I remember those first few days after my first son was born and trying to breastfeed him. Oh. My. Gosh. The pain.
Being a first-time mom, I had no idea how to breastfeed. My lack of knowledge led to cracked, sore, bleeding nipples.
Oh, how I wish I knew what I know now back then!
Considering nipple pain is the leading cause of moms stopping breastfeeding, this is an important topic! Most nipple pain issues can be overcome with time and help.
Understanding the causes of breastfeeding nipple pain can be a great place to start to see where you need to go next for help.
Hang in there, momma, breastfeeding should not be painful so getting to the root cause of the pain is key!
8 Causes of Breastfeeding Nipple Pain
1 – Postpartum
All the lovely hormones raging through our bodies after giving birth can cause sore nipples. On top of that, our brand-spanking-new babies are learning to breastfeed just like we are, so that can lead to some discomfort as they learn to latch properly.
It is always best to ask the hospital for a Lactation Consultant to visit you while you are there so they can check your baby’s latch and give you some tips on how to properly hold your baby while breastfeeding.
The pain associated with postpartum hormones and with the beginning stages of nursing a newborn will start to gradually get better after a week or so.
2 – Shallow/Bad Latch
My third baby was what I called, “a lazy latch-er.” She would latch perfectly to start a feeding but after a few sucks, she would slip down to just being on my nipple (shallow latch).
That is a great way to end up with cracked, bleeding nipples. Thankfully, she was my third and I knew right away she slipped and was able to correct her before causing any pain.
Your baby should take your entire nipple and some of the areola into their mouth when latching. If they are just on the nipple, you will end up with very sore, and possibly bleeding nipples. Ouch.
One tip is to cup your breast with your hand in the shape of a “C” and gently touch your baby’s nose with your nipple. This will cause your baby to open their mouth wide so you can bring their head to your breast for a deep latch.
Pain with a bad latch will typically lessen as the nursing session goes on. You can avoid cracked, bleeding nipples by using your finger to break your baby’s latch and relatching them as soon as you feel they are on incorrectly.
3 – Poor position
In addition to a poor latch, you need to ensure you position your baby correctly when breastfeeding. You should be belly to belly with your baby and their mouth should be positioned just slightly higher than your nipple.
You always want to bring your baby to your breast. If you lean into your baby or if your baby’s mouth is lower than your nipple, then it can cause pain from pulling and result in a shallow latch.
4 – Vasospasm
Vasospasm is a sudden narrowing of blood vessels and can be brought on by breastfeeding often because of a shallow latch or because of Raynaud’s.
The signs and symptoms of vasospasm are:
- White/Blanched nipples after a feed
- Burning, itching, or stabbing pain felt for a short time after feeding or between feeds
- Misshapen nipples
- Sore nipples while feeding
- Deep breast pain
In the book, Breastfeeding Answers Made Simple, Vasospasm is explained this way:
Vasospasm is a constriction of the blood vessels in the nipple that causes the nipple to blanch, or turn white. Compression of the nipple is a common cause, either due to shallow breastfeeding or the baby compressing the nipple to slow fast milk flow. When the nipple is compressed, it may look misshapen after feedings—pointed or creased, like the tip of a new tube of lipstick. The blood flowing back to the nipple may cause a burning sensation, intense throbbing, or shooting pain. (Credit: Breastfeeding Answers Made Simple)
Vasospasm is often misdiagnosed as the fungal infection, thrush. The symptoms will not improve with thrush treatments and thus, the mother will have to go back to their doctor until a correct diagnosis is made.
You can avoid vasospasm by staying active which promotes blood circulation, avoiding alcohol nicotine, and caffeine, staying warm (being cold is a trigger), and seeking help from a Lactation Consultant.
5 – Thrush
Thrush is a fungal infection (also known as yeast) that can affect both you (on your breasts) and your baby (in the mouth). We all have the fungus Candida Albicans in our bodies.
