Nipple Pain

You’ve probably heard a few stories about nipple pain. Some people have horror stories about cracked, bleeding nipples. Others warn you that breastfeeding hurts until your nipples “toughen up.” Some say nursing should never hurt at all, and if it does, you’re “doing it wrong.” So where does this leave you, if you’re sore? Research has found that nipple pain affects many, maybe even most of us in the early days after birth. Nipple soreness is a common reason for stopping breastfeeding before you’d planned to. But we also know that when the baby’s latch is deeper, the pain is less. Getting an effective latch right from the beginning can make a big difference.

The Art of Breastfeeding, La Leche League International 2024

We’re so sorry you’re sore! Pain is always a signal to pay attention to. This information is about the common (and less common) causes of sore nipples. Most causes of nipple pain are fixable, or resolve over time. Research tells us that early nipple pain usually improves in the two weeks or so after birth. (1) But while you’re in pain, you deserve support. If the information here isn’t enough, La Leche League Leaders can help. In the meantime, don’t forget the pain relief, if you need it. There are lots of safe options during breastfeeding (2) – check with your midwife, doctor, pharmacist, or a breastfeeding supporter if you’re not sure what you can take.

Whilst there are a number of causes of nipple pain, by far the most common is the baby not  having a big enough mouthful of breast (you might hear this called ‘shallow attachment’ or ‘shallow latch’). (3) When this happens, the nipple gets squashed between the baby’s tongue and the roof of their mouth. 

It’s important to pay attention to how breastfeeding feels, as well how it looks. Even if someone tells you that your baby’s latch looks great, if nursing is really painful, or your nipples are becoming damaged, it’s important to do something about it. Nipple pain isn’t something you just have to put up with. And helping your baby latch more deeply helps your baby, too – they get more milk, more easily. 

Different kinds of pain

When pain happens and how it feels can tell us a lot about why it might be happening, and how to make it better. Here are some common scenarios.

Continuous discomfort and sensitivity in the first few days 

In the first week or two after birth, many mothers find that their nipples are extremely tender. Some describe it as similar to just before their period arrives, or the sensitivity of early pregnancy. 

If your baby is under two weeks old and your nipples:

• feel sensitive all the time, not just when you’re nursing your baby,
• look like they usually do (the skin isn’t damaged), and
• don’t look squashed at the end of a feed,

then this discomfort is most likely caused by hormones, and will settle down in a few days. In the meantime, you might find it helps to take deep breaths or distract yourself while breastfeeding. If clothing feels intolerable, you could experiment with soft breast pads. Some mothers find it more comfortable not to wear a bra.

Pain all the way through feeding that stops when the baby comes off

The most common cause of this type of pain is that the baby hasn’t got a big enough mouthful of breast. The nipple is near the front of their mouth, and gets squashed against the roof of the mouth as the baby nurses. Ouch! 

As your baby lets go of the breast you might notice:

• your nipple looks slanted, like the tip of a new lipstick,
• a paler ‘compression stripe’ across the tip of your nipple, or
• the skin of your nipple looks chafed, cracked, or broken.

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You can find lots of tips on how to get your baby more deeply and comfortably latched here and here. Your midwife, health visitor, and local breastfeeding supporters are there to help. Small adjustments can make a really big difference to how it feels.  

While you’re working on it, you might find it helps to:

• start on the less sore side first, if you have one. 
• try some different positions. It might be easier to help your baby attach deeply in a new position – but even if it’s still difficult, nursing at a different angle may take the pressure off the sorest part of your nipple.

Healing damaged nipples

There is no agreed guideline on how to treat sore nipples – different experts suggest different strategies. Blood from cracked nipples is not harmful to your baby. 

Here are some ideas you could try:

• Keep the nipple moist. Apply expressed milk, or a tiny smear of petroleum jelly, purified lanolin, or extra virgin coconut oil with clean fingers after feeding. These don’t need to be wiped off before feeding again. Commercial nipple creams often have multiple ingredients which may not be as safe for you and your baby.
• Use a hydrogel dressing. It’s important to keep dressings clean and change them regularly. (4, 5)
• Wear silver nipple cups over your nipples between feeds. (6, 7)

Stop, and talk to your doctor or a breastfeeding supporter, if what you are doing is not helping, or seems to be making things worse.

