Nipple Pain When Breastfeeding: Causes, Fixes, and When to Get Help

Nipple pain is one of the most common reasons women stop breastfeeding earlier than they intended. And a significant portion of that pain is preventable or treatable. Pain is always a signal — it's telling you something needs to change. Here's how to work out what.

What's Normal

There's a distinction between the expected initial discomfort of breastfeeding and ongoing or worsening pain.

Normal in the first few days:

• Tenderness and sensitivity as the nipples adapt to frequent feeding
• Brief initial discomfort (ten to thirty seconds) at the start of a feed in the first week or two
• Some nipple stretch during feeding

Not normal at any stage:

• Cracked, bleeding, or blistered nipples
• Pain throughout the duration of the feed
• Toe-curling pain at the start of each feed beyond the first week or two
• Burning pain between feeds
• Pinched, white, or misshapen nipples after feeding
• Shooting pain deep in the breast

If you're experiencing anything in the second list, there's a cause that can usually be identified and addressed. Pushing through severe, prolonged pain is not the answer.

The Most Common Cause: Poor Latch

The most frequent cause of nipple pain is a shallow latch — your baby is not taking enough breast tissue into their mouth and is effectively chewing on the nipple itself rather than drawing from a full mouthful of breast.

Signs of a Shallow Latch

• Pain throughout the feed rather than just at the start
• Nipples that come out of the feed flattened, creased, or pinched (like a lipstick)
• The baby's lips are not flanged outward (they may be tucked inward)
• The baby is making clicking sounds during feeding
• You can see or hear the baby gulping air

Fixing the Latch

Break the latch by inserting a clean finger into the corner of the baby's mouth, wait for a wide-open mouth, and try again. A wide-open gape before latching is the key — you're aiming for the baby's chin to lead onto the breast with the mouth wide open, taking a large asymmetric mouthful that includes more breast below the nipple than above.

If you're not sure what's happening at the latch, your midwife, health visitor, or a breastfeeding counsellor can observe a feed. This is invaluable — it's very hard to assess your own latch while managing the baby.

Position Problems

Positioning is so closely linked to latch that they're really the same problem. If the baby is twisted, if they're feeding with their chin to their chest rather than slightly tilted back, or if they're approaching the breast at the wrong angle, the latch will suffer.

See our guide to breastfeeding positions for a rundown of common holds and when each works best. The cross-cradle and laid-back positions both give good latch control and are useful when pain is a problem.

Tongue Tie

Tongue tie (ankyloglossia) is a tight or short frenulum — the piece of tissue under the tongue — that restricts tongue movement. The tongue needs to be able to move forward and upward to effectively draw milk from the breast, and if it can't, the result is often nipple trauma and ineffective milk transfer.

Signs That Might Suggest Tongue Tie

• Ongoing pain despite getting help with position and latch
• A nipple that comes out misshapen (flattened, wedge-shaped)
• A baby who is feeding constantly but not gaining weight
• A baby who makes clicking sounds when feeding
• Difficulty maintaining a latch

Tongue tie is diagnosed by a trained healthcare professional — not all tongue ties cause problems, and not all visible frenulums affect function. If tongue tie is suspected, ask your health visitor or GP for a referral to a specialist. Division of a tongue tie (frenotomy) is a quick procedure and can be transformative for breastfeeding.

Nipple Thrush

If you've got past the latch issues but still have burning or shooting pain — particularly pain that persists between feeds — thrush (candida) could be the cause.

Signs of Nipple Thrush

• Burning, itching, or shooting pain in the nipple and breast, often between feeds
• Nipples that are pink, flaky, shiny, or unusually sensitive
• The pain may be deep and aching, not just on the surface

Nipple thrush is often accompanied by oral thrush in the baby (white patches in the mouth — see our guide to oral thrush). They need to be treated simultaneously or you'll keep reinfecting each other.

Treatment is with an antifungal cream (such as miconazole) for the nipples and oral drops (nystatin) for the baby. Both are available on prescription or from a pharmacy. Complete the full treatment course, and sterilise dummies, breast pump parts, and anything that goes in the baby's mouth.

Raynaud's Phenomenon of the Nipple

Less common but often misdiagnosed: Raynaud's phenomenon affecting the nipple. This causes vasospasm — a brief reduction in blood flow — usually triggered by cold or by release from the baby's mouth, causing intense burning or throbbing pain and classic colour changes (nipple goes white, then blue, then red).

Raynaud's is not caused by infection and doesn't respond to antifungals. Keeping the nipple warm immediately after feeding (a warm flannel, a breast pad, a warm hand) helps. Some women with significant Raynaud's are treated with nifedipine (a vasodilator) which is safe during breastfeeding.

Cracked and Bleeding Nipples

Cracks usually result from a poor latch — fix the latch and cracks will heal. In the meantime:

• Express a little milk and rub it into the cracks — breast milk has antibacterial and healing properties
• Use lanolin cream (such as Lansinoh) which is safe for baby and helps maintain moisture while healing
• Air dry after feeds
• Avoid soap on the nipples

Badly cracked nipples are very painful. If feeding is unbearable, expressing temporarily while the cracks heal is a reasonable option.

When to See a Lactation Consultant

If you've tried improving the latch and position, you've seen your health visitor, and pain continues, ask for a referral to an International Board Certified Lactation Consultant (IBCLC). They're the highest level of breastfeeding support professional and can assess and treat complex problems including tongue tie, low supply, pain, and more.

Pain is not something to accept as inevitable. Most causes are identifiable and treatable.