I appreciated Sue Huml's comments on sore nipples and I agree with her.  In
the "old" days LLLI took the position that sore nipples in the first few
postpartum days of frequent breastfeedings was common and normal. What the
mom needed was anticipatory guidance and reassurance that the soreness
would resolve--which it did in most cases.  In later years, we took the
stance that chronic sore nipples (soreness that did not resolve after the
first week) was separate from this early "normal" soreness. The possible
causes of this chronic soreness needed to be assessed and special
treatments needed.  Now, we talk as if all normal early soreness is because
the baby is not positioned "correctly." This conclusion flies in the face
of good data from several studies by various researchers showing that
80-95% of all new breastfeeding mothers report that they have some level of
nipple discomfort that peaks 3-4 days postpartum. It seems reasonable that
at least some of these many hundreds of women in these studies would have
positioned their babies correctly just by accident!  Many were were
experienced, successful breastfeeders.
It is said that pain always means something is wrong.  But what if pain can
also mean that something is "right"? i.e. the infant is vigorously suckling
and the skin response is temporary soreness.  As an anology, childbirth
educators years ago went through a phase of saying that childbirth could be
completely painless if the "right" things were done, breathing etc.
I propose that we return to our earlier assumption that there are two types
of sore nipples,1) normal/transient, and 2) pathologic/chronic. We should
still teach positioning not because it prevents early nipple soreness but
because it is helpful to prevent and treat pathologic/chronic sore nipples
and can be critical for the baby who is not gaining. We should also
reassure mothers that temporary nipple soreness is common and can be
anticipated.