Nipple shields 

Using nipple shields (a thin piece of shaped silicone placed over the nipple during feeds) is sometimes suggested for sore nipples. This is not their best use, as a shield can mask the pain caused by shallow latch, rather than helping you fix it. However, some mothers have found them a useful short term tool, enabling them to keep breastfeeding while their nipples heal. If you want to try using nipple shields, if possible work with a breastfeeding supporter who is experienced in using them, who can also help you work on getting a deeper latch.

You can read more about nipple shields here.

Bacterial infections 

Bacterial infection of the nipple can cause symptoms such as burning pain and soreness. Some experts suggest washing damaged nipples once a day with soap, to help prevent infection. (5)

If your nipple is infected you might see:

• yellow discharge or pus,
• crustiness,
• nipple swelling,
• colour change, or
• nipple cracks or wounds which don’t heal. 

An infected nipple is likely to be painful all the time, not just when breastfeeding. You’ll probably have had recent nipple damage, perhaps in the early days of breastfeeding, or from an older baby who is teething or biting. Staphylococcus aureus (Staph. A) is the most common bacterium associated with breast infection (8) and can be treated with antibiotics. Contact your GP if you think you might have an infection. (9)

Extra challenges 

Breasts and nipples come in all shapes and sizes, and almost all of them can work well for breastfeeding. If you’ve got flat nipples (which don’t stick out) or inverted nipples (which tuck themselves inwards), establishing breastfeeding may take a little extra time and patience in the early days. You can find more information on different nipples here.

Occasionally, breastfeeding doesn’t become more comfortable over time, even with really good help. This may be because, however hard you both try, your baby has some kind of physical issue that makes breastfeeding harder, for example tongue tie. A breastfeeding specialist can assess your baby and refer them for treatment, if needed. (11)

Pain as the baby latches, that improves as milk starts flowing 

This is most often a sign that the nipple has been damaged by shallow attachment. As your baby latches, they draw the nipple out, towards the back of their mouth. It’s quite a stretch, to double its resting length or more! (12) If the nipple is sore, this stretch is uncomfortable. If the baby is now deeply attached, though, this latching pain reduces or disappears entirely once the baby is settled on the breast, 20 seconds or so into the feed.

If no further damage occurs, your nipple will soon heal, and nursing will be comfortable. In the meantime, it might help to use gentle massage, hand expression, or a pump to get your milk flowing before or as your baby latches on.

Short, sharp, shooting pains at random moments

This twinging kind of pain, lasting a few seconds at most, is sometimes described as cramping, or like a small electric shock. It’s thought to be caused by cells within the breast contracting to move milk towards the nipple. You might notice it a few seconds into a feed, when your milk releases (also known as ‘milk ejection’, or ‘letdown’), and at other times during and between feeds. It’s common to start feeling it a few weeks after birth, though some mothers never notice it at all. It can feel more intense if the breast is very full. (13) The sensation can be unpleasant, but it is usually brief, and you don’t need to do anything about it. This type of pain usually vanishes as mysteriously as it arrived, a few days, weeks, or (rarely) months later.

Pain as your baby comes off, after a comfortable feed

This can happen if suction is not broken when taking your baby off. Try putting a clean finger between your baby’s gums to break the suction, if you need to pop them off mid-feed!

