4 common reasons for breastfeeding pain and what to do 

Kristin Gonzalez, RN

Certified Lactation Consultant

Being able to breastfeed your baby is amazing, but it’s not always easy. It can even be painful at times, causing some moms to give up trying.

Certified lactation consultant Kristin Gonzalez, RN, said that while nipple tenderness is normal for up to six days after delivery, breastfeeding should not be painful. She explained common reasons for pain during breastfeeding and offered tips for breast care and continued breastfeeding success. 

1. Improper or shallow latch  

“One of the most common reasons for breastfeeding pain, probably the most common, is a latch that is too shallow,” Gonzalez said. “This means the baby’s mouth is not opened wide enough or the baby’s tongue is not placed far enough under the nipple to remove milk from the breast.”

If the nipple is placed just barely inside the baby’s mouth, the nipple will be compressed and pinched and will not release enough milk to empty the breast well or adequately feed your baby.

For a better latch, position the baby directly in front of the breast. With their head tilted back, bring baby’s chin into the breast first. The nipple should be positioned far into the back of baby’s mouth, toward the soft palate. With the baby’s mouth opened wide on the breast and lips rolled outward against the breast, there should be no pain, only rhythmic suction and pulling.

A deep, well-positioned latch allows for better suction and release of milk from the breast and a much more comfortable breastfeeding experience for parent and baby.   

2. Engorgement 

Engorgement happens when milk isn’t fully removed from your breast. An engorged breast will tighten the nipple, making it difficult for your baby to get enough of the nipple in their mouth. This can happen when feedings are not frequent enough or when your baby is not latched well at the breast.

“Even if feedings are frequent but your baby is falling asleep soon after latching, engorgement can happen,” Gonzalez said. “Frequently breastfeeding your baby is the best way to avoid this problem.” 

She offered these tips to help with engorgement: 

• Apply a warm compress a few minutes before feeding to help let down your milk. Do this with caution as heat can cause more swelling and worsening engorgement.
• Hand express milk for a few minutes before breastfeeding to soften your nipple and allow your baby to get latched on more easily. 
• Try a “reverse pressure softening” technique. To do this, use two fingers to apply gentle inward pressure all around the engorged nipple to help your nipple protrude and allow baby to get the nipple further inside the mouth.  
• Compress or gently massage the breast during feeding to help empty the breast. 

“The better treatment for engorgement pain is cold packs after and in between feedings, as well as over-the-counter anti-inflammatory medications,” Gonzalez said. “Be sure to check with your health care provider before taking medications or if you have unrelieved pain from engorgement.”

3. Mastitis 

Persistent engorgement can sometimes lead to mastitis, an inflammation of breast tissue caused by backed up milk ducts. It’s one of the most common reasons for breastfeeding pain.

“If breasts are not well-drained by the baby or pumping, milk can back up and cause pain, inflammation, and ducts that feel like hard knots under the skin,” Gonzalez said. “Excessive pumping when a baby is already feeding well can also cause the problem of oversupply and more clogged ducts. It’s best to talk with a certified lactation consultant about how often you should pump, which depends on how often and how well your baby feeds.”

Mastitis can also occur when bacteria enter the breast through cracked nipples due to a shallow latch, yeast or broken skin.

Other causes of mastitis include: 

• Stagnant or dry cabbage leaves placed on the breasts to control swelling. 
• Abruptly stopping breastfeeding or pumping because of a new medication, stress or illness. 
• Spaced out or less frequent feedings (usually overnight).  
• Replacing feedings at the breast with bottle feedings or failing to pump the breasts when baby cannot empty them. 
• Wearing a tight bra or bra with underwire while breastfeeding. 

Mastitis can come on quickly and cause flu-like symptoms, such as chills, body aches, nausea, vomiting or fatigue. Fever can also be a symptom, but not always. Another telltale sign of mastitis is breasts that are red and feel hard or hot to the touch.

To relieve mastitis, apply a cold compress, get plenty of rest and drink lots of fluids.

“Do not abruptly stop breastfeeding without consulting a health care provider or certified lactation consultant,” Gonzalez said. “If your symptoms don’t improve within 24 hours, contact your doctor because you may need to be treated with an antibiotic.” 

4. Thrush 

Oral thrush is a common yeast infection that can form on the nipples or in the breast.  

Symptoms of thrush include:  

• Sore nipples after several weeks of pain-free breastfeeding.
• Pink, flaky, shiny, itchy, cracked or blistered nipples.
• Achy breasts or shooting pains deep in the breast during or after feedings.
• White spots on the inside of baby’s cheeks, tongue or gums. 

To prevent yeast infection on the nipples or breast, express a bit of breast milk and rub it onto your nipples after feeding or pumping and then let your skin air dry before replacing breast pads or clothes. It’s also important to change out of wet clothes quickly and wash bras in hot water to prevent an overgrowth of yeast.

If you think you might have thrush, call your doctor and your baby’s doctor so you can both be diagnosed and treated to avoid passing the infection back and forth.  

Breast care tips 

To prevent these problems and keep your breasts healthy, here are some steps you can take: 

• Clean your breasts by letting water run over them in the shower. Do not use scented soap or lotion on breasts. 
• Use hydrogel pads to soothe and decrease swelling when nipples are sore. 
• Allow breasts to be exposed to the air whenever possible. 
• Use specially designed breast pads or a large handkerchief in your bra to prevent leakage through to your clothes. Before removing pads or cloth from your nipples to feed or pump, express a few drops of colostrum to prevent tearing skin. 
• Use a few drops of olive oil to lubricate the inside of breast pump flanges or cups and to ease the discomfort of pumping.  
• Contact an experienced lactation consultant to have your nipples measured and breast pump cups sized to prevent additional nipple trauma, swelling and pain.  

The main takeaway if you’re feeling pain while breastfeeding

If pain is felt during latching or breastfeeding, call a lactation consultant early to get help with positioning to get a deeper, more comfortable latch. Your lactation consultant is available to help you and provide guidance throughout your breastfeeding journey to help you deal with the most common reasons for breastfeeding pain and more.