Do you have excruciating nipple pain when breastfeeding? They might be so damaged that they’re sore even between feeds and you can see literal cracks in your nipples. They might even be bleeding (this isn’t harmful to your baby. It’s safe to keep breastfeeding as long as you can tolerate the pain). If you said yes to any of these, I feel for you mumma! It’s a horrible position to be in! I know because I’ve been there. In the first month of my own breastfeeding journey I found myself dreading feed times (and then feeling super guilty for that!) and feeling really anxious and tensed up, with toe curling pain whenever my baby latched. It was awful.
I want you to know that what you’re experiencing is NOT NORMAL! BREASTFEEDING SHOULD NOT BE PAINFUL! Nipple pain when breastfeeding is a sign that something isn’t right. Once you can figure out the cause, then you can work on fixing it. That’s what I want for you!
In this post, I’ll cover the common causes of nipple pain when breastfeeding including shallow latch, nipple infections, white spots on the nipple, vasospasm, nipple damage from breast pumps, skin irritation and biting. You’ll also find out what to do to fix it.
Disclaimer: This information is general in nature and doesn’t take into consideration yours or your baby’s individual situations. You will likely find it helpful to work with an International Board Certified Lactation Consultant (IBCLC) to help you work out a plan that works for you and your baby’s individual situation.
The most common causes of nipple pain when breastfeeding are:
Shallow latch
When your baby has a shallow latch on the breast, your nipple is getting squashed between their tongue and their hard palate (the roof of their mouth) instead of sitting further back in their mouth where the hard palate meets the soft palate (and your nipple doesn’t get squashed!). If you try and find this spot in your own mouth, you’ll see it’s quite far back. You might notice that your nipple looks a bit squashed when your baby unlatches and you might see a white line through the centre of your nipple.
Your baby needs to be positioned well and have a big wide, open mouth when latching to get a good amount of breast and nipple in to stop the squishing. They also need to be latched well so they can draw the milk out of your breast properly. If they’re not latching well, they often aren’t getting enough milk either.
How to fix it:
- Check out this blog post for more information on how to fix a shallow latch with some positioning tweaks.
- Expressing a few drops of breastmilk onto the damaged area of your nipple can help it to heal. Your breastmilk is full of antifungal and antibacterial elements that get healing happening faster.
- Using a different breastfeeding position can help take the pressure of the sore areas until they heal.
- Get support from an International Board Certified Lactation Consultant (IBCLC) to help you figure out what’s going on and work out a plan to make breastfeeding more comfortable. You can book a home visit or online consultation with me here.
Nipple infection
If your nipple is damaged, there is an easy entry point for germs to get into the nipple and cause an infection. There are different types of infections, but the most common are thrush (fungal infection) and staph (bacterial) infections.
Signs of nipple thrush:
- nipple and/or areola may be red, shiny or flaky (though sometimes there are no visible signs)
- sharp, stabbing or burning pains deep in the breast
- burning pain in the nipple during a feed and after a feed
How to fix it:
- Discuss antifungal medications with your GP. You will likely need to treat your baby’s mouth with a different medication as thrush can be passed between the two of you when breastfeeding (speak to your pharmacist if you’re not sure).
- Make sure bub is getting a good latch to prevent further damage to your nipples.
- If bub uses a dummy (pacifier), bottles or nipple shields, sterilise them daily to kill any germs that could be causing the infection
- Be really thorough with hygiene. Make sure you wash your hands regularly and anytime after you’ve touched the infected areas.
- Use disposable breast pads and change them frequently.
- Wash bras, clothes and cloth nursing pads daily in a hot wash (60 degrees C) or with “Canesten disinfectant laundry sanitiser”.
- If you’re using hydrogel breast pads, discard them and don’t use new ones until infection is cleared.
- Trim bub’s fingernails to make sure the infection can’t sit under their fingernails and be transferred to their mouth.
- Wash all baby’s toys thoroughly, especially ones they put in their mouth.
Signs of bacterial infection:
- Stinging sensation in the nipple, usually starting as soon as bub starts to feed
- Dull aching or burning pain deep in the breasts
- Pain often lasts even after the feed is finished
- An open wound that won’t heal, even after correcting bub’s latch and using breastmilk on the nipples to try and heal
- Nipple wound may be weeping a yellow or red liquid with or without crusting
- Nipple may shiny and swollen with a reddened area surrounding.
