Key takeaways: Mild tenderness at the start of feeds in the first week is common. Ongoing pain, cracks, bleeding, or blisters usually point to a latch problem, which is fixable. Fix the cause first, then use your own milk, purified lanolin, or a gel pad to help healing.
“Breastfeeding shouldn’t hurt” is a common saying, but many parents feel some tenderness in the first days. The key is knowing the difference between normal early sensitivity and pain that needs attention.
What’s Normal
In the first few days, many people feel:
- A strong tug or brief tenderness for the first 30 to 60 seconds of a feed, easing once milk flows.
- Some general nipple sensitivity that improves by the end of the first week or two.
What Isn’t Normal
- Pain that lasts throughout the feed.
- Pain that gets worse instead of better over days.
- Cracked, bleeding, blistered, or scabbed nipples.
- Nipples that come out of your baby’s mouth flattened, creased, pinched, or white.
- Burning or shooting pain during or after feeds.
Common Causes
- Shallow latch: the most common cause. The nipple is compressed near the front of the baby’s mouth instead of reaching the back.
- Positioning: baby’s body turned away, head too flexed, or pulling down on the breast.
- Engorgement: a firm areola makes it hard to latch deeply.
- Breaking suction incorrectly: pulling your baby off without breaking the seal first.
- Pump problems: a flange that’s too small or suction set too high.
- Infant oral factors: tongue-tie, a high palate, or a weak suck.
- Vasospasm: blanching (whitening) of the nipple after feeds with burning or throbbing pain, often worse with cold. Warmth helps.
- Infection: bacterial infection of a cracked nipple, or less commonly yeast.
- Skin conditions: eczema or dermatitis.
- Milk blisters (blebs): a small white or yellow dot on the nipple tip, sometimes painful.
Healing Sore Nipples
1. Fix the latch first.
Healing is slow if the cause continues. Try a deeper latch: wait for a wide gape, bring baby in chin first, and keep them close. Different positions, like laid-back or football hold, can shift pressure to new areas.
2. Break the seal gently.
Slide a clean finger into the corner of your baby’s mouth before removing them from the breast.
3. Start on the less sore side.
Letdown may already have happened by the time you switch.
4. Soothing care.
- A few drops of expressed breast milk on the nipple after feeds, allowed to air-dry.
- Purified lanolin or another nipple ointment, if you find it helpful.
- Hydrogel pads, which some find soothing.
- Clean water rinses for cracked skin. Avoid soap and alcohol on the nipples.
- Breathable bras and frequent nursing-pad changes.
Studies of different nipple treatments show no single product is clearly best. The most important treatment is correcting the cause.
5. Pain relief.
Acetaminophen or ibuprofen are compatible with breastfeeding. Ask your provider about the right dose.
6. Pumping temporarily.
If feeding is too painful, pumping (with a well-fitted flange) or hand expressing for a day or two can let nipples heal while protecting your supply. Feed your baby the expressed milk.
Nipple Shields
A nipple shield can help in some situations, such as flat nipples or a premature baby, but it doesn’t fix the underlying cause of pain and may reduce milk transfer for some babies. Use one with help from a lactation consultant.
Call your provider if: you have signs of infection (increasing redness, pus, a cracked area that won’t heal, or fever), a red, painful area on the breast, or shooting or burning pain that doesn’t improve. Call your baby’s doctor if: your baby isn’t producing enough wet or dirty diapers, has poor weight gain, or has white patches in the mouth that don’t wipe away.
When to Get Help
See a lactation consultant (IBCLC) if pain lasts beyond the first week, gets worse, or your nipples are damaged. They can observe a feed, assess your baby’s mouth and suck, check your pump fit, and help you make a plan.
The Bottom Line
A little tenderness at the start of feeds early on can be normal. Ongoing pain or damage is a signal, not something to push through. Fix the latch, care for the skin gently, and get help early.
For more breastfeeding tips, see my book, From First Breath to First Birthday.
Sources
- Dennis CL, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database Syst Rev. 2014;(12):CD007366.
- Berens P, Eglash A, Malloy M, Steube AM; Academy of Breastfeeding Medicine. ABM Clinical Protocol #26: Persistent pain with breastfeeding. Breastfeed Med. 2016;11(2):46-53.
- Mitchell KB, Johnson HM, Rodríguez JM, et al; Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine Clinical Protocol #36: The mastitis spectrum, revised 2022. Breastfeed Med. 2022;17(5):360-376.
- Meek JY, Noble L; Section on Breastfeeding. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2022;150(1):e2022057988.
- Drugs and Lactation Database (LactMed). National Institute of Child Health and Human Development. https://www.ncbi.nlm.nih.gov/books/NBK501922/
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
