Nipple pain can be very disheartening when you are breastfeeding your baby. Your nipples are one of the most sensitive parts of your body. The pain of a damaged or pinched nipple can be very intense.
There are a number of reasons why nipples can be painful:
- Latch. The most common cause of nipple pain is a shallow latch. This means that your baby does not have enough breast tissue in his mouth. When your nipple is deep in your baby’s mouth, it will not be pinched. With a deep latch your baby will be able to get more milk. If your baby is not latched properly, you may notice a crease across the tip of your nipple when it comes out of your baby’s mouth. It may be shaped like a new tube of lipstick. Or it may look white at the tip. See Positioning and Latching for information on how to improve your baby’s latch.
- Tongue Tie. In some babies, the frenulum that attaches the tongue to the floor of the mouth is short or tight. This may make it harder for your baby to latch well. This is called “tongue tie.”
There is also a frenulum at the base of the upper lip which can be too tight. This makes it hard for the baby to uncurl the lip to get a good latch. This is called a “lip tie.”
A tongue tie or lip tie can affect how well your baby latches. It may look like your baby is well latched from the outside but your nipple may still be getting pinched. If you have tried to improve the positioning and latch but you still feel intense pain, seek help. Some discomfort when latching in the early days is normal. Intense pain that does not subside after a few seconds indicates a problem. You may want to consult with a healthcare professional who specializes in tongue and lip ties. This could be a family doctor, pediatrician or pediatric dentist. International Board Certified Lactation Consultants (IBCLCs) can give you some information to share with your healthcare professional but they cannot diagnose or treat a tongue tie.
- Thrush. Thrush is a yeast infection. When breastfeeding, it can be on your nipples or in your baby’s mouth. It often feels like ‘burning’, ‘stabbing’ or ‘shooting’ pains in the nipples and sometimes also in the breasts. The pain may begin during a feeding and continue between feedings. Pumping is usually painful as well. It is not improved with correcting your baby’s latch. If your healthcare provider diagnoses a yeast infection on your nipples, both you and your baby need to be treated. See Thrush for more information.
- Mastitis. This is the name given to a range of conditions that involve inflammation in the breast. You may notice an area that is hard, swollen, warm, painful or red (on lighter skin tones) that isn’t relieved by nursing or pumping. This is a sign of mastitis. One or more milk ducts may have become inflamed. See Mastitis - a Matter of Inflammation for more information.
- Vasospasm or Raynaud’s phenomenon. A vasospasm occurs when the muscles inside the nipple tighten. This causes the blood to leave the nipple, turning the tip white. When your baby comes off the breast, the blood flows back into the nipple. It can cause a stinging or burning feeling. This might remind you of the feeling you have when your fingers warm up after being very cold. Women who are prone to having very cold fingers and toes may also experience nipple vasospasm. Placing a warm hand or a warm compress on your nipple immediately after nursing can help to ease the discomfort while the blood flows back into the nipple. If this is not enough to bring you comfort, consult with your healthcare provider. There are some supplements and medications that can help.
- Bacterial infections. These can develop on any nipple. They usually occur on nipples with open wounds. Bacterial infections often present with yellow pus, scabs or crusty areas on the nipple. Once the latch is corrected, an open wound can start to heal. If healing has slowed and pain continues, consult your healthcare provider about the possibility of a bacterial infection. You may need treatment with oral antibiotics.
- Skin issues. Skin conditions that can cause nipple pain include: contact dermatitis, eczema, psoriasis, allergic reactions, herpes, poison ivy, and ringworm. Consult with your healthcare professional if you think any of these conditions could be contributing to your nipple pain. You may need to be referred to a dermatologist (specialist in skin conditions).
- Nipple injury. Sunburn, abrasions, bruises can all cause nipple pain.
- Breast pump injury. Nipple damage can be caused by a breast pump flange that is too large or too small. It can also be caused by using a suction level that is too high.
- Wound has not yet healed. It can take wounds on the nipple 7 to 10 days or longer to heal completely. Once the latch is fixed, the nipple should start to heal. If there is a bacterial or fungal infection or other issue, such as a tongue tie, these need to also be resolved. There will still be pain until the wound is completely healed.
It can be helpful to know what a good latch on a damaged nipple feels like. The pain will usually be intense as you latch your baby. Then as your baby begins to suck, the pain decreases to a feeling that is uncomfortable but manageable. You should not be curling your toes or clenching your teeth. You should be able to hold a conversation and breathe normally.
Older Baby Issues
The issues above can occur at any time. But if your baby is older and you have been breastfeeding comfortably for a while, these are some other reasons for the sudden onset of nipple pain:
- Teething. Teething can cause pain in a couple of different ways. If your baby’s mouth is sore, she might bite down during a feeding. Babies typically do this near the end of the feeding when your milk flow has slowed down. Or the addition of teeth may require you to adjust your baby’s latch slightly to make nursing more comfortable. See Biting and Teething in the Breastfed Baby for more information.
- Changing nursing patterns. If your baby begins to space out his feedings, this may lead to a change in your baby’s latch. This may be because your breasts are fuller and the milk flow is faster.
- Pregnancy. Sensitive nipples are often an early sign of pregnancy. Many women continue to breastfeed through pregnancy despite the pain. They may limit the toddler’s time at breast. Others choose to completely wean at this time. See Breastfeeding Through Pregnancy for more information.
- Bad breastfeeding habits. Sometimes as babies get older they develop bad habits that can lead to sore nipples. For example, they can get fidgety at the breast. They may pull at your nipple as they twist and turn. You may need to remind your little one to be gentle and sit still for nursing. If they continue to bounce around so much that it hurts your nipple, gently take your baby off the breast. Give them a few seconds and then allow them back to the breast. Your baby will soon learn that if she wants to feed, she will need to do so in a way that does not hurt your nipples.
If you need help figuring out why your nipples are sore, or any other information or support with breastfeeding, contact your local La Leche League Canada Leader.
Update December 2022