Our focus here is pain that is concentrated in your areola and/or nipple, with or without accompanying breast pain. Nipple pain is one of the primary reasons women quit breastfeeding, so let’s ease this pain ASAP by figuring out what is normal, what isn’t, and how to fix problems that arise. 

Normal

In the first few days of breastfeeding:

It is very common to have discomfort with breastfeeding that you may describe as “tender or sore” for the first ten days of breastfeeding. After seven to ten days, your nipples should be getting better, not worse.

When the baby first latches on, take a deep breath, because it can be intense. After about 30 seconds, you should describe the sensation as “pulling” or “tugging,” not “pinchy,” “biting,” or “excruciatingly painful.”

Your nipples may look a little pink or chafed with mild scabbing in the first week or two. 

You should find that using lanolin or a non-lanolin substitute such as Earth Mama Angel Baby Nipple Butter is soothing after feedings and helps your nipples feel ready for the next feeding. You may find Hydrogels kept in the refrigerator soothing as well. 

Not normal

If you describe nursing as “extremely painful,” “toe curling,” “excruciating,” or “very pinchy,” unlatch and try again. It is not normal to have moderate to severe pain for the entire feeding.

If your nipples are cracked, bleeding, or have open wounds, something is seriously wrong. It is not normal for breastfeeding to cause that level of damage to a mom’s skin.

If after a week your nipples are getting worse, not better, you need an intervention to stop and reverse this damage.

If lanolin or a non-lanolin substitute feels like it isn’t doing anything to help your nipples at all, you may need something stronger while you work on fixing whatever is causing your pain.

It is not normal to be completely pain free for days or weeks, then suddenly have pain. 

What’s going on?

There are a number possibilities:

  • Something isn’t right with your latch. This is especially true if pumping is less painful than directly latching. 
  • Early latch learning damaged your nipple tissue and it is taking time to heal. 
  • There is a possibility your baby has a dysfunctional suck or “tongue tie.”
  • If you are pumping, you may be using the wrong size flanges and causing nipple damage. 
  • You have a milk blister, also known as a bleb. If you have a sudden, sharp, needle-like pain in one nipple, take a look at it and see if you can see a small white spot on the face of your nipple.
  • Nipple yeast, also called thrush, feels like burning in both nipples before, during, and after breastfeeding. You will definitely feel this whether you are pumping or directly latching. You can have nipple yeast even if the baby doesn’t have signs of oral thrush. You can have nipple yeast even if your nipples look pretty normal. Sometimes yeast presents as bright pink, shiny, and/or flakey; sometimes it doesn’t. If you have yeast, air feels good to your nipples.
  • Raynaud’s Disorder, or vasospasm, often happens in both nipples at once and is typically described as needle-like pain, shards of glass, or burning. It often does not radiate up into your breasts, but rather stays very concentrated in the nipples. When you experience pain, the nipple undergoes biphasic color change. Your nipples turn white, then purple, then return to pink. The pain either subsides or changes to a throbbing sensation once your nipples return to pink. If you feel a searing pain in your nipple, quickly pull it out of your shirt and look at the color of your nipple (assuming you are in an appropriate place to do this; it might not be a great idea to do this while checking out at the grocery store). If you have vasospasms, exposure to air triggers the pain.

Note: It isn’t uncommon to have color change in your nipples during or after breastfeeding or pumping. The color change isn’t the problem; the pain is the problem. So, if you see your nipples turning purple and you have no pain at all, no worries! 

If you cannot get a comfortable latch:

  • Try a nipple shield.
  • Pump in place of breastfeeding to give your nipples a rest.
  • Up your nipple care game and ask for the prescription nipple cream All Purpose Nipple Ointment.
  • Consider the possibility that your boobs and/or nipples are getting new architecture. 

General nipple care

Everyone should use the following techniques: Express, Air, Lanolin 

  • Wash your hands before every breastfeeding session.
  • Express your own milk onto your nipples and let air dry.
  • Apply a pea-sized amount of lanolin or lanolin-free nipple cream. 
    • Warm the cream up in your fingers before applying for easier application. 

Care for sore but intact nipples (no cracks or bleeding): 

  • Use general nipple care: Express, Air, Lanolin
  • Seek the assistance of an International Board Certified Lactation Consultant (IBCLC) ASAP to fix the latch and rule out any other problems.
  • Ask your Midwife, OB, or IBCLC if All Purpose Nipple Ointment, a prescription strength nipple cream, is right for you. 
  • Allow nipples to be exposed to open air whenever possible if it feels good. If it is more painful to have them open to air, apply a clean breast pad and a well-fitting bra. 

Care for sore, cracked nipples:

If you have any open wounds on your nipples, follow these guidelines: 

  • Always wash your hands before touching your nipples!
  • After breastfeeding, cleanse nipples well with normal saline solution. 
    • The easiest way to do this is with infant saline nose drops. You can also make your own solution and drip it onto your nipples with a cotton ball.
    • To make your own saline solution, mix half a teaspoon of sea salt in eight ounces warm water. Dilute the salt well. This shouldn’t sting! If it stings, you used too much salt. Do not contaminate the solution by reintroducing a dirty cotton ball or dirty hands. Make a fresh batch daily.
    • After cleansing with saline, express your own milk onto your nipples and let air dry or pat dry with a clean piece of gauze or cotton ball.  
    • Apply All Purpose Nipple Ointment (prescribed by your healthcare provider) or lanolin.
    • Apply a clean breast pad (think of this as a clean bandage).

Healing your nipple pain

If you can’t bear the pain of breastfeeding anymore, you always have the option to pump in place of feeding. 

Seek help. Make an appointment with an International Board Certified Lactation Consultant if: 

  • You can’t get a comfortable latch.
  • You have open cracks or wounds on your nipples.
  • There are lumps in your breasts that aren’t softening even after multiple nursing sessions (this is probably plugged ducts).
  • Engorgement lasts for five or more days after the birth of your baby.

Call your Midwife or OB ASAP if:

  • You spike a fever of 100.4 or higher (this is probably mastitis).
  • You feel flu-like symptoms, chills, body aches (this is probably mastitis).
  • You have a very painful, red, warm lump in one or both of your breasts (this is probably plugged ducts)