Breastfeeding pain: sore nipples, full breasts and mastitis

Breastfeeding can be uncomfortable in the first days, but pain at every feed is not something to put up with. Most of the time the cause is simple and a little help fixes it.

Sore nipples

The most common cause is how your baby attaches to the breast. When they take only the nipple, it gets squeezed against the roof of their mouth and damaged. After a feed the nipple looks flattened, wedge-shaped or white, and your baby is often still unsettled.

• Ask a midwife or breastfeeding counsellor to watch you feed. Until the attachment is fixed, no cream will solve it.
• Change breast pads at every feed and wear a bra without underwire that does not dig in.
• After a feed, dab a little of your own milk on the nipple and let it dry.
• Use nipple shields only on advice, as they can make attachment harder.

We explain what good attachment looks like in breastfeeding: the first days.

Overfull breasts

Your breasts feel hard, tight and painful, and the nipple can flatten so much that your baby struggles to latch.

• Feed often.
• Before a feed, a warm cloth or a warm shower helps the milk flow.
• Hand express only enough to feel comfortable. Expressing more makes your breasts produce more.
• Between feeds, a cold compress eases the pain.

A small, tender lump

This is usually a blocked milk duct. Keep feeding from that breast, gently massage the lump towards the nipple while you feed and avoid tight clothes. Do not leave it, as it can turn into mastitis.

Mastitis

Mastitis is inflammation of the breast, usually from milk building up. The signs are:

• a swollen, hot, painful area on one breast, sometimes red (redness is harder to see on darker skin)
• a lump or hard area
• burning pain, all the time or only while feeding
• flu-like feelings: aches, a temperature, shivers, tiredness

“My breast caught a chill”

In many families breast pain is blamed on cold air or a draught, and compresses with raki or alcohol are suggested. Mastitis does not come from the cold: it comes mostly from milk that is not flowing well, damaged nipples or tight clothes. Alcohol irritates the skin on the breast and should not reach your baby. What really helps is frequent feeding and help with attachment.

When to see a doctor

• if you do not feel better 12 to 24 hours after starting these steps
• if you feel worse at any point
• if you have a high temperature or feel very unwell
• if nipple or breast pain does not go away

Your doctor may give you an antibiotic. Very little of it passes into breast milk and it is not a risk to your baby, though it may make them a little more unsettled. Breastfeeding carries on.

Sources we consulted

• NHS: Sore or cracked nipples when breastfeeding
• NHS: Breast pain and breastfeeding
• NHS: Mastitis

Written by the mam.al editors as general information. It does not replace advice from your doctor or midwife. Contains public sector information licensed under the Open Government Licence v3.0.