OUCH! Breastfeeding Hurts! (Even With A Good Latch)

Experiencing pain while breastfeeding is NOT normal, and it’s definitely not something you should have to endure to make breastfeeding work.

Breastfeeding is naturally supposed to be comfortable and enjoyable— so breastfeeding hurting is a clear sign that something isn’t quite right.

In order to come up with a solution, you need to first identify the PROBLEM.

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NOTE: As many as 90% of new moms experience some level of nipple soreness during the first few days after birth. This is perfectly normal as you and baby are learning and trying to figure out breastfeeding. It’s not even actual pain, but more a sensitivity of the nipples and usually doesn’t indicate a problem. This normal postpartum nipple discomfort usually peaks around day 4 and then subsides as you and baby get better at latching and positioning in the first couple weeks. The sensitivity should not be severe and shouldn’t last throughout the whole feeding session, and be gone within a couple weeks.

When To Seek Help If Breastfeeding Hurts

Latching that extremely hurts is absolutely NOT normal and indicates a change is needed. Troubleshoot your latching and positioning right away and reach out to skilled lactation help if it doesn’t get better.

Ask yourself this: 
On a scale of 0-10, how much does the latch hurt?

0 = pain free   
10 = toe-curling/wanting-to-scream/can’t-take-it-any-longer

Normal discomfort is 0-4 on the scale. 
Abnormal pain is 5-10 on the scale. 

Call an International Board-Certified Lactation Consultant as soon as possible if you have:

• Intense stabbing or pinching pain while breastfeeding

• Pain that occurs throughout the feeding

-nipples that look pinched, elongated, squashed, or flattened after a feed (like a tube of lipstick)If the nipple looks squashed

• Nipple pain even when not breastfeeding

• Experiencing nipple pain beyond the first two weeks

• Nipple trauma such as blisters, abrasions, scabs, bleeding, bruising, cracks, rash, or bright red color

Wisdom from Lactation Consultants About Breastfeeding Pain

“Breastfeeding in the first couple of weeks is like breaking in a new pair of shoes - a little bit uncomfortable at the beginning but you wouldn’t walk around with bleeding feet! Breastfeeding isn’t meant to be painful. So if your nipples are hurting, bleeding, stinging or burning - please reach out to your local IBCLC.””

— KAROLINA OCHOA, BSN, IBCLC

Tenderness is normal. Toe curling pain or pinching is NEVER normal and is either a sign that baby is not latched deep enough or there may be a baby structural issue like tongue tie. If you feel any pain or are starting to see any damage, seek help sooner rather than later. If it’s tender but there’s no damage, keep practicing your positioning and latching. If you’re unsure, don’t hesitate to call for help!  Lactation consultants LOVE to help teach you to nurse without pain!”

-Julie Matheney, IBCLC at The LA Lactation Lady

“I believe it’s a fallacy to teach that initiating breastfeeding should be without ANY tenderness. There are a lot of nerve endings in the nipple, and the pressure an infant exerts is extraordinary. That said, I often tell moms they can expect an initial nerve response as the nipple adjusts the first couple of weeks. But if discomfort lasts more than the beginning of a feed, or there is continuous pain, sensitivity, cracking, blistering, or bleeding, then infant latch needs evaluation.

-Holly Beck, IBCLC at The Holding Presence

“I always tell mothers I work with that in the beginning breastfeeding can cause your nipples to feel slightly sensitive.  Sensitivity is NOT pain.  Sensitivity is aware of pulling and tugging.  Abnormal is pain, bleeding, cracking, or anything that makes your toes curl.  Always ask for help if there is pain and discomfort. Catching it early can help prevent cracking, bleeding, and a continued poor latch.”

-Nicole Kekesi RD, IBCLC at Breastfeeding Resource Center at Virtua

19 Reasons Why Breastfeeding Might Hurt Even With A Good Latch

YOU May STILL HAVE A POOR LATCH, EVEN IF PEOPLE TELL YOU IT’S A GOOD ONE

The most common cause of nipple soreness is a poor latch. Easy, breezy, comfy breastfeeding begins with a deep, asymmetrical latch. The first step to fixing sore nipples is to analyze the baby's latch because absolutely NOTHING will fix nipple soreness if a poor latch continues.