How to fix it:
- Discuss antibiotic ointments and oral medications with your GP.
- There is some weak evidence that probiotics can help restore your breasts normal bacterial balance.
Keep in mind that there are other infections that can cause damage or pain to the nipples and breasts, so if your symptoms don’t fit the fungal and bacterial infections described above, it’s really important to see an IBCLC and GP to help you figure out what’s going on.
White spot on the nipple
Some people call these milk blisters, milk blebs or nipple blebs. They’re caused by inflammation in the milk ducts of the breast that block the opening at the nipple.
How to fix it:
- Don’t pop or pierce the white spot because it can cause trauma to the nipple and make the inflammation worse.
- Discuss topical steroid cream and oral lecithin medications with your GP. These medications are safe with breastfeeding. The steroid cream can be wiped off with a tissue before a feed.
Vasospasm
This is a spasm of the blood vessels in the breast or nipple that temporarily stop blood flow to those areas. It can feel like a shooting or burning sensation in the nipple. You will also see the nipple change colour to purple, red, and white before returning to normal. Vasospasms can be caused by trauma to the nipple (eg if baby has a shallow latch) or from a condition called Raynaud’s phenomenon where other parts of the body may also experience the symptoms (eg. Fingers and toes).
How to fix it:
- Make sure bub is getting a good latch to prevent further damage to your nipples.
- Warm packs to the nipples straight after a breastfeed or whenever the pain is happening.
- Avoid exposing nipples to cold
- Discuss the use of Nifedipine medication with your GP.
Nipple or areola damage from incorrect pump flange size
If you’re expressing, check that the pump flange size is right for your nipple. The flange is the part of the pump that sits on your breast over your nipple, sometimes called the breast shield. Most pumps come with a 24mm flange as standard, but most women’s nipples are smaller than this.
If your pump flange is too big it can suck too much of the areola tissue into the pump and cause it to swell and be damaged by rubbing on the inside of the pump. If the pump flange is too small, it can damage your nipple by pinching and friction rub. Also, the amount of milk you get out when you express can be reduced if the size isn’t right for you.
How to fix it:
- Download and print out this fantastic FREE measuring tool from Kate Visser over at Milky Business to make sure you’ve got the correct size flange for your nipple size.
- Measure your nipple in between feeds or expressing sessions so that you get an accurate size (nipples can swell slightly during feeds/expressing and give you the wrong measurement).
- Make sure you measure both nipples. It’s very common for each nipple to be different sizes.
- Damage to your nipples may mean that your nipples are larger than usual and you might need to change down sizes as they heal.
- There’s no need to add “extra room” to the measurement you get from the measuring tool. Adding extra room can often cause pain, swelling and damage to your nipples and decrease the amount of milk you can express.
- You can get different size flanges from many baby shops and some chemists or you can order from your pump manufacturer, but many brands don’t make smaller sizes. If you need a smaller size, you can buy flange inserts that fit into a 24mm flange to make it smaller
Overuse of Haakaa bulb suction pumps
Haakaas are so popular and can be handy tools, but they can also cause damage to your nipples and areola tissue since you can’t easily adjust the intensity of the suction. Using the haakaa a lot or for too long at a time can cause swelling and bruising that feel painful.
How to fix it:
- Reduce how often you’re using it or for how long you keep it on.
- If you really don’t need it, you can stop using it all together.
- Lots of mums find that they can just hold it under the breast to catch the leaking let down milk instead of suctioning it onto the breast.
Skin irritation
Some mums experience skin conditions like eczema, dermatitis or psoriasis around their nipple and areola areas. This is common for mums who already experience these conditions on other parts of their body.
Eczema
Eczema lesions can be itchy and painful, sometimes with a burning sensation. It can look like:
- Reddened/irritated skin.
- Blisters
- weeping/oozing
- crusty areas around the irritation
- dry, scaly, and thickened areas of skin.
How to fix it:
- Remove environmental or food triggers if you can work out what they are.
