Let’s start with the basics: Breastfeeding isn’t supposed to hurt. But for many of us, breastfeeding pain is all too real—especially at first. So, usually if you have pain, dryness, cracked nipples, or other discomfort, it’s a sign that something needs to be corrected. We’re going to walk through the five most common causes of breastfeeding pain and how to address them.
The most common causes of breastfeeding pain
1. Latch problems
- How to tell: Pain in the nipples, breastfeeding is uncomfortable or painful, nipples appear sculpted after breastfeeding, nipple skin may be cracked or blistered or bleeding, baby is fussy, baby isn’t gaining much weight, baby bites down on nipple.
- Causes: This can be tough for mom and baby to navigate at first, but a great latch means that the baby’s mouth is all around the areola. A shallow latch means the baby is latching onto the nipple, as opposed to the nipple going to the back of the baby’s mouth. In a healthy latch, the baby’s suction is compressing the entire breast to get the milk out, but if the nipple isn’t positioned far enough back, the tongue may rub and apply pressure to the nipple, causing pain, dryness, and discomfort.
- Solution: Fix the latch. This is easier said than done, but it could be as simple as adjusting the positioning to improve comfort and latch success. If you can’t seem to improve the latch, or if you’re swollen and engorged, making a solid latch more challenging, it could be helpful to drop into a breastfeeding clinic or have a lactation consultant pay a visit. Here are some tactical tips for improving your latch:
- Position baby’s body close to you with your elbow and allow its head to rest back slightly.
- Tilt up your breast using your thumb near the nipple with your other fingers securely under your breast, by your chest.
- Align baby’s nose with nipple, so its mouth is lined up with the lower portion of your breast.
- Rub baby’s full lower lip with your breast while keeping your nipple aligned with the nose.
- Baby will open its mouth, similar to a yawn—pull the baby in with the heel of your hand, pushing toward your breast. The lower lip and tongue will take in much of the breast, and you can help by tucking the nipple under baby’s top lip with your thumb, if needed.
- With correct positioning, baby’s chin should be hidden by the breast, while the nose is away from the breast. This position protects the nipple because it places it toward the back of baby’s mouth.
- For already cracked or painful nipples, express a small amount of breastmilk after feeding, apply it to the nipples, and let them air-dry before re-dressing. You can also try lanolin or other healing balms to soothe.
2. Tongue tie
- How to tell: Pain in the nipples, the tip of nipple is injured, feels as though nipple is being pinched, baby’s frenulum appears short and tight.
- Causes: Your baby’s frenulum (the thong of skin underneath its tongue) is short and tight, so baby is unable to lift its tongue adequately to breastfeed. The baby can’t bring its tongue forward for correct latching, and instead, the tongue rubs against the end of the nipple, causing irritation and pain. It’s actually becoming more commonly diagnosed, so consult your doctor if you suspect tongue tie in your baby.
- Solution: Your doctor can snip the baby’s frenulum in an easy procedure. Sometimes, it stretches out over time on its own, but breastfeeding may be very painful during that period.
3. Yeast infection or thrush
- How to tell: The telltale sign of thrush is the rash on your body and dots in the babies mouth. If you’ve got thrush, you might have burning and sharp pain in the nipples between and during feedings, pink or red rash around nipples, smooth and shiny nipple skin, white dots or circles inside baby’s mouth, or baby may be fussy.
- Causes: Everyone has yeast in their body, but an overgrowth of it can cause infection. When nipples crack or become damaged, it’s easier for Candida fungus to grow and lead to a yeast infection. Often, taking antibiotic medication can cause an overgrowth of yeast, as well as low iron levels in the mother.
- Solution: If you’re experiencing thrush symptoms, you’ll need to visit your doctor to be diagnosed and get a medication prescription. You may be able to treat the infection with over-the-counter meds, like Mycolog ointment, Monistat 7, Lotrimin AF, or Micatin. Early treatment is best, and both baby and mom should be treated, even if baby isn’t showing any symptoms.
4. Clogged duct
- How to tell: Tenderness and soreness in the breast, may feel a lump under the skin, skin may appear red.
- Causes: Blocked milk ducts happen when there’s too much pressure applied to the area, like a bra that’s too tight, or if a duct doesn’t get fully drained during nursing or pumping. Milk backs up and causes pressure, which creates the clog. Often, plugs occur in the breast, but sometimes it happens in the nipple. If this occurs, it will look like a small white dot on the end of the nipple.
- Solution: Apply moist heat, like a warm wet washcloth or a hot bath, rest, massage the clogged area, and empty the breast. While it might feel like the last thing you want to do, nurse your baby as much as possible. When massaging, treat it like an almost-empty tube of toothpaste, and push the mass toward the nipple. After massaging, put the baby or pump to the breast to relieve the plug. If the block doesn’t clear up after doing this three times, consult a doctor or lactation consultant.
5. Mastitis
- How to tell: Red, hot, and very tender area of the breast, fever and flu symptoms, you may have a plugged duct.
- Causes: Mastitis is often the result of the progression of an unaddressed clogged duct. It occurs when there’s inadequate drainage of the breast accompanied by an infection. Bacteria can develop in the milk when there’s a clog, when the nipples are cracked, or when thrush goes untreated, causing mastitis.
- Solution: Treat mastitis initially with the same treatment for clogged ducts (heat, rest, massage, empty). If your symptoms worsen over the next 24 hours, visit your doctor. Usually, an antibiotic will be prescribed. Continuing to nurse your baby will help clear the infection, as well.
Of course, it’s not the only way to nourish your baby. And, like we always say at Motherfigure, fed is best. So, whether or not you choose to solely breastfeed or supplement with other methods, your baby will be its healthiest and happiest so long as it’s fed. For those going the breastfeeding route, whether it’s partially or entirely, one thing that you may encounter is some pain from breastfeeding.