Feeling the ‘nipple cripple’ – when breastfeeding hurts and how to stop the pain

Are you curling your toes in pain at each breastfeed? Are you becoming anxious and dreading every feed because you know it will hurt like hell?

It’s normal to feel some nipple tenderness in the early days, a bit like breaking in a new pair of shoes – your nipples have never worked this hard before – but breastfeeding isn’t meant to be really painful. So if your nipples are burning, stinging or even bleeding, call in an expert such as a lactation consultant or see your doctor for a diagnosis. It’s important to treat cracked nipples as bacteria can enter the cracks and may lead to mastitis.

Preventing sore nipples

  •  Nipple soreness can be related to dryness and cracked skin from inappropriate treatment (such as using soap), a lack of skin suppleness or nipples that are not especially ‘stretchy’. Many experts recommend massaging your nipples with pure lanolin before the birth, to increase suppleness.
  •  After your baby is born, it’s better to avoid creams, film and hydrogel dressings as these can keep nipples moist and may encourage the growth of Candida Albicans (thrush) or bacteria – the latest info suggests that some bugs can become resistant to antibiotic based creams so in some cases, creams may prolong wound healing.   Instead, try washing your nipples after feeds or applying a warm wet face washer to help relieve pain. Then air dry your nipples before you cover them.
  •  Some mothers swear by breast milk to keep nipples healthy and research shows that this is even more effective than applying lanolin.- squeeze out a little hind milk after feeds and massage your nipples, then air dry your nipples.
  •  Make sure your bras aren’t squashing your nipples flat – some bras apply pressure that pushes your nipples inwards and moisture in the resulting crevices can be a breeding ground for bacteria, often resulting in a ‘ring’ of nipple damage around the base of the nipple.
  •  Vitamin supplements can help healing and boost your immune system – try a good pregnancy/breastfeeding multivitamin containing zinc and vitamin E and take evening primrose, omega 3 oils (found naturally in oily fish such as salmon, tuna and sardines or flaxseed) and vitamin C and D.


Let’s look at the causes of nipple pain – and what will help

Often one look can tell us what’s causing nipple pain and what you can do to fix it and make breastfeeding the relaxing, natural experience it is meant to be:

Squashed nipples- check baby’s latch

If your nipples are squashed after a feed, this usually means there is a problem with your baby’s latch or suck. Changing your baby’s position at the breast can help but it’s important to check if there is an underlying problem such as a tongue tie: sometimes the little membrane called the frenulum which joins the middle of the tongue to the floor of the mouth is too tight and ‘ties’ or restricts movement of your baby’s tongue so that attaching and sucking effectively is difficult, so this can cause pinching as your baby feeds and after a feed, your nipples can look like the pointy end of a lipstick or they may have a graze or crack across your areola. Get a professional to check a feed and assess your baby’s mouth – they need to feel inside your baby’s mouth, not just see that he can poke his tongue out. A tongue tie can be revised easily by a doctor or dentist and you will be able to breastfeed immediately after the procedure.  You may be surprised how quickly breastfeeding becomes pain free.

Nipples turn white – nipple vasospasm

Nipple vasospasm is caused by poor peripheral circulation. You may notice that your nipples look white after a feed, when they are exposed to cool air after a shower or if you treat sore breasts with cool-packs. They may also turn purple before they return to their normal colour. As you feed, vasospasm will cause a stinging , stabbing pain, and as circulation to your nipples returns and they regain their normal colour, you will feel an intense burning feeling.

Some asthma medications, decongestants, caffeine, cigarette smoking (even two cigarettes a day can affect your circulation), a condition called Raynauds’s phenomenon or poor attachment to the breast may be contributing factors to vasospasm.

Vasospasm can be avoided or treated by:

  • Exercising to increase circulation
  • Keeping yourself warm (for example, breastfeeding in a warm room)
  • Applying heat packs to your breasts before and after feeds (cool packs are nor appropriate if you have vasospasm)
  • Taking supplements of magnesium and a six week course of evening primrose or fish oil. There is also a prescription medication (Nefidipine) – discuss this with your doctor.

