Sore nipples while breastfeeding: causes and treatment

Sore nipples or nipple pain from breastfeeding is extremely common, especially in the early days, when you and your new baby are getting to know one another and starting out on your breastfeeding journey together¹.

If nipple pain is something you’re experiencing, breastfeeding might be the last thing you feel like doing. However, rest assured that sore nipples are easy to explain and treat, usually by adjusting your breastfeeding position¹. With a little help and support around the causes and treatment, there’s no reason why your breastfeeding journey can’t continue.

From learning to latch and breastfeeding positions to answering some frequently asked questions, let’s look at what could be causing sore nipples while breastfeeding and how you can treat them.

Nipple sensitivity or soreness is most common during the first week of starting to breastfeed. It usually happens because you and your baby are still getting the hang of things, and your baby isn’t quite latching on effectively¹.

When your baby is latched onto your breast properly, your nipple will rest at the back of their mouth against the soft palate.

If your baby isn’t attached properly, your nipple will be further toward the front of their mouth, where it can be pinched against the hard palate, leading to sore or cracked nipples².

If your baby is struggling to latch and your nipples are becoming sore, it’s always best to seek support from your healthcare professional or breastfeeding specialist sooner rather than later. They’ll be able to help you find a position that works for you and your baby, so that you can keep up your breast milk supply and continue breastfeeding².

Inverted nipples fold inwards instead of protruding out. Sometimes, your nipples can become inverted when breastfeeding as your milk ducts change shape³.

You can usually still breastfeed with inverted nipples, but they can make it a little harder for your baby to latch onto your breast properly. This can cause your nipples to crack and become sore⁴.

Tongue tie is a condition where the small bit of tissue that connects your baby’s tongue to the bottom of their mouth is shorter than usual⁵.

Some babies with tongue tie have no trouble breastfeeding, whereas others may find it harder to latch on and take longer to feed. If that’s the case, they may need a little extra support to help them get enough milk, feed efficiently, and prevent you from having to deal with painful or cracked nipples⁵.

It might be that your healthcare professional recommends a simple surgical procedure to cut the piece of skin between your baby’s tongue and the bottom of their mouth. For most babies, this helps them to feed better⁶.

If your baby isn’t properly latched on and the duct isn’t drained during feeds, you might experience a blocked milk duct, as well as sore nipples as a result of your baby’s efforts to nurse.

If the duct isn’t relieved, it can become inflamed and lead to mastitis, which can cause breast pain and flu-like symptoms⁷.

If you think you have mastitis, try to continue breastfeeding from the affected breast. You can try applying a cloth soaked in warm water or having a warm shower or bath to help the milk flow. If the soreness and other symptoms persist for 12–24 hours, contact your GP⁷.

If your breasts become too full of milk, they can feel hard and tight, and you might have sore breasts while nursing⁸. This can lead to your nipples becoming flattened, stretched and sore⁷.

Like many causes of soreness while breastfeeding, breast engorgement is most common when you first start nursing and your milk supply is balancing out to match your baby’s feeding needs. It can also happen when your baby is older and you’re not breastfeeding as often (because they’re starting to eat solid foods, for example)⁸.

Soreness from breast engorgement usually settles down on its own after a few days as your milk supply evens out⁸.

Sometimes, irritated nipples when breastfeeding can be caused by a thrush infection in your breast. Thrush is caused by a fungus that likes to grow in environments that are warm, dark and moist, which is why it can grow on your nipple when breastfeeding⁹.

Signs of thrush include⁹:

• A burning nipple pain after breastfeeding
• Sensitive, itchy or irritated nipples
• Shiny, flaky or red nipples
• Small blisters or white patches around your nipple or areola
• A loss of colour in your nipple

If you think you might have thrush, it’s important to seek advice from your GP. They’ll be able to prescribe a treatment such as an antifungal cream to prevent the thrush from coming back⁹.

Also known as a ‘bleb’, a milk blister looks a little like a white spot on your nipple and usually occurs in the early days of breastfeeding. They usually get better without treatment, but if they’re causing nipple pain, speak with your GP or midwife for advice¹⁰.

Don’t be tempted to apply creams or ointments, as this can irritate the blister and make it worse. In addition, don’t pop the blister, as this can lead to it becoming infected¹⁰.

Perhaps one of the lesser-known causes of sore nipples is a condition known as vasospasm. This happens because of pressure between your baby’s soft palate and tongue, leading to poor circulation to the nipple¹⁰. 

Symptoms of vasospasm include¹⁰:

• Throbbing or burning after breastfeeding 
• Your nipple has a white tip after breastfeeding
• A flatted or ‘squashed’ nipple

If you’re experiencing any of the above symptoms, speak with your GP or midwife. 

Irritated or sore nipples can make breastfeeding painful. Luckily, there are some simple things you can do to ease and prevent nipple pain so you can continue breastfeeding.

Breastfeeding positions to try include¹¹:

• Cradle hold: Sit in a comfy chair and lie your baby across your lap facing your body
• Lying on your side: Lie your baby down next to you so you’re tummy-to-tummy
• Lying back: Lie in a reclined position with your baby on your front
• Rugby hold: Sit in a chair with a pillow and lie your baby at your side

When you’ve found a comfortable breastfeeding position, help your baby latch on securely by¹²:

• Holding them close with their nose in line with your nipple
• Allowing their head to tilt back so their top lip brushes against your nipple and their mouth opens wide
• Bringing your baby to your breast (not the other way around)

If your baby’s latched on properly, you should see more of your areola above their top lip than below their bottom lip, and their cheeks should look full and round¹².

Try these steps to soothe nipple pain from breastfeeding^1, 2:

• If you’re using breast pads, change them after every feed
• After nursing, let your nipples dry fully before you get dressed
• Wear cotton bras without an underwire to help air circulate
• Dab a little expressed milk onto cracked nipples after feeds
• Use a lanolin-based cream to help with moist healing if advised by your GP, which is something that worked for Sebastian’s mum: ‘Lanolin cream was a breastfeeding staple! Not only did it soothe my sore and cracked nipples, it doubled up as a really great lip balm too - I’m still using it for that now!’¹³

To soothe and heal nipple pain, try to avoid^1, 2:

• Nipple shields or breast shells, which are unlikely to help your baby latch on
• Using soap on your nipples to prevent dryness
• Stopping or shortening feeds, as this can reduce your milk supply (if you’re in too much pain to breastfeed, try expressing your milk by hand)

A burning feeling in your nipples after breastfeeding could be a symptom of thrush⁹. Your GP can prescribe a cream or tablet to clear up thrush and prevent it from returning.

If you’re in pain during breastfeeding, it might be that your baby isn’t latched on properly. Try changing positions and letting your baby attach again¹.

Nipple pain is usually nothing to worry about and often solves itself as you and your baby get used to breastfeeding¹.

That being said, it’s always a good idea to speak to your GP, midwife or health visitor about nipple pain from breastfeeding. They can help rule out infections like thrush and support you in relieving and preventing nipple pain².

When your milk is ‘let down’ at the beginning of a feed, you might feel a strong tingling sensation, but breastfeeding shouldn’t be painful¹⁴.

If latching is causing nipple pain when breastfeeding, this is likely because your baby isn’t latched on properly. Try letting them latch on again or switching positions to help them attach more securely¹.