Pain and sore nipples when breastfeeding: treatment and relief

Is it normal for breastfeeding to hurt?

In a word, no. It really shouldn't be properly painful, as breastfeeding expert Justine Fieth, a trained breastfeeding counsellor at La Leche League GB says:

A little bit of initial soreness may be normal but, in general, if breastfeeding is hurting, then it means something isn't right. Pain is your body's way of letting you know something is wrong
Justine Fieth, La Leche League GB

If you are feeling pain when breastfeeding, the causes can include:

An incorrect latch: in other words, your baby isn't attaching to your breast properly when they feed. This is by far the most common cause of breastfeeding pain (and the more common reason women give up breastfeeding early).² And it's the very 1st thing you should get checked if you're feel pain when you feed. Left uncorrected, a poor latch can led to further pain, soreness and inflammation.
Engorged breasts – most commonly when your milk 'comes in', which is usually between the 2nd and 5th day after the birth
Sore or cracked nipples
Blocked milk ducts
Inflammation, such as mastitis
Infection in your nipple, areola or breast, such as thrush

How can I ease the pain of breastfeeding?

To stop the pain, you need to find the cause – and take the action needed to prevent it happening again. And you also need to give your sore, painful breasts and nipples some TLC, to help them recover and heal.

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So, this means you should:

Check your baby's latch. Make sure your baby is attached properly to your breast at each feed by following our step-by-step latching guide (with pictures). "So much is about getting the latch right," says Justine. "A few quick adjustments to how you are sitting or lying, or how your baby comes towards your breast may be all that are needed."
Be kind to your nipples. If your nipples are sore or cracked, soothe them with a cold compress or some nipple cream (check out the nipple creams that our testers liked best), expose them to air as much as you (decently) can, and wipe them gently with water-moistened cotton wool after each feed to remove any debris that might cause infection.
Get help. Even if you think or have been told that your baby's latch is correct. "You are the only one who knows if it is hurting," says Justine, "whatever the latch might look like. And if it is, seek skilled help and keep asking." For the best places to start, see Where can I get help with breastfeeding?, below.

How can I tell what's causing the pain?

Here are some of the ways women describe the pain they feel when they're breastfeeding, together with likely reasons for what might be causing it – and how to sort it out...

It hurts when my baby latches, then gets less painful

If your nipples aren't sore or cracked and you've ruled out problems with the latch, make sure your fingers aren't squeezing or compressing your breast or nipple when you bring your baby to your breast. Sometimes, pain on latching can also be a sign that your 'milk let-down' reflex is a bit slow: try massaging your breast a little before you start to feed.

It hurts all the time I'm feeding, then stops hurting afterwards

This is very probably the result of a poor latch (see our step-by-step latching guide) but it's possible your baby has a condition called tongue-tie. Either way, it's wisest to ask a lactation consultant to assess you (see Where can I get help with breastfeeding?, below).

If your baby has become used to sucking a dummy or a bottle teat, some experts think this can cause 'nipple confusion', meaning your baby may start using their tongue incorrectly when sucking at the breast – which can be painful for you. If you think this is what's happening in your case (other signs can include struggling and crying at the breast), you'll need help encouraging your baby to latch more effectively again.

It hurts when my baby comes off my breast

Check that you're breaking the suction when you're taking your baby off your breast. To do this, just slide your little finger between your baby's gums.

It doesn't hurt to begin with but then hurts as the feed goes on

Check that your body or arms, or your baby's body hasn't slipped down as you've been feeding, as this can sometimes change the latch.

My breasts hurt because they're so full

Your breasts can become engorged and painfully swollen when your milk 'comes in' a few days after the birth. They can also become engorged later on if you miss feeds. You can relieve the pain by feeding frequently, applying an ice pack for 15 to 20 minutes between feeds and putting a warm, wet towel on your breast before a feed – to help the milk flow.

Kelly, who is a member of our MadeForMums community, found gelpads really useful: "You keep them in the fridge till you're ready to put it on your breasts. I used them and they were ace, really cool and soothing! It does get better: your boobs will feel like melons but they do soften. Persevere because it is worth it!"

Engorgement shouldn't last longer than a day or 2; if it does, get some help. If areas of either swollen breast are red, inflamed and hot and you feel flu-ey or feverish, see your GP: you may have a condition called mastitis that may need antibiotic treatment.

Could it be a blocked milk duct? How can I tell?

A blocked milk duct feels like a small, tender lump in your breast (and happens when part of your breast isn't drained properly during a feed, probably because your baby wasn't latched on correctly).

You may find that when baby feeds on the side where the blocked duct is, they might fuss because they’re getting your milk more slowly than usual. Do persist with feeding on that side, though, as it's the best way to try to clear the blockage.

Other things that can help include putting warm flannels on the affected breast and gently massaging the lump towards your nipple while your baby feeds, as Naomi, who is a member of our MadeForMums community, recommends: "I had a blocked duct and kept putting hot flannels over the lump and massaging it gently. Eventually, it unblocked and milk spurted everywhere!"

A blocked milk duct can turn into mastitis if it's not relieved; do see you GP if the lump becomes red and inflamed and you feel flu-ey or feverish.

I feel stabbing pains when my baby feeds

This could be because you need to get a better latch or position or it could be that, because your baby isn't attaching deeply enough to your breast, the blood vessels have become constricted, causing a condition called 'vasospasm'. Either way, it's wisest to ask a lactation consultant to assess you (see Where can I get help with breastfeeding?, below).