And it doesn’t necessarily matter what the latch LOOKS like, it matters what it feels like. As long as you’re comfortable breastfeeding and baby is transferring milk well, your latch is (by definitely) a good latch!

Related: 11 Easy Latch Tricks For Pain-Free Breastfeeding

BAD POSITIONING

Positioning is just as important as latching. Your baby uses their whole body to breastfeed so try to limit swaddling during nursing sessions. Whatever position you choose, always remember to be belly-to-belly with your baby. And always draw them in close to help the baby latch deeply onto the breast. Position your baby a little bit below the breast so that their chin rests on the bottom of your breast and so they can tilt their head back a little while latching on.
Related: How To Do Every Single Breastfeeding Position

TONGUE TIE OR LIP TIE

Tongue and lip ties are caused by thick or malformed oral tissues.

Many babies with a tongue-tie or lip-tie have difficulty sticking their tongue out and cannot properly grasp a nipple in their mouth when they’re trying to breastfeed. To compensate, your baby may try to suck harder or may not be able to latch at all. 

Tongue Tie: If baby’s tongue cannot reach past their lower lip, their tongue looks heart shaped or seems to curl downward, baby may have a possible tongue tie. With a tongue tie baby will usually have decreased tongue mobility, making it harder for them to use their tongue to cup the breast and this prevents a proper latch. 

Lip Tie: Lip ties occur when the piece of tissue behind your baby's upper lip is too short and tight, limiting the upper lip's movement. Baby can't get their lips around the nipple and can’t form a proper seal around it, causing an inability to latch well.

Symptoms of Ties: Feeling like baby is “chomping on the breast,” abrasion/compression of the nipple tip, possible clicking or smacking noises, nipple may look misshapen after unlatching

Treatment: Practice deep latch techniques, moist wound healing, pump to protect supply as needed, seek in-person help

Thrush infection

Thrush is a contagious yeast infection that can infect your nipples. It thrives on the lactose in milk and can affect both your nipples and your baby’s mouth.

Symptoms: 

In Mom: Shooting/burning pain in your nipples and deep within your breast tissue during or after feeding sessions, sore nipples after a period of pain-free breastfeeding, persistent pain in both nipples, nipples and areolas may appear shiny with flaky skin, nipples that are pink, itchy, crusty, or burn.

In Baby: Their tongue/lips may have a white or pearly gloss and they may have diaper rash. Check the inside of your baby’s cheeks/tongue for a creamy, curd-like coating or white spots that will not rub off easily. 

Treatment: Keep breastfeeding. See your healthcare provider as they will provide you with an anti-fungal treatment.  Change your breast pads frequently.  Hot wash your bras to kill spores, Avoid freezing expressed milk until infection is resolved.

If you are expressing breast milk, do not freeze the milk until you have completed the course of treatment and are symptom-free.

Mastitis

A breast infection that happens when a blocked milk duct prevents the milk from properly draining out of your breasts. Can also develop when bacteria enters the breast through a crack in the nipple.  Most likely to happen in the first 6 weeks of breastfeeding.

Symptoms: wedge-shaped area of redness, warmth, and pain, fever, body aches, red streaks on your breasts, flu-like symptoms, pain and swelling in your breasts/nipples, hard lump in the breast, breasts that feel warm to the touch.

Treatment: Continue breastfeeding to help clear the infection. See your healthcare provider as soon as possible. They may prescribe oral antibiotics to clear the infection. 

Related: How To Use Cabbage To Help With Mastitis 

Milk blister

(aka a milk bleb)

A milk blister is a painful blister that forms when milk flow is blocked near your nipple opening. It usually happens when a milk duct becomes clogged and causes breast milk to back up in the breast

Symptoms: Painful tiny white spot on or around the nipple (almost like a whitehead pimple),

Treatment: Continue breastfeeding. If the milk blister isn’t painful, no treatment is needed as it will probably clear on its own. Most of the time they resolve on their own within 24 hours. To speed up the process, try these → (15 Ways To Clear A Clogged Duct Quickly)

Vasospasm 

A vasospasm is an abnormal constriction of blood vessels in the breast. It happens when circulation to the nipple gets restricted during a nursing session. Women who have Raynaud’s Disease are more susceptible to having vasospasms.