Comfortable at first, becoming painful as feed progresses

This probably means that attachment has become shallower during the feed, because either your breast or your baby has slipped. These tips may help:

• Take a moment before you begin, to make sure you’re sitting, semi-reclining, or lying comfortably. If you recline (sometimes called ‘laid-back breastfeeding’), some or all of your baby’s weight can be supported by your body, rather than your arms and hands. 
• Let your breast rest at its natural level and bring your baby to the breast, rather than lifting your breast into your baby’s mouth. If your baby is higher than your breast, reclining (lying back at an angle, like on a sun lounger) opens up more space on the front of your body for your baby to fit into. Or try lying on your side next to your baby. 
• Once your baby is settled at the breast, notice where you’re using muscle tension to hold yourself in position, and find ways to relax those muscles. Use props and pillows if they help, e.g. put your feet up on a stool, or thick book, or wedge a cushion, blanket, etc. under your elbow or wrist.

You can find lots of ideas for comfortable feeding positions here and here. La Leche League Leaders will be pleased to help.

Stabbing breast pains after feeding

The most common cause of this type of pain is vasospasm – a sudden narrowing of the blood vessels. The main cause of nipple vasospasm is a shallow latch. If the nipple is squashed against the roof of your baby’s mouth during feeding, blood flow may be constricted. You might see the signs of shallow attachment (listed above, ‘Pain all the way through feeding’).

As blood flows back into the nipple you might feel intense pain in the nipple itself, and sometimes deeper in the breast. It’s often described as ‘shooting’ or ‘burning’ pain, a bit like the ‘pins and needles’ you feel after you sit on your foot for a long time. This vasospasm is sometimes misdiagnosed as thrush (yeast infection).

Relieving vasospasm symptoms

Helping your baby take a bigger mouthful of breast can often solve the problem. In the meantime, you might find it helps to apply dry heat (such as a warm wheat bag or hot water bottle) to your nipple as soon as your baby comes off the breast. Or you could:

• hold your baby close against your breast,
• cup your nipple in your warm hand, or
• gently massage your nipple with your fingers. If you do this, it may feel more comfortable to use a bit of edible oil, e.g. olive, to help your fingers glide smoothly.

Other causes of vasospasm

Vasospasm may also be associated with the circulatory condition Raynaud’s Phenomenon which affects the blood supply and can involve the extremities: hands, feet, nose, and nipples. A history of Raynaud’s may increase the likelihood of it happening during breastfeeding. Symptoms may happen in response to cold, separately from breastfeeding. Warmth may help prevent vasospasms caused by Raynaud’s, and if necessary it can be treated with medication. Caffeine can make Raynaud’s worse, so it may also help to drink less coffee. (You can read more about coffee and breastfeeding here).

Tension in your body may add to deep breast or muscle pain. This deep breast pain is sometimes described as ‘Mammary Constriction Syndrome’, and may be relieved by massage and stretching. 

Pain during or after pumping

Flange fit

If you are pumping, it’s important that your pump flange fits you comfortably. A poorly fitting pump flange can cause nipple pain and damage:

• If the flange is too big, too much of your areola can be pulled into the tunnel of the flange during pumping, resulting in rubbing and soreness. 
• If the flange is too small, your nipple can rub against the tunnel. 

It’s horrible to be uncomfortable every time you pump – and you’ll get less milk, too.  Flange sizes vary between different pump makes and models. It’s worth taking the time to find a flange that fits really well. One way to check the fit of your flanges is by measuring the width of the tip of each nipple in millimetres with a ruler before feeding or pumping, to get an accurate measurement. (14) Often the most comfortable flange size will match the size of your nipples. Manufacturers often provide their own sizing guide, though these may not always give accurate measurements. Many pumps have flanges available in a choice of sizes, and you can buy flanges from other companies that are compatible with the main brands of pump, giving lots of options. 

Make sure you’re centering your nipple within the flange. Some mothers also find it helps to lubricate their nipple and areola with purified lanolin before pumping. The best flange for you is completely comfortable, not just tolerable. You might need to try a few sizes, shapes, or materials to find one that works really well for you. You may need a different size for each breast! 

Pump suction

You can also damage your nipples if your pump’s suction (vacuum) is turned up too high. When pumping is going well, the flow of hormones causes your breast to release (‘eject’) milk – you don’t need to try and drag milk out by force. Again, more comfort means more milk. To find the best suction pressure for you, try turning it up so it’s just a tiny bit uncomfortable, and then turn it down a fraction.

