Quick Answer
Some nipple tenderness in the first days of breastfeeding is common as the nipples adapt to frequent feeding. However, significant or persistent nipple pain is not a normal or inevitable part of breastfeeding and should not be accepted as such. In the majority of cases it has an identifiable cause and a solution. The most common cause by far is a shallow or incorrect latch, and correcting the latch resolves the pain in most cases. Other causes include tongue tie, thrush, vasospasm, and skin conditions. This guide covers the main causes of nipple pain, how to identify which is most likely, and what to do about each.
Normal vs. Abnormal Nipple Discomfort
A brief period of tenderness when the baby first latches at the start of a feed is considered within the normal range in the early days and weeks, particularly during the initial latch-on phase (the first 10 to 30 seconds of feeding). This tenderness typically reduces as the feed progresses and should not be present throughout the feed. It usually resolves by 2 to 4 weeks as the nipples adapt.
The following are not normal and warrant assessment and intervention:
- Pain that persists or worsens throughout the feed
- Pain that is present between feeds or when nothing is touching the nipple
- Cracked, bleeding, blistered, or visibly damaged nipple tissue
- Nipple pain that is not improving after 2 weeks of breastfeeding despite technique adjustments
- Burning, shooting, or deep breast pain during or after feeding
The Most Common Cause: Shallow Latch
A shallow latch occurs when the baby takes only the nipple into the mouth rather than a large mouthful of breast tissue including the nipple and a significant portion of the areola. When the nipple is compressed against the hard palate rather than drawn back to the soft palate, the result is significant friction and compression pain during every feed.
Signs of a shallow latch include:
- Pain that continues throughout the feed rather than easing after the first few seconds
- The nipple emerging from the baby's mouth compressed, lipstick-shaped, or creased rather than rounded
- A clicking or smacking sound during feeding, which indicates the baby is losing suction and reattaching repeatedly
- The baby appearing to chew rather than draw back and suckle rhythmically
To improve latch depth:
- Wait for the baby to open their mouth very wide (a wide gape) before bringing them to the breast, rather than pushing the breast toward a partially open mouth
- Aim the nipple toward the roof of the baby's mouth so it enters the mouth from below, encouraging a deeper, more asymmetric latch
- Ensure the baby's lower lip is flanged outward and their chin is pressed into the breast
- If the latch is painful from the beginning and does not ease, break suction by inserting a clean finger into the corner of the baby's mouth and relatch rather than continuing a painful feed
A lactation consultant (IBCLC) can assess latch in real time and provide specific guidance that is difficult to fully replicate from written instructions. If latch correction at home is not resolving the pain within a few days, seeking an in-person assessment is the most effective next step.
Tongue Tie
A tongue tie (ankyloglossia) occurs when the frenulum (the band of tissue connecting the underside of the tongue to the floor of the mouth) is short, tight, or positioned in a way that restricts the tongue's range of motion. Because effective breastfeeding requires the tongue to extend forward over the lower gum and cup and draw the breast in with a wave-like motion, a restricted tongue can prevent the baby from achieving a deep enough latch and maintaining suction effectively.
Signs that tongue tie may be contributing to nipple pain include:
- Latch correction alone does not resolve the pain despite consistent effort
- The baby appears to have a restricted tongue movement (unable to extend the tongue beyond the lower gum, or the tongue tip appears heart-shaped when lifted)
- The baby makes clicking sounds, struggles to maintain suction, tires quickly at the breast, or is gaining weight poorly
- Nipple damage is consistent and significant despite technique adjustments
Tongue tie assessment and treatment (frenotomy, a simple division of the frenulum) should be performed by a qualified practitioner. Assessment by a lactation consultant alongside a tongue tie practitioner gives the most comprehensive picture. Frenotomy is a brief procedure and most parents notice an improvement in feeding within days, though some babies require follow-up support to learn to use their tongue differently after the procedure.
