I find that I generally agree with the discussion of early, transient sore nipples but with a different perspective. It is true that many mothers, experienced and inexperienced breastfeeders, have sore nipples for the first few days postpartum. However, I do not think we need to throw out the relationship between nipple pain/damage and infant position/attachment at breast. New skills take practice. We improve with repeated exposure and practice in the new activity. Babies are no different. They may nurse a time or so in an "iffy" position--not attaching just so. With additional practice, they improve their skill. The not-quite-right times may cause the nipple tenderness; the improvement allows healing and pain-free feedings. This makes sense to me as I relate the literature to my practice experience. In working with new mothers, I apply this understanding to a practical "formula." 1. Watch the infant feed with special attention to position at breast, attachment to breast, & shape of nipple when infant first detaches. 2.Suggest changes if needed. 3.Talk a bit about how we all learn new skills--practice, do it okay one time, not-so-great another, and so on. 4.Suggest that the mother continue to watch infant's position and attachment at breast and if her nipples are not okay, or at least better, in 48 hours she call the lactation center for help --OR-- if her nipples start getting worse, she call us for help. This 48 hour rule has worked well and it lets mothers know that she does not have to hurt to breastfeed--it reminds her that help is available. The ones that are not at least better by this time tend to be the ones who really need intervention of some sort as the pain & damage has gotten progressively worse. This perspective prevents me from telling mothers that they can expect nipple pain. I find that I relate pain to something not being right--position or otherwise. If there is nipple or breast pain, they are to let us know. At this time, I go to the above plan -- just a different view of the same discussion. Pardee Hinson, MPH, IBCLC Charlotte, NC [log in to unmask]