Symptoms: Intense stinging, burning, throbbing, tingling pain after breastfeeding. The nipple or nipple face may change color after unlatching, going from white to blue to red before turning to its normal color again.

Treatment: Contact your healthcare provider about medication known to increase blood flow to the nipple.  Optimize latching and positioning to alleviate symptoms. Keep the breasts/nipples warm

Avoid cold air and temperature extremes

Heat will usually stop the vasospasm by increasing blood flow to the nipples.   Use dry heat when experiencing pain. Try a hair dryer or heating pad to warm breasts. Wet, warm compresses will help during use, but when removed, evaporation will occur causing cooling, and the pain can start again.

Press forward from the base of the nipple which helps blood flow forward into the nipple.

Engorgement

Engorgement can contribute to sore nipples by making it difficult for baby to obtain a deep latch.

Treatment: Reverse Pressure Softening — A Step-by-Step Tutorial

Dermatitis

Dermatitis is an allergy to a product used on the skin. Usually it is caused by irritation from certain articles of clothing, soaps, laundry detergents, or lotions.

Symptoms: a rash is seen on the nipple or areola which may be dry or weepy. 

An itchy, scaly, flaky, irritated rash will be on one or both breasts. You may have soreness on one or both nipples.

Treatment: Reach out to your healthcare provider. They can prescribe you a topical steroid that you can apply to your nipples after feedings. Be sure to wash off the medication before nursing your baby again.

Dry Skin

Dry skin on your nipples can come from a chafing or wicking action of disposable nursing pads or different causes from your environment.

Symptoms: sore, tender, painful nipples

Treatment: You can express breast milk and gently rub it into your nipples or apply a moist wound healing measure (see below). When you take a bath or shower, don't use soap on your breasts or nipples; just plain water is fine. 

Flat or inverted nipples

Both flat or inverted nipples can prevent baby from getting a deep latch during breastfeeding which may lead to nipple soreness.

How to figure out if you have flat/inverted nipples: Do a pinch test.  If you pinch the areola (the dark area around your nipple) about an inch behind your nipple, and the nipple doesn't slightly harden and become erect, then you might have a flat nipple. If you perform the “pinch” test and your nipple retracts, then it's considered to be inverted. 

Treatment: The simple act of breastfeeding itself can often be a “treatment” for inverted nipples and allow the nipple to protrude more naturally over time. You can try pulling back your breast tissue before you go to nurse in order to encourage your baby to latch. Certain suction devices (such as breast shells, cups, extractors, or formers) can draw out flat or inverted nipples.

Slippage during feeding

Use the index finger on the hand supporting the breast to push down on baby’s chin as they latch on to help keep their mouth open wide. Continue to put gentle pressure on baby’s chin throughout the feeding.

Ignoring Hunger Cues

Nipple pain may come if your baby does not hold a tight or proper latch. If you bring your baby to the breast when they’re desperate for milk, they may not make a proper latch.  To prevent this look for early hunger cues and don’t delay nursing.

Not breaking the suction

Before removing your baby from your breast, make sure to properly break the suction of their latch. Instead of pulling your baby away, put a clean finger into the side of baby’s mouth to release the suction so it doesn’t damage your nipple. 

Teething

If you have an older baby, your sore nipples may be caused by teething.

Treatment: Before nursing, offer your baby a teething toy or frozen wet washcloth. If your baby does take a chomp on your breast, break the suction immediately and say “NO!” and put baby down. This will help them understand action and consequences.

Wearing bras that are too tight

Pregnancy During Breastfeeding

If you become pregnant while nursing, your nipples may become sore as a result of pregnancy hormones. Increasing fluid intake may help alleviate pregnancy-related nipple soreness.

INCORRECTLY SIZED BREAST PUMP FLANGES

If your breasts are sore, pinched or reddened during or after pumping, you’re likely using the wrong size pumping flanges and it’s causing too much friction.  Your nipple should be centered in the pump flange tunnel and be able to move freely during pumping.

Incorrect Breast Pump Setting

Make sure you’re not turning the suction on the breast pump too high. Everybody is different and pump settings are a personal thing. Put the pump setting up to the highest possible point where it’s still comfortable for you, and then dial it back a bit.

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