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Breastfeeding Pain: What’s Normal and What’s Not

For parents who have never breastfed before, breastfeeding pain is a big concern. We’ve got the lowdown on what you can expect with your letdown.

“Should it hurt this much?”

“I thought it would get better by now.”

“This is not what I expected.”

If you’re just starting your breastfeeding experience, the whole thing is a new sensation. Latching, letdowns, engorgement—if you haven’t breastfed, then you don’t have a good point of reference. So if someone tells you that breastfeeding hurts, why wouldn’t you believe them?

Let’s stop right here: Breastfeeding shouldn’t hurt.

What should it feel like? Some parents describe the feeling as a tugging or pulling sensation. Sometimes a tingly, warm, or electric sensation during letdown. Some parents describe the feeling of breastfeeding as a relief.

Depending on your baby’s latch, breastfeeding position, how full of milk your breasts are, and a range of other factors, there’s a vast range of sensations in breastfeeding. But while it can take time to adjust, breastfeeding shouldn’t be uncomfortable after the first few weeks.

What’s Normal and What’s Not

It’s normal: Sore and tender nipples in the early days of breastfeeding
There’s a whole range of reasons for sore nipples in breastfeeding, and some of them require more assistance than others. We always tell breastfeeding parents to expect a little bit of nipple tenderness at the very beginning of breastfeeding—it’s something that your nipples aren’t used to yet!

Ask for help: Nipples that are cracked, blistered or bleeding

Early breastfeeding nipple pain should never be excruciating, though, nor should it involve cracked, blistered, or damaged nipples.

Nipple problems are almost always related to bad latches and the baby not getting enough breast tissue in their mouth.

Says Nest Collaborative IBCLC Lori Theisen, “Remember, it’s called BREASTFEEDING, not NIPPLEFEEDING. We want the baby to take as much breast tissue in the mouth as possible. The nipple is just the faucet for the milk, not the milk factory.”

If you see signs of nipple injury, like sores or bleeding, your baby may be struggling with a latch or tongue or lip tie problem. In those cases, book an appointment with an IBCLC to get help—it will make a massive difference in your breastfeeding happiness.

It’s normal: Engorgement

You thought your breasts had grown during pregnancy, but engorgement is a whole other thing.

Engorgement often occurs to breastfeeding parents at the beginning of breastfeeding. In the first few days, your baby will be cluster feeding, which causes your colostrum to transition into mature milk. This transition can create engorgement for some breastfeeding parents. If you experience engorgement, you’ll notice that your breasts have become tight, firm, and maybe even a bit shiny. They may be warm and slightly lumpy, and, yes, they may be painful.

But remember: the pain of engorgement is short-lived, subsiding within a few days. As you nurse or pump, your breasts will feel better. (Although they may be a little tender from the initial engorgement.)

During that time, nurse (and nurse and nurse!) and stay hydrated. To relieve discomfort, you can apply a warm, wet compress to your breasts or take a hot shower to improve circulation and milk flow. Breast massage is also another helpful technique for lessening engorgement pain.

A few important notes about engorgement

First, not all breastfeeding parents have engorgement. While it’s more common with new parents breastfeeding for the first time, some parents don’t experience it to the same degree—or even at all.

On the other hand, for parents who have had breast surgery—whether implants, reductions, biopsies, etc.—engorgement can be painful. This pain is due to scar tissue in their breast tissue.

Finally, those parents who received IV fluids during their birth can experience fluid overload. In addition to a swelling of fingers, feet, and toes, this can also increase engorgement. Pay attention to how your body feels and make sure to take extra care of yourself during this time!

Ask for help: Sore or engorged breasts with hot spots, lumps, or redness combined with fever, aches, or fatigue.

If you’re experiencing this kind of breast pain, you might be experiencing clogged ducts or mastitis.

Clogged ducts

Clogged ducts are both common and painful, but thankfully they can successfully be treated at home most of the time.

Clogged ducts are characterized by a small, hard lump in your breast. They’re usually palpable, and they’re typically sore or painful. The causes for clogs are:

  • Not emptying your breasts fully after nursing or pumping
  • Wearing tight tops or bras
  • Missing or skipping a nursing session

While clogged ducts can be treated at home though, it’s essential to address them quickly. Untreated clogged ducts can cause your milk to back up. This isn’t just prolonging the pain—it’s creating a situation where mastitis can occur.

The first thing to remember: While nursing through a clogged duct can be painful, it’s essential to keep your milk flowing. Milk flow helps break up the clog and return your breasts to their happy place.