It typically lives harmlessly in the mouth, vagina, on the skin, and GI tract. Under certain conditions, the fungus can grow and spread leading to an infection.
Breastfeeding provides the perfect place for an overgrowth of candida – warm, moist, and sugar from the milk – Making you and your baby at risk.
Signs of Thrush include:
- Cracked nipples that won’t heal after time
- Nipples that look red, puffy, scaly, weepy, flaky, scaly, or have tiny blisters or white spots
- Itchy nipples and/or burning
- Nipples that become sore suddenly with no other cause
- Baby may have white patches or tiny blisters in the mouth around the cheeks, gums, or tongue.
- Baby may be fussy and sucking can be uncomfortable
- Yeast can cause a diaper rash in a baby as well. It will appear red or pink and possibly have a scaly texture. The rash will not go away with the use of diaper creams or powders. Those may actually make it worse.
Often thrush needs to be treated with prescription medicine. There are some over the counter and home remedies that can be used as well.
6 – Infection
Signs and symptoms of an infection may include:
- Swelling in breast
- Pain or burning while breastfeeding
- Painful lump in breast
- Breast warm to the touch
- Nipple discharge such as puss
- Skin redness
- Flu-like symptoms
If you are experiencing any symptoms of an infection, you need to seek medical attention immediately. Infections can become very serious and require antibiotics and treatment right away. Do not wait.
7 – Milk Blisters
A milk blister occurs when a tiny amount of skins grows over a milk duct causing it to become blocked.
A blister forms and looks white, clear, or yellow in appearance. (See photo in this article, here). Nursing while having a milk blister can be very painful. Eventually, the blisters peel away and heal.
Milk blisters can be caused by an oversupply of milk, bad latch, lip or tongue ties in baby, pressure on the breast, or thrush.
You can treat milk blisters with the following steps:
- Prior to nursing, soak nipple in saline solution then apply a warm compress directly to the nipple.
- With the soak and warmth helping loosen the blister, gently scrape the blister open using a warm washcloth or clean fingers.
- Nurse or pump to help clear the duct.
- Treat the nipple after nursing or pumping by soaking again in saline solution. Then apply expressed breast milk to the nipple and air dry. Follow that up with a layer of nipple ointment such as MotherLove Nipple Cream.
- Repeat until healed.
8 – Lip or Tongue Tie
What does it mean when your baby has a lip tie or a tongue tie?
This is referring to the connective tissue under the tongue and behind the upper lip called the frenula.
When a tongue or lip tie occurs, the frenula is tight or positioned in a way that interferes with your babies ability to move their tongue or flare out their lip.
Those are both essential functions for a proper latch when breastfeeding.
Signs and Symptoms of a Tongue or Lip Tie:
- Nipple Pain
- Nipple looks pinched, blanched, or creased after a feeding
- Vasospasm/breast pain
- Low milk supply
- Plugged ducts/mastitis
- White stripe on nipple after feeding
- Bad latch and poor suck
- Clicking sound while nursing
- Ineffective swallowing after milk letdown
- Slow weight gain
- Gas and reflux
- Fussy at the breast and arching of back frequently
- Sliding off the breast and unable to maintain deep latch
- Fatigue after a few minutes of nursing
- Chewing or biting the nipple
- Coughing, choking or gulping at the breast
If you suspect your baby has a tongue or lip tie, you need to have a professional (Lactation Consultant or Doctor) assess your baby and determine if there is, in fact, an issue.
Having a tongue or lip tie corrected is quick and can resolve the issues associated with the tie.
Dealing with nipple pain while breastfeeding is not fun.
Breastfeeding isn’t always easy and adding pain to the mix is enough to make anyone throw in the towel.
Often times, you may have a combination of symptoms that make it hard to pinpoint what the issue is. Consulting with your doctor or Lactation Consultant is the best way to ensure you get a proper diagnosis and information for next steps.