You can find more information about expressing your milk in our Expressing and Storing Milk booklet.

Pain that starts after the early weeks of breastfeeding

This can happen for several reasons, including:

• Your baby’s latch has become shallow because they’ve grown, and the position you’re holding them in needs to be adjusted to account for their new size. This often seems to happen a month or so into breastfeeding, just when you thought you were getting the hang of it! The principles you learned in the early days of breastfeeding will be useful again now, like making sure your baby is held close, and approaches the breast chin-first, head tipped back. You might want to explore some more ‘grown up’ positions. Attending an LLL meeting gives you the opportunity to observe other mothers feeding older babies.
• Teething. Some babies start teething as early as two or three months (though it’s always hard to tell until you eventually see teeth!) It may help to offer your baby something cold to chew on before nursing. 
• Biting. A young baby who starts chomping down on the nipple is probably in discomfort with teething. Older babies (from eight months or so) may bite to get your full attention, or because they enjoy the exciting reaction!  It’s usually an annoying but short-lived phase. 
• Skin irritation. Some mothers become sore when the skin on their nipples reacts to food particles present in their older baby’s mouth. If it’s triggered by particular foods, you might need to avoid offering that food for a while. It can help to rinse your baby’s mouth with water or brush their teeth before nursing. Skin can also become irritated by laundry detergent, toiletries (e.g. bath or shower products), or breast pump flanges. If you have eczema or another skin condition, you might get it on your nipples during breastfeeding. The skin might look flakey and irritated, and feel itchy. Creams (including low dose topical steroids) used to treat dermatitis, eczema, and other skin conditions are usually safe to use during breastfeeding. (15) If it’s been suggested that you might have nipple or breast thrush (yeast infection), see our thrush page
• Hormonal sensitivity. Many mothers notice that their nipples become sensitive for a couple of days during each menstrual cycle. Sensitivity that goes on for more than a few days can be an early sign of pregnancy. It might help to hand express to get the milk flowing, and vary nursing positions. A toddler may be willing to nurse for shorter times until the discomfort decreases. You can read more about breastfeeding during pregnancy here.

A blister or white spot on your nipple 

Milk blisters (also known as blebs) look like tiny white or yellow dots on the tip of the nipple. They haven’t been studied much, and we don’t fully understand why they form. Milk blisters that don’t block milk coming out, and don’t hurt, can be safely left alone. They eventually disappear. 

Sometimes, though, a milk blister is extremely painful (often described as ‘stinging’ pain). Sometimes they form in one or more ‘milk pores’, blocking milk from coming out of part of the breast. If this happens, see our mastitis page.

Blebs are part of the mastitis spectrum of related conditions. You may be more likely to get them if you have oversupply, recent nipple damage, localised swelling in the breast, or are exclusively pumping. The self-treatment measures suggested for mastitis may help, as well as managing any oversupply of milk. 

The Academy of Breastfeeding Medicine Mastitis Protocol has some extra suggestions for treating troublesome blebs. (16)  

For more information see Further Reading. 

Summary

• There are lots of different reasons for nipples becoming sore while breastfeeding.
• By far the most common is that the baby doesn’t have a big enough mouthful of breast.
• Paying attention to when and how pain happens can give you clues to why.
• Don’t forget the pain relief, if you need it.
• Almost all nipple pain resolves with time, or can be improved with breastfeeding help and (where necessary) medical treatment.
• If you need to take a break from direct breastfeeding because it’s just too painful, your baby won’t forget how to do it. You can express your milk and feed it to your baby some other way.
• As long as you keep your milk flowing, you’ve got plenty of time to work on any breastfeeding issues.

You can get support from an LLL Leader online, by calling your local Leader or our national callback helpline, or through one of our breastfeeding support groups. Getting support and encouragement from other breastfeeding mothers in your local LLL Group may help more than you think – many will also have been sore in the early days of breastfeeding, and found their way through. 

