Pain in your nipples or breasts whilst breastfeeding is most often linked to how you are holding your baby and bringing them to your breast (often referred to as positioning and attachment). Before considering other reasons for experiencing pain whilst breastfeeding please use our guide to positioning and attachment to rule this out as a cause of pain. You may find that you need to seek help from a skilled breastfeeding supporter with this, as however much theory you read, there is no substitute for having someone with training and experience help you. Even if there is another medical basis for your pain, getting positioning and attachment as comfortable as possible will still help.
When you first start breastfeeding, it is common to experience a strong and sometimes uncomfortable sensation for the first few seconds of your baby latching on. However, this should pass quickly, and feeding should become comfortable. If this doesn’t happen, trying some small changes to your positioning and attachment could help make feeding more comfortable for you.
Signs that attachment is not as effective as it could be include:
- If the pain is worst at the start of a feed, and continues for more than a few seconds
- If your baby slurps onto nipple rather than attaching with open gape
If positioning and attachment isn’t optimal, your nipple can be compressed in your baby’s mouth, which can restrict the blood flow or damage your nipple. Signs that this is happening include:
- Your nipple changes shape after breastfeeding – it could be lipstick shaped, ridged or flattened.
- Your nipple changes colour after breastfeeding – you might see a white tip to your nipple, which is a sign that the blood flow has been restricted, although this may not be visible on darker skin tones. This is sometimes referred to as vasospasm. There is more information on this below.
- Your nipple is cracked or bleeding.
If your pain is not improved after trying some of the ideas in our guide on positioning and attachment, please seek support from a breastfeeding supporter. They can observe and assess a full feed. Your midwife or health visitor should be able to tell you what support is available in your area. You can also find a local support group here or contact the National Breastfeeding Helpline.
If your nipple is damaged, use moist wound healing within the wound (avoid applying cream to whole nipple) to stop a scab forming, which will deepen the wound. You can read more about moist wound healing in our factsheet. You can continue to breastfeed on a damaged nipple as it will still be able to heal, but it is very important to get support with positioning and attachment to prevent further damage occurring.
If a breastfeeding practitioner has helped you adjust your positioning and attachment and you still have pain or nipple damage, your baby may need to have their oral function assessed, including an examination for possible tongue tie or other issues that might be making breastfeeding harder.
Other causes of pain in breastfeeding:
Strong let-down
If the pain is strongest at start of feed or just before a feed and there is a sharp intense pain in your breast(s), often described as squeezing pain, this can be due to the let down or milk ejection reflex. Pain can be worse on a fuller breast.
If it is associated with leaking milk, you can reduce this by applying firm hand pressure to your breast at the time of leaking.
If your baby also makes a clicking noise during feeds or pulls away choking once the feed has started, the fast flow of milk may mean your baby is struggling to attach well. Further support from a skilled breastfeeding practitioner to improve attachment may be useful.
You may find it helpful to express a small amount of milk just before a feed if your breasts are full, to get past the powerful let-down before starting the feed, or to use a laid-back breastfeeding position, so that the milk flow is less overwhelming for your baby.
Engorgement
If your breasts are painfully hard and full, and feeding or expressing milk relieves this sensation, your breasts may be engorged. This may be worst first thing in the morning, especially if you have not fed frequently through the night. You can avoid engorgement by feeding frequently and responsively, including at nighttime. Consider offering your baby a feed whenever your breasts start to feel full or uncomfortable. If you are unable to feed at that time, or if your baby refuses a feed, you can express just enough milk to relieve the discomfort. Avoid expressing more milk than necessary, as this could trigger an increase in your milk supply and make the engorgement worse. Allowing your breasts to remain engorged could lead to your breasts becoming inflamed (mastitis), or a reduction in your milk supply, so it is best to avoid this whenever possible.
If you find it hard to latch your baby on when your breasts become very full, you can express a little milk first to soften them. You may also like to try reverse pressure softening. Reverse pressure softening is a way to soften your areola. It can help make latching and removing milk easier when your areola is very swollen and engorged by temporarily relieving firmness and swelling.
It can be particularly helpful if you have some oedema or swelling due to IV fluids or drugs given during labour and birth, especially if you had a caesarean section. Breast engorgement in the early days can be caused by your milk coming in or by a combination of fluid held in the breast tissue around the milk ducts as well as by milk within the breast.
