What to Do About Nipple Pain

Nipple pain is a common symptom postpartum in women who are breastfeeding. It can also be debilitating. Some people feel so much nipple pain in nursing that they come to fear the experience of their baby latching on. The data shows that nipple pain is one of the top reasons women stop breastfeeding earlier than they planned.

Part of what is challenging here is that it is hard to know what is normal and transitory and what needs help. Initial nipple tenderness is common in the first days postpartum. Sometimes discomfort continues past that. But if you’ve never been through this before, how do you know what is expected and what needs intervention?

The good news: most nipple pain has identifiable causes, and there are solutions.

Take me to the bottom line

The importance of a good latch

The most common cause of nipple pain is poor latch or positioning. Breastfeeding requires a particular position of the mouth around the nipple. Relative to what you might expect prior to having a baby, they have to open surprisingly wide to breastfeed correctly. If that doesn’t happen, it creates friction or compression that can damage your nipples. Then, you’ll see signs of damage — cracks, fissures, and bleeding. Here’s more information on how to tell what a good latch should look like.

The fix here is straightforward but requires help. A lactation consultant can assess the latch and positioning. The Academy of Breastfeeding Medicine defines persistent pain as lasting longer than two weeks — if you’re still hurting at that point, definitely get expert help. But if you’re miserable, even if it has been less than that, you should ask for help, too. Earlier intervention often prevents worse damage.

All infants will occasionally have a bad latch; when that happens, you can just gently move them off the breast and reposition. However, if there is an ongoing issue with latching, it is common to blame infant tongue tie. This is a condition in which the ligament that attaches the tongue to the bottom of the mouth is very short, limiting tongue mobility. Tongue tie is generally overdiagnosed, but one place where treatment does seem to help is with nipple pain. Studies on frenotomy — the procedure to release a tongue tie — show significant improvements in maternal pain. A 2023 meta-analysis found large effect sizes for nipple pain reduction one month after the procedure.

When latching is an issue, nipple shields can be a lifesaver. They are very effective at promoting a good latch, even in preterm babies. This can help start and maintain breastfeeding. The downside is a lower rate of milk transfer — perhaps a 15% reduction. This needs to be weighed against the value in improving pain and increasing breastfeeding continuation.

Other possible causes of nipple pain

Sometimes nipple pain doesn’t seem to reflect mechanical trauma. Two specific conditions are worth knowing about:

Vasospasm causes deep, burning pain that feels different from surface damage. Your nipple may turn white or blanch after feeding, then return to a normal color. This happens when blood vessels constrict, often triggered by initial nipple damage or poor latch. It can be exacerbated by cold and is thought to be related to other circulatory issues.

The pain can last several minutes after feeding ends. Treatment focuses on keeping the breast warm, fixing any underlying latch issues, and, in some cases, treatment with medications, which are typically used for hypertension.

Thrush is a fungal infection of the baby’s mouth that can, in principle, spread to the breast and cause pain. This is a very commonly diagnosed reason for breastfeeding pain, but, in fact, it is usually not correct. One study of 25 women diagnosed with thrush and treated with antifungals found that none of them had any actual evidence of yeast, and treatment did not improve any symptoms. In the literature on vasospasms, they are often initially diagnosed as thrush and treated with no success. So, while thrush is one possible explanation, it’s worth exploring others before treatment.

How to treat nipple pain

Especially when nipple pain is caused by a poor latch, you’re probably looking for treatment to have less pain. None of these available treatments is a substitute for figuring out what is going on and fixing it, but some of them can help in the short term.

Lanolin and breast milk

Randomized trials show that both lanolin and your own breast milk, rubbed on painful or cracked nipples, can provide some benefit for nipple pain and increase healing. The effects are small but significant. Neither approach seems better in the data, so pick whichever you prefer (or use both).

Hydrogel dressings or pads

These are a very high-moisturization solution, and some randomized trials have shown improved healing. It’s worth considering if lanolin doesn’t seem like enough.

Silver cups (Silverettes)

These are small silver caps that are worn over the nipples when not nursing. The antibacterial and antifungal properties of silver are thought to help heal. Small studies show faster pain resolution compared to standard care, though the evidence base is limited. It’s also worth saying that these are expensive.

Closing thoughts

Generally, it’s easiest to think about this problem as an overall wound problem. The issue is that you’re constantly using the nipples, so the solutions need to work around that. The best advice is probably what I got very early on from another mom — moisturize the nips every time!

The bottom line

Most nipple pain comes from a poor latch, and getting early help (including adjusting positioning, using shields, or treating a tongue tie) can quickly reduce discomfort.
Other possible causes of nipple pain include vasospasm (related to circulation issues) and thrush (an often overdiagnosed fungal infection of the baby’s mouth that can, theoretically, spread to the breast).
Short-term treatment solutions include applying lanolin and/or breast milk to the nipple, using hydrogel dressings or pads, and Silverettes.
The best advice is to use nipple cream every single time you breastfeed.