Breasts are sensitive part of the body. Most mothers will experience some degree of soreness during the early stages of nursing. It is important to have a good latch to prevent any damage to the nipple. Secretions from montgomery glands (sebaceous glands in the areola surrounding the nipple) have anti-infective properties to keep nipple and areola lubricated and protected. Avoid washing nipples with soap as it may lead to dryness and even cracked nipples.

Research suggests that there is an association between nipple pain and trauma with early termination of breastfeeding and postpartum depression. Persistent pain and trauma to the nipples can discourage mothers from continuing to breastfeed, leading to early termination. This can have a cascading effect, contributing to postpartum depression due to feelings of inadequacy and frustration. Therefore, addressing nipple pain is vital not only for the physical health of the mother and baby but also for the emotional well-being of the mother. 

There are several possible causes of sore nipples during breastfeeding. Understanding these causes can help address the issue effectively:

• Poor Latch or positioning: Poor positioning of the baby during breastfeeding can result in an improper latch and increased nipple pain. If the baby is not latched onto the breast correctly, it can cause friction and pressure on the nipple, leading to soreness and pain.
  
  
• Baby’s mouth anatomy: Certain mouth anatomy, such as high palate or tongue tie, can interfere with the baby’s ability to latch properly and cause nipple pain for the mother.
  
  
• Thrush (Candidiasis): A yeast infection in the baby’s mouth or on the mother’s nipples can cause significant pain. Thrush can present as white patches in the baby's mouth and may cause burning, itching, or stabbing pain in the mother’s nipples.
  
  
• Engorgement: When the breasts become overly full with milk, they can become hard and swollen. This engorgement can make it difficult for the baby to latch properly, leading to sore nipples.
  
  
• Dry Skin: Dry or cracked skin on the nipples can cause pain and soreness. This can be exacerbated by frequent breastfeeding and exposure to saliva.
  
  
• Blocked Milk Ducts: A plugged duct is a blockage that obstructs milk flow in a part of the breast, which can occur at the nipple and areola or deeper within the ductal system. A clogged areola can cause swelling and result in nipple soreness as pressure builds up in the surrounding area.
  
  
• Pumping Issue: Using a breast pump with incorrect suction settings or poor-fitting flanges can cause nipple trauma and soreness. It's essential to ensure the pump is used correctly and comfortably.
  
  
• Vasospasm: Some mothers experience vasospasm, a condition where the blood vessels in the nipple constrict, causing spasming pain and blanching of the nipple. This can be triggered by cold temperatures or poor latch.
  
  
• Eczema or Dermatitis: Skin conditions such as eczema or dermatitis can cause irritation and soreness of the nipples. These conditions might be exacerbated by the moisture and friction associated with breastfeeding.
  
  
• Nipple Biting: As babies grow and start teething, they may bite the nipple during breastfeeding, causing pain and potential injury to the nipple.

Here are some tips to alleviate sore nipples:

• Ensure a good latch and position: Make sure your baby is latching deeply and effectively. The baby should have a considerable amount of areola in their mouth, not just the nipple. If the latch is still painful despite improvements, give your nipples a break by hand expressing or gently pumping. Using nipple shields can temporarily protect your nipples while they heal. Consult a lactation consultant to ensure proper use, as nipple shields can cause more nipple damage if not used correctly.
  
  
• Warm compresses: Applying warm compresses can alleviate pain associated with vasospasm.
  
  
• Cold compresses: Use of ice packs on your nipple and areola can reduce pain and swell related to engorgement or clogged areola.
  
  
• Hand expression: Manually express milk at nipple and areola to remove clogged ducts.
  
  
• Moisturising agents: Nipple creams are used to heal sore and cracked nipples. Coconut oil or olive oil has been shown to have anti-inflammatory and antioxidant properties to aid healing. Lanolin provides a moist wound healing environment. Expressed breastmilk contains anti-infective properties to promote wound healing and decrease inflammatory risk or infection.
  
  
• Avoiding contact: Breast shells or silver cups can be worn over nipple to avoid contact while healing happens.
  
  
• Seek medical help: Consult your doctor for appropriate treatment if you see signs of fungal/ bacterial infection or eczema.