Breastfeeding is intended to be comfortable and enjoyable—so experiencing painful or sore nipples is a clear sign that something isn’t quite right. The information should help you identify the most likely cause of your discomfort and take steps to resolve it. Whilst there are a number of causes of nipple pain, by far the most common is poor attachment at the breast. Almost always the first step is to try to improve your baby’s latch-on. Experiment with different ways of holding your baby and also try letting your baby take the lead: sitting in a semi-reclined position and placing your baby on your front triggers his instinctive feeding reflexes (laid-back breastfeeding). You can also get skilled help from an LLL Leader by calling our Helpline. The sooner you seek help, the easier it usually is to resolve the problem.
If improving attachment brings no relief then you may need to consider other causes. An LLL Leader can tell you more about specific causes and treatments, and further written information can be found in our other pages listed below Getting support and encouragement from other breastfeeding mothers in your local LLL Group may be a real help too.
Pain on latch-on that improves as milk starts flowing, caused by:
- Poor latch-on – Try adjusting how you hold your baby at the breast. See Comfortable Breastfeeding and seek support from an LLL Leader.
- Holding your breast between your index and middle fingers while latching on, too close to the nipple – Try supporting your breast between your thumb and fingers, keeping your fingers well back from the areola. Sometimes shaping your breast slightly to match the oval of your baby’s mouth can help. Or try laid-back breastfeeding, which reduces the need to hold your baby, leaving you with both hands free to shape your breast and help him latch.
- Slow let-down of milk – At the start of a feed use gentle massage, relaxation, hand expression and breast compression to get milk flowing before or as your baby latches on.
Pain throughout feed, stops when baby comes off, caused by:
- Baby not attaching deeply enough so nipple rubs on baby’s tongue or roof of baby’s mouth – Adjust how you hold your baby at the breast and seek further help from Comfortable Breastfeeding and/or from an LLL Leader.
- Baby is using tongue incorrectly having become used to bottle teat or dummy – Avoid using teats or dummies. See Nipple Confusion? and Dummies and Breastfeeding
- Baby is using his tongue incorrectly possibly due to a tongue-tie (ankyloglossia) – Seek skilled breastfeeding help to assess your baby for tongue-tie. Ask for a referral for assessment and treatment if necessary.
Pain as baby comes off, caused by:
- Suction not broken when taking baby off – put a clean finger between your baby’s gums to break the suction if you need to remove him from the breast.
OK at first, painful as feed progresses.
- Attachment has slipped during feed perhaps because either your breast or your baby has dropped into a lower position – Sit or lie comfortably with your body and arms supported. Keep your baby’s whole body against yours. If you recline, some or all of his weight can be supported by your body so your arms aren’t holding his entire weight throughout the feed. Let your breast rest at its natural level and bring your baby to breast, not breast to baby. Experiment with different breastfeeding positions and seek further help from an LLL Leader.
Stabbing pains in the breast throughout feed and afterwards.
- Vasospasm caused by baby not attaching deeply enough leading to constriction of blood vessels. Or referred pain due to poor positioning and attachment – Adjust how you hold your baby at the breast and seek further help from Comfortable Breastfeeding and from an LLL Leader. If you continue to have vasospasms even after latch-on is improved, see Raynaud’s phenomenon below.
- Raynaud’s phenomenon. This is where blood vessels narrow, associated with cold – Eliminate other causes first, especially if breastfeeding has always been painful or your nipples are flattened or wedge-shaped after feeds. Seek medical assessment. Keep warm and avoid nicotine and caffeine, which can be triggers.
When baby is around 3 months or older.
- Shallow latch because baby has grown and positioning has not been adjusted – Adjust how you hold your baby so he can latch more deeply onto the breast. Seek further help if needed.
- Teething – Offer your baby something cold to chew on before breastfeeds.
- Baby bites to get your full attention or clamps down as he releases the breast at the end of a feed – Give your baby your full attention while nursing and have a finger ready to break suction at end of feed if needed.
- Skin of nipple reacting to food particles present in baby’s mouth – Rinse baby’s mouth with water before nursing; avoid offering that particular food for a while.
