Painful feeding is one of the most common reasons parents come to me, and one of the most fixable. In my experience the great majority of nipple pain comes down to a shallow latch, and putting that right often changes everything. Some tenderness in the very early days can be normal, but ongoing pain, whether in your nipples or in your breasts, is a sign that something needs adjusting. The good news is that it nearly always has a cause that can be found and put right. This guide is an overview of the common causes and where to read more.

Painful latch and sore nipples

Most nipple pain comes from a shallow latch. When your baby takes mostly the nipple rather than a deep mouthful of breast, the nipple gets rubbed and pinched. Improving positioning and attachment resolves the majority of nipple pain. Other causes include thrush and vasospasm. Read more in Latch and nipple pain. If your nipples are cracked or too sore to feed from, a nipple shield can sometimes help for a short time, used with guidance.

Engorgement and mastitis

When your milk comes in, your breasts can become very full, firm and tender, which is engorgement. If an area becomes hot, painful and swollen and you feel unwell, that can be mastitis. Current advice is gentle, using cold rather than heat, no vigorous massage, and first-line pain relief. Read more in Engorgement and mastitis.

Tongue tie

Sometimes painful feeding is linked to a tongue tie, where a tight piece of tissue under the tongue limits how your baby moves it. Tongue tie is often over-diagnosed, so it needs a proper assessment of how your baby feeds, not just how it looks. Read more in Tongue tie and breastfeeding.

Looking after sore nipples

While you get to the cause, caring for your skin matters too, from air drying to gentle products and changing breast pads often. Read more in Looking after yourself while breastfeeding.

Get help from your midwife, health visitor or an IBCLC if:

  • Pain is not improving after adjusting the latch and positioning.
  • Your nipples are cracked, bleeding or look infected.
  • You have a hot, painful area on your breast, or feel unwell. It may or may not look red, depending on your skin tone.
  • You are dreading feeds, or thinking about stopping because of the pain.

How a consultation helps

Painful feeding almost always has a cause that can be found and put right, and a consultation is the quickest way there. I watch a full feed and see exactly what is happening for you and your baby, check the latch and how your baby is taking the breast, and look for the specific cause of your pain, whether that is positioning, tongue tie, thrush or something else. You leave with the pain understood and a clear plan to ease it.