What are they?

Breastfeeding may possibly make your nipples feel a little sore at the beginning of a feed during the first few days. But sore, cracked and bleeding nipples are not a normal side effect of breastfeeding, they are a sign that your baby is not latched on properly at the breast. Breastfeeding isn't meant to be painful - in fact, pain is a warning sign that you have a problem that needs resolving.

Occasionally, you may see blood though you feel no pain. A bloody discharge from the nipples during the first week of breastfeeding may be caused by increased blood flow to the breast, along with the growth of milk-producing tissue. This is a harmless condition, known as "rusty pipe syndrome" and should go away without treatment in a few days.

The main cause of cracked or bleeding nipples is that your baby is not latched on at the breast properly. This often causes severe nipple pain. Adjusting your feeding technique can substantially soothe or cure cracked nipples. Sometimes just the slightest correction of attachment can make a world of difference.

If your baby has thrush, you may get cracked nipples and shooting pains in the breast during or after a feed. Thrush is a fungal infection of the mouth that results when organisms naturally present in the body grow and spread out of control. (See our articles on thrush in babies and thrush in mothers.)

Your nipples may also crack or bleed because of severe dry skin, or eczema. You can get an eczema-like condition on the nipples or breasts as a result of very dry air, clothes detergent residue, ointment or lotion applied to the breast, bath soap or antibacterial cleanser, powder, hair spray, deodorant, perfume, or cologne.

Using a breast pump incorrectly can also damage your nipples, and make them crack or bleed. Be especially careful when you pump, as certain machines and handling your breasts too roughly can injure delicate breast tissue, breaking the capillaries. Excessive suction from a breast pump has caused haemorrhages under the skin in some women.

What should I do?

If your nipples bleed or crack, here's what you need to do:

• Get some expert help as soon as possible. It's very important to sort out your baby's latching on technique so that he is feeding properly without damaging your nipples. Contact a breastfeeding counsellor or infant feeding specialist, or your midwife or health visitor may also be able to advise you. Once your baby is latching on properly, feeding should be pain free. Your baby should face your breast, and be turned towards you. Your baby's mouth needs to open wide to take in a good mouthful of both the nipple and the areola.

• Some mums find using a modified lanolin ointment made specifically for breastfeeding mothers can help heal the nipple. Rub a small amount of the ointment on your nipples. This treatment, called "moist wound healing," relieves pain and allows the wounds to heal much faster without forming a scab. It does not need to be washed off before feeds. Your local pharmacist should be able to help you select a suitable product.

• Don't use soap, alcohol, lotions, or perfumes on the nipples. Washing or bathing with clear water is all it takes to keep your breasts and nipples clean.

• Take painkillers. If the pain is severe, you can take a mild painkiller about 30 minutes before feeding. Check the most appropriate type with your GP or health visitor.

If a crack or wound shows no sign of healing, check with your doctor or health visitor.

Will the condition affect my baby?

Babies generally ignore cracked or otherwise injured nipples. Blood in the milk doesn't hurt them, and breastfeeding can continue. The main issue here is to correct the problem and allow the nipple to heal, so that feeding is once again a pleasurable experience for both you and your baby. However, if your baby is not latched on at the breast properly, he may be taking in too much of the thirst quenching foremilk, and not enough calorie-rich hindmilk that comes at the end of a feed, and this may result in him not gaining enough weight.

Can I still breastfeed?

Nothing in the world is more wonderful than breastfeeding your baby - but convincing a mother with cracked, bleeding nipples of this is virtually impossible. If you want to continue to breastfeed, you should know that there are remedies for painful breasts and injured nipples. With determination, and expert help, you can eventually experience pain-free breastfeeding.