Stabbing pain during a feed can also be a sign of thrush infection. If this is the case, your nipples may look pale and have shiny, flaky skin, and your baby may have white patches in their mouth. If you think it's thrush, see your GP: you and your baby may need some medication.

It hurts right at the tip of my nipples

This is a common sign of a latch that needs adjusting (check out our picture guide to getting the latch correct). It can also happen when you're expressing breastmilk and the pump suction is too high.

When breastfeeding hurts with an older baby

If your baby is over 3 months old and you're suddenly getting pain when breastfeeding, it's worth rechecking the latch – in case you need to adjust positioning now that your baby has grown.

But it could also be that your baby's nipping you because they're teething or trying to get your attention. Break the suction with your finger and reattach when you're both ready.

It could also be that your nipple sensitivity has increased because your periods have returned or are about to return.

Or if you're baby's over 6 months and weaning, the skin of your breasts or nipples could be reacting to food particles in your baby's mouth. Rinse your baby's mouth before feeding.

My nipples are really sore, cracked and/or bleeding

This is usually a sign that your baby isn't attaching to your breast deeply enough. "If your baby has a ‘shallow’ latch," says Justine, "and doesn’t have a big mouthful of breast, it can lead to sore nipples for you – and maybe even blocked ducts or mastitis. And your baby won't be getting all the milk they need efficiently."

Follow our step-by-step latching guide (with pictures) and/or ask for support in checking that your baby is attaching deeply enough.

Keep breastfeeding – blood from cracked nipples won't harm your baby. Ease the soreness by using a nipple cream or applying a cold compress (you can also buy hydrogel pads that can be put in the fridge).

"I had cracked nipples," says Lisa, who is a member of our MadeForMums community. "I used nipple cream, which I found was brill, really eased them. A tip the midwife gave me was not to let your nipples dry up: keep them well moistured with cream – and this really helped also."

You could also try wearing 'breast shells' inside your bra, if you don't want your clothes rubbing against your sore nipples.

If your nipples start weeping or looking crusty, see your GP – in case you have an infection.

My nipples are red and itchy

It's possible that, because they're already tender, they've become further irritated by clothes or breast pads rubbing against them or by your nipple cream or washing detergent.

Or if your nipples also have shiny, flaky skin, and your baby has white patches in their mouth, you could have a fungal infection called thrush. Often with thrush, you get stabbing pains when you're feeding, too. If you think it's thrush, see your GP: you and your baby may need some medication.

When you need to see a doctor

Most painful breastfeeding issues can be sorted fairly quickly with some great advice from a trained counsellor who can make sure your baby's latch is correct.

But if there's any possiblity that the pain you're feeling is the result of mastitis or thrush in your breasts, you do need to see your GP.

Could be mastitis? If 1 of your breasts feel hot and tender, with an area that's red and painful to touch, and you also feel feverish or achey and tired, you may have mastitis. It may resolve itself with continued feeding, rest and warm flannels on the affected breast but, if it's still there after 12 to 24 hours, you need to see your GP – who may want to prescribe antibiotics.

Could it be thrush? If it's very painful (in both breasts) to feed and the pain continues for up to an hour after the feed has ended, you may have thrush (a fungal infection) and you should seek help and advice from your GP.

Where can I get help with breastfeeding?

La Leche League GB (LLLGB). They have local leaders (all breastfeeding counsellors) you can call and support groups in many areas where you can meet with other breastfeeding mothers and get support from LLLGB's accredited counsellors. LLLGB also runs a helpline on 0345 120 2918.
Association of Breastfeeding Mothers (ABM)helpline. Call 0300 330 5453 (open every day, 9.30am to 10.30pm). ABM also runs local support groups and webchat breastfeeding support.
NCT National Breastfeeding helpline. Call 0300 330 0700 (open every day, 8am to midnight).
National Breastfeeding helpline. Call 0300 100 0212 (open every day, 9.30am to 9.30pm)
The Breastfeeding Network supporter line in Bengali and Sylheti: Call 0300 456 2421
Baby Café is a network of breastfeeding drop-in centres. Find your nearest drop-in by entering your postcode.
The Breastfeeding Network provides breastfeeding support and information.
Lactation Consultants of Great Britain can help you find a lactation consultant near you.
Twins and Multiple Births Association (TAMBA) has information about feeding twins and triplets.

About our expert Justine Fieth

Justine Fieth is a trained breastfeeding counsellor based in Cambridge, who is on the Council of Directors of La Leche League GB. She is co-founder and trustee of the Cambridge Breastfeeding Alliance, and became a recognised post-natal doula in 2016. She is now part of Doula UK and Cambridgeshire Doulas. Justine has extensive experience in helping families with a wide-range of breastfeeding issues, including breastfeeding babies with tongue-tie, twins, premature babies, and slow-weight gain babies.

References

^{1. Breastfeeding Concerns at 3 and 7 Days Postpartum and Feeding Status at 2 Months. Wagner, EA et al. Pediatrics 2013 Oct; 132(4): e865–e875.doi:10.1542/peds.2013-0724}
^{2. Latching-on and suckling of the healthy term neonate: breastfeeding assessment Healthy Children Project. J Midwifery Womens Health 2007 Nov-Dec;52(6):638-42.}