- refer to the clinic
Breast Abscess
Signs and Symptoms
- history of recurrent mastitis
- unilateral breast pain
- swelling and redness
- possible lump
- fever and feeling unwell
- poor response to antibiotics
Treatment
- requires needle aspiration or incision for drainage
- resume feeding on affected breast once treatment has started and if abscess does not involve the nipple
Before breastfeeding
Candidiasis - Mother and Child
Signs and Symptoms
- persistent cracked or painful nipples
- painful nipples that develop suddenly when breastfeeding was going well
- severe nipple pain that lasts throughout the entire feeding and immediately after breastfeeding
- sharp shooting or burning pain in the mother’s breast
- areola may be red, swollen, flaky/scaly, or shiny in appearance
- nipples may be red, sore, cracked, itchy, burning or painful
- recurrent mastitis
Treatment
- both mother and baby need to be treated
- consider treating partner in resistant cases
- frequent hand washing
- wash and boil, once a day, all objects that come in contact with infant’s mouth (e.g. toys, artificial nipples, droppers, pacifiers, teethers)
- over-the-counter treatments
- Miconazole (topical)
- Ketoconazole (topical)
- treatments requiring a prescription
- Nystatin (topical or oral)
- Medication including “azole”, i.e., clotrimazole (topical), miconazole (topical), itraconazole (oral),ketoconazole (topical or oral), and fluconazole (oral)
- All-Purpose Ointment (APNO)
- before breastfeeding
- breastfeed on the pain-free side first, then switch sides
- after breastfeeding
- wash breasts and nipples with clear water at the end of each breastfeeding and then air dry
- apply a cool cloth for comfort
- express both breasts after breastfeeding if baby is unable to breastfeed effectively
- refer to the clinic for ongoing breastfeeding support
Related Information for Your Patients
Date modified: January 14, 2026
