Latch and nipple pain, why breastfeeding hurts and how to ease it

Sore nipples are one of the things I am asked about most, and I always start with the same reassurance: breastfeeding should not hurt, and when it does there is nearly always a fixable reason. A little tenderness as your baby latches in the first few days can be normal and usually settles quickly, but ongoing pain, or cracked, bleeding or misshapen nipples, is a sign that something needs adjusting. The good news is that it can nearly always be improved.

Is some pain normal?

Brief tenderness at the moment your baby latches, in the first days, is common as you both learn, and it should ease within the first week or so. Pain is not something to simply put up with if:

• It continues right through the feed.
• Your nipples are cracked, grazed or bleeding.
• Your nipple looks flattened, pinched or lipstick shaped when your baby comes off.
• Your nipple looks blanched after a feed, paler than its usual colour.

The most common cause is the latch

Most nipple pain comes from a shallow latch, where your baby takes mostly the nipple rather than a good mouthful of breast. With a deeper latch, the nipple is drawn right to the back of the mouth, to where the roof of the mouth becomes soft, near the join of the hard and soft palate. There it is cushioned and out of harm's way, rather than being pressed and rubbed against the hard palate at the front.

With a comfortable, deeper latch:

• Your baby has a wide open mouth with lips turned outward.
• More of the areola is covered below the nipple than above.
• Your baby's chin touches the breast and their nose is free.
• Feeding feels like a drawing or pulling sensation, not a pinch or a bite.

Improving the latch

• Hold your baby tummy to you, with their head, neck and back in a line, and their nose level with your nipple.
• Wait for a wide open mouth before bringing your baby on, aiming your nipple towards the roof of their mouth.
• Bring your baby to the breast rather than leaning your breast towards them.
• Try different positions, such as laid back feeding, the cross cradle hold, or the rugby hold, to find what works for you both.
• If a feed is hurting, gently break the suction with a clean finger, take your baby off, and try again. A better latch is worth the pause.

Other causes of nipple pain

• Tongue tie. A restriction under the tongue can stop your baby latching deeply and moving milk well, which keeps feeds painful. See Tongue tie and breastfeeding.
• Thrush. A burning or itching pain in both breasts, often after a spell of comfortable feeding, can be thrush. It usually needs treatment for both you and your baby, so see your GP.
• Vasospasm. If your nipple loses its colour and then turns dusky or flushed after feeds, with a stabbing or burning pain, this can be vasospasm, which is worse in the cold. Keeping warm helps, and it is worth getting it checked.

Caring for sore or cracked nipples

• After a feed, smooth a little of your own expressed breast milk over the nipple and let it air dry.
• Keep the area clean and dry, and change breast pads often.
• A purified lanolin can help with healing.
• Paracetamol and ibuprofen can ease the pain and are usually compatible with breastfeeding.
• If a nipple is too painful to feed from, you can express from that side for a short time to rest it while it heals, and give the milk to your baby. A nipple shield can occasionally help here too, used with guidance.

How a consultation helps

Painful feeding almost always has a cause that can be found and fixed, and watching a feed is the quickest way to find it. When I see you I watch a full feed from start to finish and see exactly what is happening for you and your baby, adjusting the latch and positioning in the moment so you can feel the difference. If the pain is coming from thrush, vasospasm or a tongue tie rather than the latch, I will spot it and point you to the right treatment.