The Causes of Nipple/Breast Pain While Nursing.. And How to Make it Better

What causes nipple pain? What can be done about it? Do you have to stop breastfeeding? Do you want to skip breastfeeding altogether? No. If you treat breast pain promptly, continuing to breastfeed is actually less painful than other options such as weaning. And breastfeeding has many benefits to you and your little one.

There are many causes of breast pain which I’ll get into in a minute. I want to introduce you to two very important concepts first:

First, let’s learn about how to UNLATCH your child. If your child is latched on properly or not and you simply pull your breast out of your child’s mouth or pry apart your baby’s lips before pulling your breast out… You’re gonna be in for some pain. To properly break a baby’s latch you want to take your clean pinky finger and insert it in the corner of your baby’s mouth. Work it between the gums and you should feel suction break loose. Use your finger as a lever to pry your baby’s gums open until your nipple can pop out without rubbing against your baby’s mouth in the process.

Second, let’s learn about washing your breasts properly. Many women wash their breasts with soap and hot water. I did that too for most of my life, and thought that it was a good idea to continue after giving birth. Afterall, we want our breasts to be clean for our babies, no? BAD idea. Your nipples and areola secrete natural antibacterial oils that help keep them free of infection and that help keep the nipples and breasts in good shape and protect them from cracking. Soap removes that, chaps and irritates the breasts, and makes us more prone to infection. Simply wash your breasts with warm water and allow them to air-dry after you’ve patted them mostly dry with a clean towel.

HORMONES

Toward the end of pregnancy your hormones are in overdrive. Think of when you have PMS. Do you ever have breast pain? Your breasts are probably going to hurt toward the end of pregnancy, and for the first few weeks or even a month or so after you give birth. Some of this is hormonal. You’re simply more sensitive.

ENGORGEMENT

When your milk first comes in you may find that you have enough milk for twins or even triplets since your body is preparing for all options. When my milk came in my breasts went from their normal “large D” state to the size of small watermelons. It was PAINFUL. But once I got the milk out, I felt much better.

Keep in mind that if your breasts become engorged it may be harder to latch your baby on, your baby may freak out if the milk flows too quickly, or your breasts may be simply too painful to deal with the immature and awkward latch of a newborn. There are things you can do to minimize the pain and make breastfeeding more comfortable for both of you.

If you are engorged and your baby refuses to latch, you can use a breast pump for a short while (1-5 miutes) to relieve engorgement and make it so that the milk will flow to your baby more slowly, and your breast tissue won’t be quite so swollen and hard- making it easier for baby to latch on and stay latched on.

If you are engorged continuously and your baby is nursing all the time but still not helping, you may want to chill some cabbage leaves in the fridge and place them in your bra. These can be very soothing and decrease milk supply slightly to more comfortable levels. Just be careful with this method or with any method that involves cool compresses as you can decrease your milk very quickly and you may freak out and think you’re drying up. (See my other journal post on “I dried up!” myths.)

CIRCULATION

Another interesting thing about engorgement.. Is that you may find that your nipples periodically become rock-hard, white, and painful. This is due to a lack of circulation in your nipples from all the extra fluids in your breasts. You can simply roll them between your fingers lightly to restore circulation. Stop rolling them once they become pink again. This is more common in the winter and in the first few months of breastfeeding, and it’s easy to resolve. Just painful and confusing if you don’t know what it is and how to fix it.

INITIAL STRETCHING

Unless your husband and you have some interesting methods of foreplay, I’m guessing your nipples are not accustomed to being stretched out to quite the degree that they will be stretched out when you start to nurse. This can be a bit painful in the early days, particularly when you add in engorgement and hormonal tenderness.

There are things you can do to help the process go more smoothly. If you’re doing fine, continue. But if you’re cracked and bleeding or have hard scab-like things on your breasts and your lactation consultant has determined your little one is latched on fine, is not tongue tied, etc. then it may simply be a matter of your nipples being stretched out too quickly.

Soak your breasts in warm water for a couple of minutes before one or two feedings each day. Gently rub the water into any scabs that are on your breasts, then carefully insert your nipples into your breast pump and pump for about one minute. This relaxes your nipples and stretches them out a bit more gently than a hungry newborn will be willing to do.

If your breasts are simply too tattered and latching becomes painful and you’re considering switching to formula or even simply handing your child to your husband and running off to join the circus.. Look into breast shields first. These fit on over your nipples and can give your breasts a chance to heal before you try again. Keep in mind that breast shields should be used for a VERY short duration, as they can cause more problems such as low supply, nipple confusion, an even more aggressive latch, etc.

