Nipple pain is common in the early days of breastfeeding. This is because your nipples are not used to breastfeeding. The pain lasts for a short time, usually around 1 week.
Soreness that continues throughout the breastfeed, or lasts for more than 1 week of breastfeeding, is not normal.
Nipple pain 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.
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
Get help from a lactation consultant 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:
- midwife
- public health nurse (PHN)
- lactation consultant
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.
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Expressing breast milk
If it feels too painful to feed, try expressing milk for a day or 2 to give 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 (candida)
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 in your nipples.
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 your baby’s mouth that will not rub off easily - these can be on the tongue or in the cheeks
- 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.
Learn more about mouth thrush.
Thrush treatment
Your GP will advise you on how to treat your thrush.
Possible treatments include:
- ointment or cream for your nipples and your baby's bottom
- oral gel for your baby's mouth
- probiotics
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
Vasospasm happens when circulation to the nipple gets restricted due to pressure between the baby’s tongue and soft palate.
Signs of vasospasm include:
- a white tip to your nipple after breastfeeds
- a burning or throbbing pain after breastfeeds
- your nipple appears flattened or squashed after breastfeeding
If you think you may have vasospasm, contact your:
- midwife
- PHN
- local breastfeeding support volunteer
- lactation consultant
Raynaud's phenomenon
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.
Treating vasospasm
Vasospasm is generally caused by poor attachment when breastfeeding. This means that taking medicine to improve the circulation will not work.
Pay attention to the positioning and attachment of your baby. Ask your midwife or lactation consultant for help and advice.
Applying heat to your 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 milk blister
A bleb or milk blister usually starts in the first few days of feeding. It may appear like a white spot on your nipple. It may or may not be painful.
The pain is caused by either a small blister on your nipple or a small block at the very tip of a milk duct.
You may have a milk blister at the same time as a blocked duct. The treatment is the same for both.
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.
If the milk blister is not painful, no treatment is needed. It will clear up on its own.