- Hormonal changes associated with pregnancy or your period can increase nipple sensitivity – Hand express to get milk flowing and vary nursing positions. A toddler may be
willing to nurse for shorter times until the discomfort decreases.
Nipple shaped normally but pain experienced, commonly at the tip of the nipple.
- Baby not attaching deeply enough – Adjust how you hold your baby at the breast. Seek further help from Comfortable Breastfeeding and/or from an LLL Leader.
- Breastpump suction too high or pump flange poor fit – Reduce suction or vacuum to a comfortable level. Moisten the flange of the breastpump. Centre your nipple in the flange and/or try a different sized flange. Use breast massage and hand expression to encourage milk to flow. Lubricate your nipples and areolae with purified lanolin suitable for breastfeeding mothers.
Nipple not so prominent—baby having difficulty latching on.
- Engorgement – Breastfeed frequently—watch for early breastfeeding cues. Take steps to relieve engorgement and soften the breast. Try reverse pressure softening—gently pushing swelling backwards away from the areola using fingertips. Gentle massage or hand expression can also help.
- Flat/inverted nipple – see page on Inverted Nipples
Nipple looks white and misshapen or wedge shaped when baby comes off; pain during and after feeds.
- Vasospasm caused by baby not attaching deeply enough causing constriction of blood vessels – Adjust how you hold your baby at the breast and seek further help from Comfortable Breastfeeding and/or from an LLL Leader. If you continue to have vasospasms even after latch on is improved, see Raynaud’s phenomenon (section below).
- Baby compressing nipple to cope with fast flow of milk – Baby may need to be attached more deeply at the breast. Try reclining nursing positions. Seek help with managing fast flow or oversupply
Nipple turns white, possibly bluish, then red.
- Raynaud’s phenomenon. May experience similar symptoms in fingers and toes, associated with cold – Seek medical assessment. Keep warm and avoid
nicotine and caffeine, which can be triggers.
Soreness or crack in line with the position of your baby’s lower lip.
- Shallow attachment and/or your baby’s lower lip is sucked in – Use your fingers to ease your baby’s lower lip out. Take steps to help your baby latch more deeply. Avoid pressure on the back of your baby’s head.
Crack across or beside nipple that may or may not bleed.
- Poor attachment either now or previously, perhaps due to engorgement – Aim to get a deeper latch. Seek further help from Comfortable Breastfeeding and/or from an LLL Leader. Continue breastfeeding—blood from cracked nipples is not harmful to your baby. Try moist wound healing using a tiny smear of ultra pure modified lanolin or a hydrogel pad.
Crack that weeps or crusts.
- Possible infection -Visit your GP who may prescribe an antibiotic. Change breastpads frequently and wash affected area daily with a mild, unperfumed soap.
Nipple area red and/or itchy. Burning sensation and/or flaky skin.
- Irritation due to contact with detergent or toiletries, or from clothing rubbing – Identify the cause of the irritation Wash nipples with plain water, avoiding soaps and other toiletries, including proprietary nipple sprays, creams and lotions.
- Eczema, dermatitis, psoriasis or impetigo – Seek treatment from your GP.
- Thrush (fungal) infection. This may occur after a course of antibiotics – Your baby may also have white patches in his mouth. Thrush symptoms, medications, hygiene and more are explained here . You and your baby may need medication prescribed by your GP.
A blister or white spot on your nipple which may/may not be painful.
- Milk blister or ‘bleb’. Thickened milk may block milk flow near the opening of the nipple or a thin layer of skin may block the milk duct opening – Apply moist heat using warm compresses or soak the nipple in warm water. Then compress the nipple behind the blockage to try and express the blockage. If this does not bring quick relief seek medical help.
Written by Karen Butler and Sue Upstone and mothers of LLLGB
Positioning & attachment
Engorged Breasts – avoiding and treating
Hand Expression of Breastmilk
Positioning and Attachment (link to a Kindle publication)
Too Much Milk
Breastfeeding with Sore Nipples
This information is available to buy in a printed form from the LLLGB Shop
Copyright LLLGB 2016