POOR LATCH

Latch has several components. Position of baby’s tongue, position of lips, how much breast tissue is in the baby’s mouth, how the baby is positioned (proximity to the breast, and where the baby’s chin is in relation to the rest of the breast),

TONGUE: Listen for clicking sounds. If you hear clicking, your baby’s tongue is on top of your nipple not underneath it. This can cause nipple trauma and will interfere with the baby getting milk. Gently un-latch your baby using the method I mentioned at the beginning of this article. Latch your little one on again by aiming your nipple for the roof of her mouth.

LIPS: Check to see if your baby’s lips are flanged out around your breast like the hyper-exaggerated lips of a cartoon fish. If a lip appears to be folded under, use your pinky finger to work it out. If the lower lip is flipped under, you can apply slight pressure to the baby’s chin just below the lower lip. Usually the lip will flip out as a result. A small hand-held mirror can help you determine if your baby’s latched on right.

DEPTH OF LATCH: If your baby is simply sucking on your nipple, you’re going to be in pain. You want to make sure that about 1″ of your areola ends up in your baby’s mouth. To do this, I would hold my breasts like it was a cigarette (between my forefinger and middle finger) just above where my “latch target” was. I would then aim my nipple for the roof of my son’s mouth and see how close his lips would come to meeting the latch target. Your baby may have a tiny little mouth when he’s first born, but you should see his latch coming gradually closer to your target over the days. As it does, the pain will decrease.

There are other things you can do to ensure a deep latch. You can press down on your baby’s chin while latching him on. Personally my favorite method was to draw a line with my nipple- first from my son’s nose down to his chin to get him interested, and then from his chin up to his nose to get him to oooooopen wide! I’d then aim my nipple for the roof of his mouth. If baby closes his mouth too quickly, patiently try again.

Make sure your baby isn’t falling asleep and drifting off of the breast to a more shallow latch. You may need to tickle his feet, strip him down to his diaper and do skin to skin contact, or otherwise wake him up to make sure he’s nursing well.

AGGRESSIVE LATCH

Sometimes babies are latched on wonderfully.. Just too strong! Little baby baracudas can be difficult to deal with, particularly in the early days when you’re dealing with so much.

There are several different reasons why a baby may be latching on so strong.

Maybe she’s upset because you’ve gone too long between feedings and she’s really hungry and impatient for the milk to start coming down. Try feeding your little one more frequently. Every hour or two instead of every 3 hours. She’s more likely to be gentle when she’s not as hungry.. And it helps your milk supply

On the other hand, maybe your baby is chomping down because your milk is coming too quickly and she’s afraid of choking. Try laying on your back and laying your baby on your chest and nursing that way. This way the milk will move “uphill”. I’ve also found that my son can’t latch on quite as aggressively when my breast tissue is being pulled down and out by gravity. After a minute or two of nursing this way you can sit up and complete the nursing session normally. (Too much nursing uphill can cause mastitis and breast infections.)

If your baby is simply too aggressive for you in the beginning and you’re sure that he doesn’t have nipple confusion (covered below), and you’re desperate for some relief from the pain… Consider nipple shields. But don’t use them for the full breastfeeding session! Instead, start out with the nipple shields, and once your baby has had some milk and is less likely to be aggressive, remove the shields and latch your little one on. The goal of nipple shields is temporary relief. Using them too frequently can compound problems by lowering your supply (by decreasing stimulation of the breasts), and can cause nipple confusion. It may also make aggressive nursers MORE aggressive as they have to work harder for the milk.

TEETHING

When your little one starts to teeth, he or she may decide to use your breast as a teething toy, may nurse far more frequently, or may have to learn to adjust his or her latch to accomodate the new teeth. You should discourage biting and chewing during this time and make sure that your child is in a deep latch which makes it less likely that teeth will rub against your nipple. Many women find it beneficial to resume use of lanolin during this stage.

The thing to keep in mind is that the first few teeth are the most painful. When more teeth come in and when they’re fully out and have had a chance to wear down a bit with use, they will no longer hurt. Nursing a little child with a full mouth of teeth is far less painful than nursing a little one with a tiny tooth ridge that has just broken the surface of her gums.

BITING

Many toddlers go through a stage where they think it’s funny to bite. There are many solutions suggested for this problem. Weaning is NOT necessary.

You can try saying “NO” loudly and terminating the nursing session. This works well with some babies. With some babies this may backfire and make them scared to nurse, or they might find the “no” to be funny and keep doing it.

You can try explaining “that hurts mommy!” and each time they bite, stop nursing.