White spot’ – milk blister or ‘bleb’.

You may notice a small painful white lump or blister on the tip of your nipple. This tends to occur when skin grows over one of the nipple pores, causing milk to block up behind the skin and thicken. These spots often open and clear during a feed, but if not, you can help the blister open and clear by soaking your nipple area in warm water or applying a warm wet compress before feeding. If this doesn’t work, you will need to open the nipple pore with a sterile needle ( if you aren’t comfortable doing this yourself see your doctor). It can often be easier to do this after your baby has sucked a little. Once you have opened the blister, remove the thickened milk by expressing or continuing to feed your baby.

Red, shiny, stinging nipples – nipple thrush (Candida Albicans)

Nipple Thrush is a fungal infection. It’s most likely to occur if you or your baby are treated with antibiotics (which can kill natural gut bacteria), during summer and in hot humid climates (which encourage yeast growth). Nipple thrush can also occur if you have vaginal thrush or if you or your partner has tinea.

Your first symptoms of nipple thrush may be excruciating, shiny red nipples or a burning pain deep in your breasts. If your baby is affected (you can transfer thrush between baby’s mouth and your nipples), he may suddenly have difficulty lathing on or fuss unusually while breastfeeding. Look inside your baby’s mouth : thrush produces a white cheesy substance on the insides of his cheeks and/or tongue and you won’t be able to wipe it away. In the early stages, thrush may not be obvious inside your baby’s mouth – your red stinging nipples will be the first sign and your baby may develop a red angry looking nappy rash.

If you suspect thrush see your health care provider as soon as possible. Your doctor can make a diagnosis (symptoms of nipple thrush can be similar to symptoms of a bacterial infection) and prescribe medication and an antifungal cream such as Kenacomb which is antifungal and antibiotic. You will need to treat baby’s mouth too as infection can be passed back and forth from baby to you and vice versa.

Meanwhile, there are some environmental precautions you can take to reduce/alleviate thrush:

  •  To prevent reinfection, apply antifungal cream to your nipples, wash bras frequently, use disposable nursing pads and boil all dummies, teats and toys that come in contact with your baby’s mouth. Insist that everybody who handles your baby washes their hands first.
  •  Reduce thrush in your body by eliminating refined sugar, alcohol and yeast from your diet (use yeast –free breads and avoid products such as vegemite). Increase your intake of plain yoghurt containing live cultures and try foods as kefir , sauerkraut and kombucha or take a probiotic supplement to increase the ‘good’ bacteria that control yeast in your gut.
  •  Keep your nipples dry (avoid creams other than those advised for the treatment of thrush)and expose them to sunshine when possible.
  •  Make sure any family members who have a fungal infection such as tinea are also treated; they will need to adhere to the diet too.

Pinky McKay is an IBCLC Lactation Consultant and best-selling author of 5 books, including “Sleeping Like a Baby” and “Parenting by Heart”. Pinky is also the creator of Boobie Bikkies, all natural and organic cookies to support breastfeeding mothers. Download Pinky’s FREE ebook “Making More Mummy Milk,Naturally” . 

  1. Robyn says

    Hi Pinky,
    I wish i had read all of this a few days ago. Have all but given up on breastfeeding my 2 week old and she has been mostly on formula the last few days as I wasnt able to deal with the pain. The pain has decreased now but of course so has my milk supply! Is it possible to build up to a full supply again after stopping for a few days?
    Thank you for a great article.

  2. Pinky says

    Hugs Robyn, Yes its is possible to build up your supply again . It’s hard work but it will be possible and worth it to give some breastmilk. For starters , if you start at the breast , then top her up with formula, then finish at the breast so she associates the breast and mummy with a full tummy. Take it gently – download our free ebook “Making More Mummy Milk,Naturally” at http://www.boobiebikkies.com.au. Lots of skin to skin cuddles and letting your baby nurse whenever she shows interest. You may like to try BOobie Bikkies too.