Reverse pressure softening briefly moves mild or firmer swelling away from under your areola, slightly backward into your breast for a short period of 5-10 minutes. This allows your areola to change shape and makes latching easier as your baby is able to get more of your areola and breast tissue into their mouth.
Reverse pressure softening also causes a ‘let-down’ reflex, making it easier for your baby to get milk or for you to remove milk by hand expressing or expressing with a breast pump.
Reverse pressure softening should not be used if you have mastitis, compressed ducts or a breast abscess.
How to do reverse pressure softening:
The key is to make your areola very soft right around the base of the nipple. This can make it easier for your baby to get a better latch.
- Press gently on the edge of your areola, inward towards your chest wall, counting slowly to 50
- Once the areola has softened, you can start to feed your baby or express (by hand or using a breast pump on low to medium pressure)
- If you have very swollen breasts, doing reverse pressure softening lying on your back (taking advantage of gravity) will give more relief
- Soften your areola right before each feeding (or expressing) until the swelling goes away. This takes two to four days or more
Expressing milk
If your nipple is sore or damaged and you are using a breast pump rather than feeding directly, you may need to reduce the strength of the suction on your pump or you may be using a flange that is the wrong size. Speak to your health visitor, midwife or breastfeeding practitioner to get support with expressing your milk if needed.
Eczema or dermatitis
Dermatitis is irritation of the skin. It may appear as redness (on paler skin tones) or discolouration, itching or soreness, flaking, cracking, scaling or crusting of the nipple, areola or surrounding skin. It can be very uncomfortable, itchy or even painful. Some people are more prone than others to developing dermatitis, and if there isn’t an identifiable cause, it is often referred to as atopic dermatitis, or eczema. Dermatitis can sometimes be caused by something your breast is in contact with, which could be irritating it or triggering an allergic reaction (allergic/contact dermatitis). This could be a nipple cream or lotion, soap or body wash, breast pads, cups or shells, clothing or a damp environment. To relieve dermatitis, you can try
- eliminating any possible irritants
- keeping your nipples and breasts dry
- avoiding getting too hot or too cold
- wearing loose cotton clothing
- using an emollient for washing and moisturising. One that states it is suitable for use on the face may be best.
- change breast pads frequently. If disposable breast pads are causing irritation, you could try washable ones, or vice versa.
If the irritation continues, a steroid cream may help. You can speak to your doctor or pharmacist about this. See our factsheet on eczema for more information.
Vasospasm and Raynaud’s Phenomenon
Vasospasm occurs when the blood supply temporarily stops flowing properly to the end of your nipple. This can be caused by your baby squashing your nipple between their tongue and the roof of their mouth. It may also be a symptom of Raynaud’s phenomenon, which happens when your blood stops flowing to your fingers and toes.
If the pain is worst at the end of or after a feed or your nipple is white at the tip or changes colour rapidly after breastfeeds (white to purple then red, although this does not always happen and might not be visible on all skin tones), you may be experiencing vasospasm.
The pain may be isolated in your nipple, but as there are lots of nerves in your breast tissue, it can also radiate out into your breast and can last for as long as 30 minutes. Vasospasm can occur in one or both breasts.
If vasospasm is caused by nipple compression, the best treatment is help with positioning and attachment from a specialist breastfeeding practitioner. You can ask your midwife or health visitor about support available in your area. You can also contact the National Breastfeeding Helpline.
If you are still experiencing episodes of vasospasm after optimising your positioning and attachment, or if you have a history of circulation problems or migraine, if your pain is worse at night, or if your pain is triggered or made worse by cold, you may be experiencing Raynaud’s Phenomenon. Pain can be immediately after a feed but may also be delayed or can be triggered by cold even when you are not feeding.
You may be able to improve your symptoms by keeping your breasts warm, avoiding breastfeeding in cold places, covering your nipple as soon as a feed is finished and applying warmth after feeds. You could try heating pads or reusable heated products such as microwaveable rice packs or hand warmers. However, take care with these and do not apply them directly to your skin due to risk of burns. Minimising stress (if possible) and reducing your caffeine consumption may also help.
Some medications can cause or worsen Raynaud’s phenomenon. If you are unsure about the side effects of your medications, check the patient information leaflet or speak to your local pharmacist. For information on the compatibility with breastfeeding of suitable alternatives that you may be prescribed, you can contact the Drugs in Breastmilk team.