You can try pressing their face into your breast which breaks their bite and which also cuts off their air. Let them go when they pull back (or after a few seconds). This discourages many from biting (although some will bite harder)

What worked for ME was to simply keep my pinky finger near the corner of my child’s mouth and every time he looked like he was about to bite, I’d jam my finger into his mouth to keep him from biting. I wouldn’t react, I wouldn’t say anything, I’d just prevent him from biting. He started biting at 10 months, bit me a few times while I was figuring things out, and now he’s 19 months and hasn’t bitten in a long time. We still nurse.

If one method doesn’t work for you, try a different method.

NIPPLE CONFUSION

Nipple confusion happens when the baby is introduced to a pacifier or bottle too early in life. Bottles and pacifiers use different (and lazy) sucking patterns. When these sucking patterns are repeated at the breast, the result is PAIN. Lots and lots of pain. I had the misfortune of experiencing nipple confusion early in my breastfeeding career as a result of providing my husband with a bottle of pumped milk once a day, and the occasional use of a pacifier in the stroller or car seat.

The result of nipple confusion is painful. And the solution is simple: Get rid of all nipples except for yours. Tough it out if you can, or try nipple shields (which you will need to wean off of quickly) if you can’t. Consider using a supplemental nursing system, eyedropper or newborn cup feeding method if you “have” to supplement (see my post on low supply myths) rather than using a bottle. Sooth your baby with rocking, breastfeeding, singing, or infant massage rather than using artificial nipples.

PHYSICAL CAUSES (MOM’S)

Inverted nipples are where the nipple hides inside of the breast instead of sticking out, or where the nipple retracts in response to stimulus. This can be hard to deal with when breastfeeding. Some inverted nipples can be corrected without use of a breast shield, but sometimes a breast shield is necessary. (If anyone has suggestions for dealing with pain related to inverted nipples I’d love to hear them!) Seek out other women that have experience with nursing with inverted nipples, and contact a lactation consultant that has experience with inverted nipples. If your LC’s first suggestion is nipple shields or weaning to formula, seek a second and third opinion.

PHYSICAL CAUSES (BABY’S)

Some babies are born with conditions that make nursing more painful for mom. Many of these conditions work themselves out over time, but if you’re experiencing pain you should seek out the help of a lactation consultant and even your pediatrician.

One of the most common physical causes of nipple pain is a baby that is tongue tied. This is where the frenulum (the ridge of skin under your tongue) is attached to too much of the baby’s tongue, or is attached too tightly. This can cause your baby to latch on very poorly or not be able to latch at all.

Tongue tied babies can have their tongues “snipped” (where the frenulum is snipped to loosen the tongue) or they can have their frenulum gradually stretched to increase the mobility of their tongues. Discuss this with your pediatrician and lactation consultant to see if there’s the possiblity that your baby’s tongue is tied.

THRUSH

Thrush can manifest itself in quite a few ways. If you’re experiencing breast pain (particularly shooting jagged breast pain that feels like shards of glass), if your baby has white patches in his mouth that bleed when you scrape them, if you or your baby smell like bread, if you have yeast infection elsewhere on your body or are prone to them, contact your doctor and ask if you may have thrush.

There are a few different treatments for thrush. You may be prescribed a lotion or an oral medication, or your doctor may suggest something called Genetian Violet. No matter what treatment you end up taking, make sure you take plenty of probiotics. I always recommend buying something called “Baby Jarro-Dophilus”. This is an infant probiotic that is safe to use with very young babies. Simply dab some on your nipples and your baby will suck it off when she breastsfeeds. You can also sprinkle this in your bra, use it as a powder to treat a yeasty diaper rash (or even a vaginal yeast infection). Probiotics are also great for treating infant gas, some causes of colic and some causes of reflux- so there are plenty of upsides to giving it a try.

NOTE: I am not a lactation consultant, nurse, doctor, or medical professional. I am a nursing mom who has successfully made it to 19 months and am going strong. I have dealt with a variety of breast problems, and have helped others successfully overcome their problems.

Always consult with your doctor or lactation consultant to see if an internet diagnosis or recommendation is safe and effective before you try it.

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Other causes that I’m adding in (courtesy of jaycee)

On the topic of bad latches some causes can be ear infection, sore throat, teething, tongue tied, headache, irritated ear (such as wax buildup), preferance for other side, uncomfortable position or simply being too tired.

Other causes of pain can be breast infection (mastitis, clogged duct), pump setting too high (sometimes it doesn’t hurt AT ALL while pumping but later hurts really bad to nurse), uncomfortable bra material (same as with the pumping, might not hurt until you nurse), engorgement, mother being sick (even a cold can make the nipples sore for a few days, but it is usually very minor)