Written by Karen Butler and Sue Upstone and the mothers of LLLGB. 

Updated by Nicola Coles-Carr, Polly Smith, Sharon Tierney and Jayne Joyce, June 2025.

Further Reading

The Art of Breastfeeding, 9th edition. LLLI. London: Pinter & Martin, 2025; chapter 4 (latching and attaching) and chapter 18 (sore nipples).

References

1. Amir, Lisa H et al. “Identifying the cause of breast and nipple pain during lactation.” BMJ (Clinical research ed.) vol. 374 n1628 (2021). doi:10.1136/bmj.n1628
2. https://www.breastfeedingnetwork.org.uk/factsheet/analgesics/ (Accessed May 2025)
3. Kent, Jacqueline C et al. “Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments.” International journal of environmental research and public health vol. 12,10 (2015): 12247-63. doi:10.3390/ijerph121012247 https://www.researchgate.net/publication/282360578_Nipple_Pain_in_Breastfeeding_Mothers_Incidence_Causes_and_Treatments (Accessed June 2025)
4. https://www.breastfeedingnetwork.org.uk/factsheet/moist-wound-healing/ (Accessed May 2025)
5. https://breastfeeding.support/treatments-sore-nipples/ (Accessed May 2025)
6. Pilloni, Monica et al. “Evaluation of the Efficacy of 99.9% Pure Silver Trilaminate Cups in the Prevention and Treatment of Nipple Pain and Fissures”. Open Journal of Nursing vol 13 (2023): 686-698. doi: 10.4236/ojn.2023.1310045 https://www.scirp.org/journal/paperinformation?paperid=128489 (Accessed May 2025)
7. Marrazzu, Adriano et al. “Evaluation of the effectiveness of a silver-impregnated medical cap for topical treatment of nipple fissure of breastfeeding mothers.” Breastfeed Med. vol. 10,5 (2015): 232-8. doi:10.1089/bfm.2014.0177
8. https://cks.nice.org.uk/topics/breastfeeding-problems/background-information/causes-of-nipple-pain/ (Accessed June 2025)
9. https://cks.nice.org.uk/topics/breastfeeding-problems/diagnosis/diagnosis-of-nipple-pain/ (Accessed May 2025)
10. Kujawa-Myles, Sonya et al. “Maternal intravenous fluids and postpartum breast changes: a pilot observational study.” International breastfeeding journal vol. 10,18 (2015). doi:10.1186/s13006-015-0043-8 https://www.researchgate.net/publication/277340706_Maternal_intravenous_fluids_and_postpartum_breast_changes_A_pilot_observational_study (Accessed June 2025)
11. https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/breastfeeding-challenges/tongue-tie/ (Accessed May 2025)
12. Elad, David et al. “Biomechanics of milk extraction during breast-feeding.” Proceedings of the National Academy of Sciences of the United States of America vol. 111,14 (2014): 5230-5. doi:10.1073/pnas.1319798111 
13. https://www.breastfeedingnetwork.org.uk/breastfeeding-information/problems-with-breastfeeding/pain-if-breastfeeding-hurts/ (Accessed May 2025)
14. Anders, Lisa A et al. “Flange Size Matters: A Comparative Pilot Study of the Flange FITSTMGuide Versus Traditional Sizing Methods.” Journal of human lactation: official journal of International Lactation Consultant Association vol. 41,1 (2025): 54-64. doi:10.1177/08903344241296036 
15. https://www.breastfeedingnetwork.org.uk/factsheet/eczema/ (Accessed May 2025)
16. Mitchell, Katrina B et al. “Academy of Breastfeeding Medicine, Clinical Protocol #36: The Mastitis Spectrum, Revised 2022.” Breastfeeding Medicine vol. 17,5 (2022). doi: 10.1089/bfm.2022.29207.kbm

Copyright LLLGB 2025

Credit for illustrations: Brigitte Sparnaaji, from Breastfeeding Illustrated, published by La Leche League GB, 2021.

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