• Poor attachment is by far the most likely cause of sore nipples, but it is important to check for the presence of a tongue tie by sweeping the index finger under the baby’s tongue to check for the presence of a tight or unusually prominent frenulum. This can be divided by one of several midwives if the baby is under 3 months old, at RCHT or at Penrice, please call 01872 252150 or 01726 291128.
• Scabbed or bleeding nipples can benefit from resting and expressing for 12-24 hours, and from moist healing and protection by applying expressed breast milk (or occasionally, in severe cases, Jelonet, with a clean 1cmx1cm square applied after each feed or after expressing.)
• Thrush is a possibility (not likely in the first couple of weeks after birth) see pages 26-28