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Sore nipples or breasts? Here’s help…

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Is nipple pain normal in the early weeks?

Some mothers never experience any nipple pain at all, but studies show that the majority of women in the US and other western countries do have some nipple pain in the beginning.  How do we tell the difference between this typical nipple pain and a problem that would benefit from the help of an experienced breastfeeding counselor and/or IBCLC (International Board Certified Lactation Consultant)?

Typical nipple pain (“transient soreness”) that does not usually indicate a problem:

  • Latch-on pain that lasts no more than 30 seconds into the feeding. This is often described as mild pain or discomfort, but since the pain sensation is very subjective every mother experiences pain differently–some mothers feel more severe pain. The pain should not continue through the entire feeding, and there should not be pain between feedings.
  • Pain usually peaks around the third day after birth, and is gone within two weeks.
  • There is no skin damage – no cracks, blisters, or bleeding.
  • Your nipple should look the same before and immediately after the feeding – not flattened, creased or pinched.

Get help from an experienced breastfeeding counselor and/or IBCLC if you experience the following:

  • Intense, excruciating pain
  • Pain that continues through the entire feeding
  • Pain between feedings
  • Pain that continues past the first couple of weeks
  • Skin damage–cracks, blisters, or bleeding

If you’re experiencing any of the above issues, then don’t let someone tell you that “everything looks fine” – it is either a sign that damage is being done or of some underlying condition (infection, etc.). If you’re experiencing pain that makes you dread feeding your baby or that you describe as excruciating or if you have cracked or bleeding nipples, then this is NOT typical and there is almost always something that can be done to address the issue and to alleviate the pain. Please do not assume this is simply “what breastfeeding is supposed to be like” and just suffer through it – ask for help! It doesn’t mean you’re doing something wrong – there can be many causes, from anatomical issues to infection. Cracking, bleeding or any other nipple damage is not typical- something is causing the damage and pain, and a good IBCLC can help you to find the cause. Seeing a knowledgeable breastfeeding professional could make all the difference.

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Some things to investigate if you have nipple pain:

  • Did breastfeeding get painful when your milk came in? Engorgement can make it difficult for baby to latch deeply. Reverse pressure softening or expressing a little milk can help baby get a deeper latch that does not hurt.
  • Does your nipple look flattened, creased, or pinched when baby unlatches? Can you see a white line across the nipple when baby unlatches? This is usually the sign of a shallow latch. A shallow latch can usually be remedied by adjusting latching technique, but it can also be caused by anatomical variations in mom or baby.
  • Do you have skin damage (bruising, cracks, blisters/blebs, bleeding)? While you investigate and address the cause of the damage, use these tips–Healing damaged skin in the nipple area.
    Some potential causes of nipple pain and damage include:

    • shallow latch, baby’s lips tucked inward instead of flanged outward when breastfeeding, removing baby from the breast without first breaking the suction;
    • unusual infant anatomy such as tongue-tie or lip-tie, unusual palate shape, receding chin, short tongue;
    • strong/unusual suckling; jaw clamping/clenching;
    • unusual nipple anatomy such as inverted or flat nipples, very long, or large nipples.
  • Do you have a rash on the nipple or areola? Contact dermatitis (from breast pads, nipple creams, soaps/detergents, etc.), eczema, psoriasis, poison ivy/oak can all be present on the nipple or breast and cause sore nipples.
  • Are you using a breast pump? Incorrectly sized pump flanges, too-high suction settings,  or too-slow cycling settings can cause nipple pain or damage.
  • Are you experiencing pain between feedings (in addition to or instead of during feedings)? Investigate thrush (yeast infection) and nipple blanching (turning white) and vasospasm.
  • Do you have a forceful milk ejection/let-down reflex? Some babies will clamp down on the nipple to slow the milk flow, causing pain.
  • Has the pain started after weeks or months with no issues? See Why are my nipples sore after months of pain-free nursing?
  • Are you breastfeeding while pregnant with a new baby? See nipple soreness during pregnancy.

More resources on sore nipples:

Is breast pain common the early days?

It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity (“comes in”) 2-5 days after birth. Engorgement typically begins on the 3rd to 5th day after birth, and subsides within 12-48 hours if properly treated (7-10 days without proper treatment). Read more about minimizing and treating engorgement here: Engorgement. See also Engorgement when tandem breastfeeding.

Breast pain

Following are some things to investigate if you are experiencing breast pain.

  • Engorgement (in addition to appearing during the first week, you may also experience engorgement if you skip a breastfeeding session or wait too long between breastfeeding sessions)
  • Plugged Ducts and Mastitis are the most common causes of breast pain in breastfeeding mothers (other than engorgement).
  • Breast pain is sometimes associated with a forceful milk ejection/let-down reflex and oversupply. This pain will appear when the milk lets down, soon after the feeding begins; it usually decreases over time and is gone within the first month after birth. 
  • Raynaud’s phenomenon/vasospasm can cause deep breast pain.
  • Some breast pain might also be caused by a tightening of the chest muscles leading to a reduced blood flow to the breast and nipples. Edith Kernerman, IBCLC has hypothesized and described this set of symptoms, called mammary constriction syndrome (read more about it here), which is treated with pectoral muscle massage.
  • Sometimes breast pain may  be referred pain from nipple trauma or a muscle strain or injury.
  • A badly fitting bra or tight straps on a baby carrier can cause shooting breast pains.
  • Breastfeeding mothers may also experience premenstrual breast pain or fibrocystic breast pain.
  • Have you had breast surgery or a breast injury in the past? Internal scarring can sometimes cause pain, as can a ruptured breast implant.
  • Mothers with very large breasts sometimes experience muscle strain due to the weight of their breasts, which may be relieved with a well-fitting bra.
  • Thrush (yeast infection) may cause breast pain along with other symptoms (shiny or flaky skin on the nipple/areola, nipple pain) but breast pain is unlikely to be the only symptom of thrush.

More resources:

Additional references:

Lawrence RA, Lawrence RM. Breastfeeding: A Guide for the Medical Profession, 7th ed. Maryland Heights, Missouri: Mosby; 2011: 253-257, 267-270, 599-600, 956-962.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, TX: Hale Publishing; 2010: 629-724.

Riordan J, Wambach K. Breastfeeding and Human Lactation, 4th ed. Sudbury, MA: Jones and Bartlett; 2010: 291-306.

Wilson-Clay B, Hoover K. The Breastfeeding Atlas, 5th ed. Manchaca, TX: LactNews Press, 2013: 51-65, 84-101.