If these measures are not effective, there are some medications your GP can prescribe that may help. You can find more detail on this in our Raynaud’s phenomenon factsheet, and this NHS Information page.
A white spot, bleb or blocked nipple pore.
If pain is worst at the end of or after a feed and you can point to a discrete spot (which may be white, yellow or pale pink) on your nipple as the origin of the pain, this is likely to be due to a white spot, also called a bleb, blocked nipple pore or milk blister. Symptoms may return periodically.
Blebs are thought to be a surface presentation of underlying inflammation, so they are best treated with anti-inflammatory measures. They may also be caused by pressure or rubbing whilst you are feeding, so it’s a good idea to get support with positioning and attachment.
You can continue to feed with a bleb, and feeding may help it to clear spontaneously. If you are in pain, you can take pain relief, such as paracetamol or ibuprofen (see our factsheet on pain relief for more information). You could also try a warm or cool compress after feeding. If the bleb does not clear, speak to a healthcare professional. They may be able to prescribe a steroid cream that could help. For information on using steriod creams whilst breastfeeding, see our factsheets on eczema and creams and ointments.
Some sources suggest that having a healthcare professional de-roof (take the top layer of skin off) your bleb or blister with a sterile needle can provide relief, as milk that has accumulated behind it can be released. However, others say that this is unnecessary and could cause further inflammation. It is not recommended that you attempt to de-roof a bleb yourself, with a needle or by picking, squeezing or rubbing it, as this could make it worse or allow infection in. If you do have your bleb de-roofed by a healthcare professional, feeding frequently from that breast afterwards may help stop it forming again.
Compresssed ducts and Mastitis
If there is a sore, lumpy area on your breast that may also feel hot and can appear discoloured or red on lighter skin tones, you may have compressed ducts or mastitis.
Compressed ducts occur when engorgement, localised swelling or pressure on your breast squashes the many tiny tubes, or ducts, that your milk passes through, stopping your milk from flowing freely in an area of your breast.
If not addressed, compressed ducts can progress to mastitis. Mastitis is an inflammation of the breast. It may be accompanied by flu-like symptoms. If you have mastitis, continue to feed responsively and seek support from a specialist breastfeeding practitioner as soon as possible. Compressed ducts or mastitis may be triggered by feeding infrequently, allowing your breasts to become overfull or other situations that increase pressure on your breast, for example, wearing a bra that is too tight or wearing your baby in a sling for longer than usual. Adjusting the way you hold your baby and bring them to your breast when feeding (positioning and attachment) may also help.
You can take paracetamol, and ibuprofen if appropriate (see our factsheet on pain relief for more information), for pain or fever. Applying a cold compress may also help reduce pain and swelling. You will not usually need antibiotics if you start self-help measures quickly, but you should see a doctor if your symptoms persist. You can visit our mastitis page for more detailed information.
Abscess
An abscess is a rare complication of mastitis. You might want to consider whether you have an abscess if a breast lump or mastitis has not resolved following frequent, effective feeding and a course of antibiotics or if the skin on your breast looks like orange peel. A milk sample should be taken to find out which micro-organism is involved in the infection and decide which antibiotic might be most effective. An ultrasound investigation is required to diagnose an abscess. Drainage of pus by needle aspiration or surgical drainage together with appropriate antibiotic might be offered. You may benefit from emotional support from a breastfeeding supporter alongside specialist support from medical staff.
Thrush
In line with up-to-date research and guidance, our information on thrush (candida) of the nipple or breast has been withdrawn. It has been common for thrush of the nipple or breast to be diagnosed as a cause of breast pain, and for an antifungal medication to be prescribed. However, more recent research suggests that breast thrush is much less common than previously thought, and some researchers believe it may never be a valid diagnosis. You can read more about this in our blog post.
If you are still experiencing breast pain after reading all the information above and excluding other possible causes, we recommend that you seek face-to-face support from a specialist breastfeeding practitioner. You can find details of our local support groups here. If you are unable to access face-to-face support, you can contact the National Breastfeeding Helpline on 0300 100 0212 or via webchat for information and support.
If you have a query relating to taking medication whilst breastfeeding, please contact the Drugs in Breastmilk team by email or on their Facebook page.
If you have a general question related to the withdrawal of our information on breast thrush that does not require an urgent response, you can contact admin@breastfeedingnetwork.org.uk.
Page last updated January 2025