Breastfeeding discomfort is common, especially during the initial days after birth. While brief tenderness when the baby first latches can occur, persistent soreness or intense pain signals that adjustment is needed. Pain should not be considered a normal or expected part of the entire breastfeeding experience. Discomfort continuing past the first few seconds of a feeding usually indicates an underlying mechanical or physiological issue.
Pain Related to Latch and Positioning
The most frequent cause of breastfeeding pain is an ineffective, or shallow, latch. A shallow latch occurs when the baby takes only the nipple into their mouth, rather than a substantial amount of the areola and breast tissue. This positioning causes the nipple to be compressed against the baby’s hard palate, leading to pinching, soreness, and physical damage. Correcting the latch is the primary way to alleviate this discomfort.
A deep latch involves the baby opening their mouth wide, positioning the nipple deep inside near the junction of the hard and soft palate. This protects the nipple from friction and allows the baby to use their jaw and tongue effectively to compress the milk ducts. Signs of a deep latch include the baby’s chin pressed firmly into the breast and the nose slightly tilted back. After feeding, the nipple should look round, not flattened, creased, or pinched.
Improving mechanics involves ensuring the baby is positioned correctly, with their head slightly tipped back so the chin leads the movement toward the breast. The mother can use the “sandwich technique” by gently compressing the breast to help the baby take in more tissue and achieve a wider gape. Bringing the baby quickly to the breast once their mouth is wide open encourages a deeper attachment. Allowing the baby to root and initiate the latch when calm also helps them open wide enough for effective milk transfer.
Identifying and Healing Nipple and Breast Injuries
Physical trauma to the nipple and areola can result from a prolonged poor latch or incorrect use of a breast pump. Injuries manifest as cracked, grazed, or bleeding nipples, indicating that mechanical forces during feeding are damaging the skin. A common injury is a milk bleb, or nipple blister, which appears as a small white or yellow spot on the nipple opening. This occurs when hardened milk or skin blocks a duct opening, trapping milk and causing localized pain.
Healing requires addressing the underlying cause, usually the latch, while providing topical care. After feeding, applying purified lanolin or a hydrogel pad promotes moist wound healing for cracked or abraded skin. Allowing nipples to air dry between feedings and changing breast pads frequently helps prevent bacterial or fungal growth. Expressed breast milk can also be rubbed onto the nipples, as it contains natural healing properties.
For milk blebs, applying a warm compress for 10 to 15 minutes before feeding can soften the skin and encourage the bleb to open naturally. Soaking the nipple in a warm Epsom salt solution can also help loosen the affected skin. If pain is severe, over-the-counter pain relievers like ibuprofen or acetaminophen are compatible with breastfeeding and can manage discomfort. If a milk bleb persists or becomes intensely painful, consult a healthcare provider before attempting manual opening, which carries an infection risk.
Pain Caused by Infection and Inflammation
Pain that is not solely localized to the nipple tip, or is accompanied by systemic symptoms, often points to inflammation or infection within the breast tissue.
Plugged Ducts
One common cause is a plugged milk duct, which feels like a tender, hard, localized lump in the breast. This blockage is typically caused by milk stasis due to inadequate breast drainage or pressure on the breast. Resolving a plugged duct involves continuing to breastfeed frequently, gently massaging the lump toward the nipple during a feeding, and applying warmth before feeding.
Mastitis
If a plugged duct is not cleared, or if bacteria enter the breast, the condition can progress to mastitis, which involves inflammation and possible infection. Mastitis symptoms are severe and appear rapidly, including flu-like symptoms such as fever, chills, and body aches. The affected area of the breast typically becomes hot, swollen, and intensely painful, sometimes with noticeable redness. While anti-inflammatory medications like ibuprofen and cold compresses can help manage the inflammation, mastitis often requires medical intervention with antibiotics.
Thrush
Another distinct cause of pain is thrush, a fungal infection caused by Candida yeast, which affects the nipples and mammary ducts. Thrush pain is often described as a deep, burning, or shooting sensation that radiates through the breast, sometimes persisting between feedings. The nipples may appear shiny, flaky, or unusually pink. Since the infection is often transmitted between the mother and baby, both require simultaneous antifungal treatment from a healthcare provider to prevent reinfection.
When Professional Help Is Necessary
While many breastfeeding challenges can be resolved with at-home adjustments, certain symptoms warrant prompt consultation with a professional. Any pain that persists despite attempts to correct the latch, or pain that prevents feeding, signals the need for expert guidance. Signs of a serious infection, such as a fever over 101 degrees Fahrenheit, visible pus, or pain that does not improve within 24 hours of home care, require immediate medical attention.
A certified Lactation Consultant (IBCLC) is the appropriate specialist for addressing complex mechanical issues. They provide hands-on support, assess the need for structural evaluations like tongue-tie correction, and diagnose the root cause of persistent nipple damage. The IBCLC and the medical doctor often work together: the IBCLC focuses on the feeding relationship, and the doctor manages infectious conditions requiring prescription medication. Seeking help early prevents minor issues from escalating into painful conditions that threaten the continuation of breastfeeding.