- Apply a moisturiser with few additives and no fragrance (these can irritate sensitive skin even more).
- Discuss the use of a low or medium strength steroid ointment, second generation antihistamines and/or oral steroid medication with your GP.
Psoriasis
Patches of skin that are scaly and itchy. These can look like:
- Reddened/irritated skin with clear borders.
- Fine silvery scales of skin
How to fix it
- Apply a moisturiser with few additives and no fragrance (these can irritate sensitive skin even more).
- Discuss the use of a low or medium strength steroid ointment and topical vitamin D creams and UVB phototherapy with your GP.
Irritant contact dermatitis
This is usually caused by direct contact between the nipple or skin with something that irritates the skin.
Common causes of irritation:
- Friction from clothes
- Oral medications baby is having.
- Solid foods your baby is eating.
- Breast pads
- Laundry detergents
- Dryer sheets
- Fabric softeners
- Fragrances
- Creams used for nipple pain.
How to fix it:
Stop using or reduce contact with whatever’s causing the irritation.
Allergic contact dermatitis
Caused by an allergic reaction to something in contact with the nipple.
Products that commonly cause allergic contact dermatitis:
- Lanolin (common nipple cream)
- Topical antibiotics
- Chamomile
- Vitamins A and E
- fragrances
How to fix it:
- Stop using or reduce contact with whatever’s causing the allergic reaction.
- Discuss the use of second-generation antihistamines with your GP.
Mammary Paget’s disease (or Paget’s disease of the nipple)
If you have dry, flaky or inflamed skin on or around the nipple that’s not responding to other treatments, it’s extremely important to discuss this with your GP. This rare cancer of the breast and nipple looks and has symptoms similar to eczema so can be wrongly diagnosed, which can be life threatening.
What it looks and feels like:
- Usually only on one breast or nipple
- Looks like nipple eczema that starts on the tip of the nipple and slowly advances outward onto areola tissue.
- Ulcers or moist reddened areas on the nipple or breast
- A flattened nipple that originally stood out from the breast
- Lasts longer than 3 weeks.
- Commonly occurs with a lump under the skin.
What to do about it:
- See your GP urgently for a skin biopsy and referral for specialist treatment if confirmed.
- Surgery and/or radiation therapy to remove the cancer may be needed.
Biting
Ah, the dreaded biting stage! This is usually an obvious cause of nipple pain or damage, but sometimes, rather than wounds to the skin, biting can leave bruised tissue that’s not always easy to see.
How to fix it:
Check out this blog post all about biting and what to do about it.
Nipple pain when breastfeeding is truly awful and it’s not always easy to figure out what the cause is since there are so many possibilities. This post has covered the most common reasons for pain, but not all causes. Remember, it’s not supposed to feel like this and you can get help! If you’ve tried the strategies above and the pain isn’t getting better, it’s really important to see an IBCLC so they can help you get to the bottom of it. Whether the pain is caused from damage to the nipple or an infection of some kind, there are things you can do to help it feel better so you can keep on breastfeeding your beautiful baby in comfort.
If you found this helpful, please share this post with another mumma so they can avoid going through this difficult experience!
If you have questions or concerns, you might like to get in touch with an IBCLC to help you to work out what’s going on and develop a plan that suits your individual situation. You can book a home visit or online consultation with me below.
References
Berens, P., Eglash, A., Malloy, M., Steube, A.M and the Academy of Breastfeeding Medicine (2016). Academy of Breastfeeding Medicine Clinical Protocol #26: Persistent Pain with Breastfeeding. Breastfeeding Medicine, 11(2). https://doi.org/10.1089/bfm.2016.29002.pjb
Mitchell, K. B., Johnson, H. M., Rodrıguez, J. M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., Cash, K. W., Berens, P., Miller, B. & The Academy of Breastfeeding Medicine (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17(5). https://doi.org/10.1089/bfm.2022.29207.kbm
National Cancer Institute (2012). Paget Disease of the Breast. https://www.cancer.gov/types/breast/paget-breast-fact-sheet
Visser, K. (2023). Top tips for sizing your nips. Milky Business: https://www.milkybusiness.com/milkybusinessblog/1sq8m31fb5h15ntha4dsftfrgxae7h
Recent Comments