What are the most common causes of nipple pain and damage when you're breastfeeding an older baby or child (with a word about teeth)?

Your child has grown longer and is more likely to cause nipple and breast tissue drag

This is the most common reason why an older baby or toddler starts to cause you nipple pain or damage, after months or a year or more of comfortable breastfeeding. She has grown, and positions that worked perfectly when she was shorter now cause nipple and breast tissue drag.

• Often, when we're sitting to breastfeed, our older child drags the nipple and breast higher than where the nipple wants to fall in response to gravity.

• Also, it's very common for our older little one to drag the nipple and breast too far towards your arm on the side you're feeding from.

For instance, if the mother in the photo at the top of this page was experiencing any problems at all, either

• Nipple pain or cracks and wounds, or

• The toddler fussing alot and getting frustrated with breastfeeding (even though she wants it)

then I'd recommend she move her daughter much further towards the little one's feet.

This means that with our older breastfeeding children, their little bottoms are almost down on the couch beside our thigh, and their feet are way out to the side. That helps them get lower at the breast, able to feed closer to where your breast wants to fall.

What about your little one's teeth?

Homo sapiens mothers have breastfed their older babies and small children for 200,000 years without being repeatedly bitten or hurt by their little one's teeth. I feel I can say this because repeated biting would likely have changed the course of evolution, so that babies were weaned much earlier than at two years of age or older, which has been the average for human cultures until the Industrial Revolution.

Still around the planet today most cultures breastfeed their babies and toddlers without difficulty, despite the eruption of teeth. Your child's teeth shouldn't be a big problem in breastfeeding, once we've sorted out two things.

1. You still have control over how much nipple and breast tissue is drawn up into your child's mouth

If your little one is pulled in deeply, much more than just your nipple is drawn up into his mouth. An older child is extremely active at the breast and is in many ways unable to be restrained or controlled. We don't want you struggling with your older breastfeeding baby - that's unpleasant for both of you! But you still have some control with your forearm over how your child comes to your breast. And you have the capacity to take the child off.

Although the rest of that gorgeous little body may be wriggling and kicking and adopting a range of acrobatic positions throughout breastfeeds, you can still use your forearm to make sure that her mouth comes on in a way that doesn't cause too much breast tissue drag (if you have any problems). You can use your forearm to ensure she is drawing up a lot of nipple and breast tissue, which protects your nipple from any rubbing on her teeth.

2. Your baby or toddler learns not to bite by the way you respond to accidental or exploratory bites

A bite requires an immediate, physical and somewhat unrestrained response which communicates clearly in that moment how much the bite hurts you - and that it's not something you'll put up with!

"Ouch!!! No!" you might say or even cry out in a clear, rather loud and upset voice, as you immediately and reflexively take your little one off, and start doing something else. Your older baby or toddler is likely to be upset at your response, but this is how he will learn that biting is not compatible with breastfeeding.

A short time later, you might return to breastfeeding, but you've communicated that breastfeeding will stop the minute you receive a bite. You repeat this whenever it happens (which for most breastfeeding pairs is very rarely, if at all).

Then focus on making sure that lots of breast tissue is drawn up into your little one's mouth, so that biting on the nipple isn't mechanically easy.

In the photo at the top of this page you'll see again how acrobatic toddler breastfeeding can be. You don't need to worry if there aren't any problems - often toddlers move the breast to where they want it anyway. But if problems emerge, you'll need to get more proactive about positioning. Usually, though, breastfeeding a toddler is a delight, a moment of cuddles and enjoyment and relative rest. Usually by this time, breastfeeding problems have been left far behind way back in the distant past, in those early weeks of your breastfeeding relationship!