Breast pain while breastfeeding: What’s normal and when to get help

When you first start breastfeeding your baby, it’s not uncommon to experience some breast discomfort. It can take a little time for you and your baby to learn how to work together, get a good latch, and become more comfortable with breastfeeding. But there’s a difference between normal breast discomfort and the sort of pain that you may want to speak to a lactation consultant about. We’re here to help you understand the difference.

What’s normal and what are signs you should get some help?

NORMAL: Sore or tender nipples when you start breastfeeding

Some nipple soreness is normal when you first start breastfeeding. Your nipples may feel slightly tender shortly after your baby latches on to the breast, for about 30-60 seconds or so. This should start to get better and more comfortable in the first weeks after birth.  

GET SOME HELP: Cracked, blistered, or bleeding nipples, or nipple pain that lasts well after your baby latches on

If you’re experiencing a lot of discomfort, especially beyond when your little one first latches on, it could be a sign that they’re not latching on well, not sucking correctly, or that their positioning needs to be adjusted. If your nipples are cracked, blistered, or bleeding, this can also be a sign that some adjustments are needed. Adjusting latch which means changing the way your baby puts their mouth around your breast and positions their tongue to nurse or adjusting positioning can help both you and your baby be a lot more comfortable. Sometimes pain can be a sign of tongue-tie, which is when a baby’s tongue movements are restricted (tied), making it hard to get a good latch. Flat or inverted nipples can also make comfortable latching more challenging. 

NORMAL: Breast fullness or engorgement

Breast fullness or engorgement is another source of normal breast discomfort. It’s caused by your breasts filling with milk, which can make them feel very full, heavy, tight, or swollen. This often happens before a feeding, and after your baby nurses they will feel softer and less full. As your body learns to regulate how much milk your little one needs, this feeling may become less extreme.  

A few days after your baby is born, breast fullness can feel particularly uncomfortable as your milk first comes in, replacing colostrum. During this period of 1-2 days, your breasts may feel especially full and tender as they become engorged with milk. They may also feel sore due to general inflammation, which can cause you to feel hot or flushed. This engorgement should improve quickly as your body starts to adjust to your baby’s needs and there’s a lot you can do to help deal with this discomfort in the meantime. And later on, if you happen to go a very long time between nursing or pumping sessions, you might feel engorged again. This can typically be relieved by nursing or pumping.

GET SOME HELP: Very sore or hard breasts, sometimes with hard, red lumps; with red streaks or patches; or with aches, fatigue, chills, and fever 

This sort of breast discomfort, paired with any of these symptoms, could be a sign of blocked milk ducts or mastitis.

Hard lumps in your breast that are sore and tender could mean that you have blocked milk duct, which is when breast milk builds up in the milk ducts in your breast and gets clogged. Feel for a clogged duct right after a feeding, as it is very normal to feel some lumps and bumps when your breasts are very full of milk. If you feel a clog, a warm compress for a few minutes before the next feeding can help. You can also try gently massaging the lumps from where they are toward your nipple and nursing your baby more often, as this can help unclog the duct. 

If one of your breasts is tender, warm, and hard, with a painful lump (as with blocked milk ducts), possibly with red streaks or patches, you might have mastitis. Many breastfeeding parents with mastitis feel like they have the flu. Mastitis can happen when a blocked milk duct doesn’t get unclogged, which leads to inflammation and swelling of the breast tissue. The breast tissue can become infected or the infection can start another way (from a cracked nipple, for example). Regular nursing, rest, massage, and brief warm compresses can help with this, but it is important to contact your healthcare provider as well. They might recommend an over the counter pain medication or antibiotic depending on your symptoms. 

GET SOME HELP: Burning or shooting pain in the nipples or breast during nursing that doesn’t get better after your baby latches or after nursing entirely; pain deep in the breast; nipples that are cracked, burning, itchy, shiny, flaky, or have a rash with blisters

These sorts of symptoms could be a sign of thrush, which is a yeast infection. (It might show up in your baby as fussinesss, white or yellow patches in their mouth, or cracked skin at the corner of their mouth.) This type of infection is often passed from your baby’s mouth to your breasts. It’s common in very young babies (who may have picked up the infection from your birth canal) or in older babies taking an antibiotic (which can kill off infection, but also good bacteria that keeps yeast infections in check). Thrush can also happen if your breasts don’t properly dry between feedings (leading to infection). This is a very normal infection, but it can still be very uncomfortable. Your healthcare provider will likely prescribe antifungal medications for you and your baby to treat thrush. A lactation consultant can also help you find relief during your medical treatment, and work with you to prevent another yeast infection.

How can you find help and get relief?

These are just some of the most common reasons you might experience discomfort when breastfeeding; there are a number of other reasons that you might experience breast pain that aren’t listed above. So if you’re experiencing any sort of pain and discomfort including those outlined above you should reach out to a specialist for health and support right away. A lactation consultant, your OB/GYN or midwife, your primary care provider, or your child’s healthcare provider are all good resources depending on the particular situation. When in doubt, reach out to a lactation consultant or the healthcare provider you feel most comfortable with either of these experts can always refer you elsewhere for more help as needed. Even if you’re experiencing any of the “normal” discomforts listed above, you should also feel comfortable reaching out for help. Breastfeeding may be natural, but it takes time to learn how you and your baby can work together comfortably. And it can be so hard to really be sure of what’s “normal” when you’re new to breastfeeding, so don’t be afraid to reach out with any questions, concerns, or just for some support. You deserve to reach your breastfeeding goals and to find comfort as you do so.


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Sources
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  • Mastitis. La Leche League. La Leche League International. Retrieved July 22 2020. https://www.llli.org/breastfeeding-info/mastitis/.
  • “Pain: General.”La Leche League. La Leche League International. Retrieved July 22 2020. https://www.llli.org/breastfeeding-info/pain-general/
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  • “Treating Breast Pain.” healthykids.org. American Academy of Pediatrics,  November 2 /2009. Retrieved July 22 2020. https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Treating-Breast-Pain.aspx.

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