Nipple pain is common in the early days of breastfeeding. This is because the nipples are not used to breastfeeding. The pain lasts for a short time, usually around one week.
Soreness that continues throughout the breastfeed, or lasts for more than one week of breastfeeding, isn't normal. Nipple pain, in this case, can be caused by many different reasons.
Poor positioning and attachment
You may feel nipple pain in the early days if your baby is not well positioned and attached. Read more about positioning and attachment during breastfeeding.
When you start breastfeeding, you can experience some tenderness at the beginning of a breastfeed. If you feel your baby is not positioned and attached correctly, take them off the breast and start again.
Get help if you still feel sore after the first week of breastfeeding. Or if you feel uncomfortable throughout an entire feed.
Getting help with sore nipples
Check your baby’s position and attachment with your:
They will discuss a plan of care with you for feeding to become more comfortable. They will also explain how to treat sore nipples.
If your baby is well positioned and attached, there could be another reason for sore nipples. Your healthcare professional will refer you for the care you need.
Expressing breast milk
If it feels too painful to feed, try expressing milk for a day or two, to allow your nipples time to heal. This way, you'll continue giving breast milk to your baby.
Hand expressing may be more comfortable than using a pump. If you do use a breast pump, start on the lowest setting and increase it slowly.
Thrush (also known as candida) is a fungal infection. When breastfeeding, the pain often goes on throughout the feed and may continue even after the feed is over. This type of pain may feel like a burning sensation.
Having thrush does not mean you need to stop breastfeeding. Continuing to breastfeed helps your baby to build up a strong immunity. This can help prevent them from getting thrush again.
You may be more likely to get thrush on your breasts if:
- you have had thrush infections before
- you or your baby have recently taken antibiotics
- your baby has thrush in their mouth or nappy area
Signs of thrush in mothers include:
- pinkness of the nipple and areola area
- shiny or flaky nipple
- sore nipple after a period of pain-free breastfeeding
- a burning, shooting pain deep in the breast after breastfeeding
Signs of thrush in babies include:
- creamy white patches or white spots in the baby’s mouth, on the tongue or in the cheeks that will not rub off easily
- tongue or lips may have a white or pearly gloss
- nappy rash, with satellite lesions (type of red rash)
There is often more than one symptom present so it's important to get checked by your GP.
Your GP will advise you on how to treat your thrush. Possible treatments include:
- ointment or cream for nipples
- oral gel for baby's mouth
Things you can do at home
Take the following steps in the home to prevent the spread of thrush:
- encourage careful hand hygiene for all family members
- use separate towels for each family member
- wash clothes in a 60-degree heat
- if you are expressing breast milk, do not freeze the milk until you have completed the course of treatment and are symptom-free.
Vasospasm happens when circulation to the nipple gets restricted due to pressure between the baby’s tongue and soft palate.
Signs of vasospasm
- white tip to the nipple after breastfeeds
- (burning) pain after a breastfeed has finished
- this burning pain may be followed by a throbbing pain
- nipple appears flattened or squashed after breastfeeding
A small number of mothers may experience vasospasm because of Raynaud's Phenomenon. This is when the very small blood vessels constrict. The affected area then becomes white and sometimes cold. Areas of the body usually affected include tips of fingers and toes, as well as nipples.
If you think you may have vasospasm, contact your:
- public health nurse
- local breastfeeding support volunteer
- lactation consultant
Vasospasm is generally caused by poor attachment when breastfeeding. This means that taking medication to improve the circulation won't work.
Pay careful attention to the positioning and attachment of your baby. Ask your midwife or lactation consultant for help and advice.
Applying heat to the nipple immediately after feeding may help. Dry heat (such as hair dryer or hot water bottle wrapped in a towel) is usually better than wet heat (such as a hot facecloth).
Bleb or blister
A bleb or blister is painful and usually starts in the first few days of feeding. The pain is caused by either a small blister on the nipple or a small block at the very tip of a milk duct.
You may have a bleb or blister at the same time as a blocked duct. The treatment is the same for both a bleb or blister and a blocked duct. Read how to treat a blocked duct.
To sooth your nipple, massage 100% lanolin nipple cream onto the affected nipple. You can also try a hydrogel pack – ask your pharmacist for details.