  3. Kat says

    Hi Pinky,
    Another reason I found out I had horrid nipple pain, from the LC after using one of the hospitals fantastic milking machines, was that I had slightly inverted nipples.
    And a real awful case of mastitis. that doesn’t help things.
    Thanks to awesome lactation consultants, and your website, I persevered and am still nursing my 15mo son and hope that next time round, much much less pain!

  4. Karen says

    Hi Pinky
    I would love your insight on breastfeeding a toddler, as I find my breasts get sore but for possibly different reasons than with a newborn. My son is 28 months and an enthusiastic breastfeeder, but I find he can be rough and that his teeth or the way he attaches seem to leave a constant “bruised” feeling especially under my nipple. Once in a while he clenches his teeth on my nipple and it’s an intense tussle for release! That said, I love the closeness, comfort and fun breastfeeding a toddler offers, but have no idea how I am going to wean him off in the future…
    Kind regards,

  5. Sarah says

    Hi Pinky,
    I have twins and feed them every four hours (sometimes more during the night). They are 16 weeks old and I have had mastitis twice and numerous blockages – too many to count. My nipples turn white after I feed and inbetween feeds I feel like someone is putting needles in and out of my nipples. I also constant blebs.
    I’ve seen a lactation consultant and they confirmed good latch etc. I task vitamins, magnesium and walk regularly. I also have a warm bath before the dinner feed with the twins and put magnesium in it.
    I breastfed my daughter for 2 years with little troubles but I’m almost at a point of admitting defeat with the twins as my breasts are always so painful during feeds and in-between.
    Any advice would be greatly appreciated.
    Kind regards

    1. Pinky says

      Hi Sarah, what an awesome job you are doing with TWO babies. if feeding is painful it would be worth getting another opinion has your LC checked the babies for tongue and lip ties? Here’s a link https://www.beautifulbreastfeeding.com/tongue-tie-is-it-causing-feeding-problems/.

      Here are good resource links for vasospasm – you can ask your GP about prescriptions meds for it – nifedipine use is described in the article by dr Jack Newman below:
      Vasospasm – Royal Womens’Hospital info sheet.

      Dr Jack Newman

  6. Lauren says

    I am 7 and a half months into my breastfeeding journey. I have been treated for thrush (although it was never evident in bubs mouth), vasospasm (didnt seem to make any difference even with the nifedipine) numerous times. I’ve seen two lactation consultants, & a gp known to be a breasfeeding guru & I am still having problems. Is it possible that the problem could stem from a baby with a narrow palate or a top tie? Her top tie isnt too bad & I’ve been told her latch is ok. I’m at my wits end, but determined to continue! I’ve come this far! Thankfully the feeds have dropped off a bit as she’s getting older so it’s eased the pain, but almost every feed I experience painful, burning, stinging, red nipples, that seem rather dry & cracked & have even bled at times. The least painful feed in the one during the night. It also doesnt help that she stretches my nipple in her mouth as she looks around the room when distracted by noises either haha. Any other suggestions? I’m worried about the constant trauma to them. Thanks Pinky, love your articles & your message to parents ☺

    1. Pinky says

      Hi Lauren, what determined mama you are, persisting with breastfeeding through so much pained trauma. it is possible that a lip tie could cause pain during feeding – very often with a lip tie there is also a posterior tongue tie , run your finger around under your baby’s tongue. Do you feel a ‘speed bump’? This may be a sign that there is a posterior tie. The burning nipples sound like a symptom of thrush but could also be nipple dermatitis. You could ask your dr for a script for kenacomb if you haven’t already tried this, it’s anti fungal, antibiotic ointment. Whatever your baby’s latch looks like on the outside , if it hurts you, something isn’t right. Trust your intuition – if you email me pinkymckay@optusnet is my personal email with where you live, I may be able to suggest a dr or LC who specialises in ties.

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