Thrush (Candida Infection)
Breastfeeding-related thrush is a candida (fungal) infection that can affect the nipples and breast tissue, often occurring after a course of antibiotics or in the presence of other thrush risk factors (nipple damage, a baby with oral thrush). Thrush-related nipple pain has a distinct character that differentiates it from latch-related pain:
- Burning, itching, or stinging pain that continues between feeds and is not confined to the latch-on phase
- Deep, shooting breast pain during or after feeding
- Shiny, flaky, or pink nipple skin (though not always present)
- A baby with white patches in the mouth that do not wipe off (oral thrush)
Thrush requires antifungal treatment for both the breastfeeding parent and the baby simultaneously, even if only one is showing symptoms, to prevent reinfection. Contact your healthcare provider for appropriate treatment. Thrush does not resolve on its own without antifungal treatment.
Vasospasm (Raynaud's Phenomenon of the Nipple)
Vasospasm occurs when blood vessels in the nipple go into spasm in response to cold, pressure, or the end of a feed, causing the nipple to temporarily lose blood supply. It presents as a distinctive colour change: the nipple typically turns white (blanching) immediately after a feed or on exposure to cold, then progresses through blue to red as blood flow returns, accompanied by burning or throbbing pain at each phase.
Vasospasm is more common in people with a history of Raynaud's phenomenon elsewhere in the body. Management strategies include:
- Keeping the nipple warm immediately after feeding: covering immediately, using a warm compress, or cupping the breast with a warm hand as soon as the baby unlatches
- Avoiding cold exposure after feeds
- Ensuring the latch is as deep as possible to minimise compression, which can trigger spasm
- In persistent or severe cases, medication (typically nifedipine, a calcium channel blocker) is effective and can be prescribed by a healthcare provider
Skin Conditions Affecting the Nipple
Less commonly, nipple pain is caused by or worsened by a skin condition rather than feeding technique or infection:
- Eczema or dermatitis: Can affect the nipple and areola, causing itching, flaking, and discomfort. Treatment with an appropriate topical preparation under healthcare provider guidance is needed; do not apply over-the-counter corticosteroids to the nipple without medical advice while breastfeeding
- Psoriasis: Can affect the nipple area; requires healthcare provider assessment and treatment
- Bacterial infection (impetigo or secondary infection of a cracked nipple): Cracked or damaged nipples can become secondarily infected with bacteria, causing increased pain, redness, crusting, and discharge. Antibiotic treatment is required
Supporting Healing Between Feeds
While addressing the underlying cause of nipple pain, the following support healing of damaged nipple tissue:
- Applying a small amount of expressed breast milk to the nipple after each feed and allowing it to air dry; breast milk has antimicrobial properties and supports skin healing
- Medical-grade lanolin or a fragrance-free nipple balm applied after feeds to prevent the nipple from drying and cracking further (do not use if thrush is suspected, as lanolin can contribute to a warm, moist environment that supports fungal growth)
- Allowing the nipples to air between feeds where possible
- Hydrogel pads for significant nipple damage, which provide a moist wound environment and immediate pain relief between feeds
- Wearing a well-fitting nursing bra that does not press the nipple against fabric constantly
When to Seek Support
Seek support from a lactation consultant or your healthcare provider if:
- Nipple pain is not improving after 2 weeks despite latch correction attempts
- You have visible nipple damage (cracks, blisters, bleeding)
- You suspect thrush or a bacterial infection
- Pain is preventing you from feeding or causing you to consider stopping breastfeeding before you are ready to
Nipple pain is one of the most common reasons parents stop breastfeeding earlier than intended, and in the majority of cases it is resolvable with the right support. Early intervention from a qualified lactation consultant is the single most effective step for persistent or significant nipple pain.
Key Takeaway
Significant or persistent nipple pain is not a normal part of breastfeeding and has an identifiable cause in the majority of cases. A shallow latch is the most common cause and is addressed by improving latch depth and relatch technique, ideally with lactation consultant support. Tongue tie, thrush, vasospasm, and skin conditions are other common causes, each with distinct symptoms and specific treatments. Support healing between feeds with expressed breast milk, lanolin or nipple balm (not with thrush), and air exposure. Do not accept ongoing pain as inevitable: seek support early for the fastest resolution.
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This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a lactation consultant or qualified healthcare provider if you are experiencing nipple pain while breastfeeding.