• Continue breastfeeding if tolerable, because regular milk removal helps prevent engorgement and mastitis. If feeding is too painful, express milk temporarily to maintain supply.
• Get hands-on latch help early from a lactation consultant, midwife, or health visitor. Tongue-tie, thrush, or dermatitis can also contribute.
• After a feed, gently apply a few drops of expressed breast milk and let the nipple air-dry. A purified lanolin nipple ointment can be used if it suits you.
• Change damp breast pads promptly; use breathable cotton bras. Avoid harsh soap, alcohol wipes, and fragranced products, which can worsen dryness.
• Simple pain relief such as paracetamol/acetaminophen or ibuprofen is generally compatible with breastfeeding if you can normally take them. Follow the label or clinician advice.
• Do not routinely use antibiotic cream unless a clinician suspects bacterial infection. A textbook notes mupirocin for a cracked nipple, but this should be individually prescribed, especially while nursing.

Current guidance for cracked nipples during breastfeeding

What to do now

1. Optimise positioning and deep latch
   • Bring baby to the breast, chin first, with a wide-open mouth and more areola in the mouth below the nipple than above.
   • Break suction with a clean finger and relatch if pain remains beyond the initial brief tugging sensation.
   • Check for factors that impair latch, especially infant tongue-tie, prematurity, oral anatomy issues, oversupply, or pumping-related injury. A direct breastfeeding assessment is needed before considering frenotomy for tongue-tie. The ABM tongue-tie statement stresses that observation of feeding, maternal comfort, and milk transfer are essential.
2. Keep milk removal physiologic
   • Continue feeding on the affected side if tolerable.
   • If pain is too severe, hand-express or pump only enough to maintain supply and comfort while arranging latch support. Check pump flange size and suction level, since poor fit or excessive suction can cause or worsen trauma.
   • Avoid “pumping to empty” or frequent extra pumping as a routine response. The Academy of Breastfeeding Medicine's 2022 mastitis protocol cautions that excessive pumping can worsen inflammation and advises against routine nipple shields. See ABM Protocol #36.
3. Basic nipple care
   • After feeds, the NHS suggests applying a little expressed breast milk to the crack and allowing it to dry.
   • Change wet breast pads after each feed, choose breathable pads without plastic backing if possible, and wear a non-underwired supportive bra.
   • Avoid soap, alcohol, fragranced wipes, or vigorous cleaning. ABM specifically advises against routine nipple cleansing because it can macerate skin and increase pain.
   • Silver cups may be used between feeds according to NHS advice, though they do not replace latch correction.
4. Topical treatments
   • Lanolin, hydrogel dressings, and breast milk may soothe some people, but evidence that any one topical product heals cracked nipples better than another is uncertain.
   • A 2024 systematic review found low-certainty, imprecise evidence for topical non-drug treatments, including lanolin versus breast milk PMID: 38837198.
   • A 2025 review found possible benefit from moisturizing approaches, but trials were weak and highly occlusive products had reported adverse effects, so use them cautiously PMID: 39713981.
   • Do not routinely use antibiotic, antifungal, or steroid creams for a simple crack. These should follow clinical examination and a diagnosis such as bacterial infection, dermatitis, candidal infection, or inflammatory nipple bleb.
5. Pain relief
   • Paracetamol/acetaminophen or ibuprofen are generally compatible with breastfeeding for most people, provided there is no personal reason to avoid them. Follow the packet instructions or obtain clinician advice.

When assessment is urgent