If nursing alone doesn’t resolve the clog, other methods can help:

  • Applying a warm compress on your breast before nursing
  • Using breast massage, lactation massager, or electric toothbrush to break up the clog
  • Dangle feeding, which uses gravity to help empty your breast


On the other hand, mastitis is the inflammation of breast tissue—but it can feel so awful, you wonder if it’s not something more than that. Although it can be caused by preexisting problems like clogged ducts, engorgement, or cracked nipples, it often feels like it comes out of nowhere and knocks you over.

Mastitis is characterized by intense breast pain. Many breastfeeding parents will see hot, red, or sore spots on their breasts or even the classic wedge of redness. But more than that, parents often experience whole-body symptoms, including:

  • Fever
  • Fatigue
  • Nausea
  • Aches
  • Chills
  • Swollen, painful lymph nodes

Mastitis can become serious, quickly. Without appropriate treatment, it can lead to infection, abscesses, and it can impact your milk supply. To get a quick handle on mastitis, make sure you do the following:

  • Nurse or pump as frequently as possible
  • Use breast massage to relieve engorgement and break up any clogs
  • Apply a warm compress

It’s not normal: Shooting pains in your nipple or breast
If you’re getting a shooting pain in your nipple and it turns white, your first thought might be thrush. But before you pull out the gentian violet, consider that nipple blanching may be occurring.

Nipple blanching happens when blood flow to your nipple is cut off. Not surprisingly, latching issues are the culprit of the blanching. But if you check your nipple after nursing and see that your usual nipple color has returned, then blanching, not thrush, is what you’re dealing with.

Nipple blanching can be surprising, but it’s nothing to worry about on its own. However, keep an eye on your baby’s latch—nipple blanching is more common when a baby doesn’t have enough areola in their mouth. (I.e., nipple feeding, not breastfeeding!)

Nipple blanching…or vasospasm?

What about when nipple blanching hurts? Like, really, really, really hurts. You might be experiencing vasospasm. Also known as Reynaud’s Syndrome, vasospasms last for longer than nipple blanching and don’t go away when you’ve fixed latch issues.

Vasospasms can be caused by exposure to cold air, i.e., when your baby unlatches. To address them, you can gently massage your nipple to stimulate blood flow and apply a warm pack to your breast right after each feeding. If it’s an ongoing problem, consider taking a calcium channel blocker like Nifedipine.

Book an Appointment Know

Ask for help: Burning or shooting pain combined with cracked, burning, shiny, or flaky nipples

Thrush is a painful yeast infection that affects both you and your baby. Thrush attacks your breasts, nipples, your baby’s mouth, and bottom area—any place that is warm and moist. What’s worse, thrush is highly contagious, meaning it quickly spreads from the parent to baby and even to other household members if you’re not careful.

While thrush is entirely different from other breastfeeding pain sources, you may have to look more closely to identify it. Thrush shows up as:

  • Persistent nipple pain, often burning or itchy
  • Red, shiny, or flaky nipples
  • Rash-like blisters
  • Cracked or damaged nipples
  • Shooting pains in the breast

You should also be on the lookout for signs of thrush in your baby. These can include:

  • White patches on their tongue, lips, gums, or roof of the mouth that you can’t wipe away
  • Cracked skin at corners of the mouth
  • Diaper rash
  • Reluctance to feed
  • Fussiness or discomfort

Tips for thrush

It’s critical for both you and your baby to be treated for thrush. The preferred course of treatment by the Academy of Breastfeeding Medicine (AMB) is nystatin. They also recommend:

  • Topical azole antifungal ointment or cream
  • Nystatin suspension or miconazole oral gel for infant’s mouth
  • Gentian violet (less than 0.5% aqueous solution) for no more than 7 days

Thrush symptoms may take some time to resolve:

  • Continue to offer your baby frequent feedings, starting with the least painful breast.
  • Take oral probiotics daily.
  • Change nursing pads when wet.
  • Wash anything that touches your breasts or the baby’s mouth in very hot water
  • Rinse your nipples with clean water and allow them to dry fully after nursing before applying antifungal cream.
  • Talk to your doctor about over-the-counter pain medication.
  • Wash your hands thoroughly after nursing your baby or changing their diaper.

Make sure to talk to your doctor about over-the-counter medications before taking them.

Help for breastfeeding when you need it

There’s a lot to figure out about breastfeeding. If you’re ever wondering whether what you’re experiencing is normal or not, there’s help available—and quickly!

Book a convenient online video appointment with one of our IBCLCs today.

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