Sore Nipples During Breastfeeding - What's Normal?

Fact: breastfeeding shouldn't hurt. Also fact: pain is highly subjective. In other words, how people register and experience what is painful and what is not can vary widely from person to person. So in some ways, describing how to recognize and remedy painful or sore nipples during breastfeeding can be tricky.

I've had some (very experienced) lactation professionals tell me that if breastfeeding hurts, then something is wrong because, "breastfeeding shouldn't hurt." I've had other (very experienced) lactation professionals tell me that some initial discomfort is to be expected with breastfeeding, but the discomfort should go away with time. The problem lies with understanding the difference between discomfort and pain, including how long and how much is "normal" before considering that there's an issue.

Thankfully, with help from some of the best experts in breastfeeding, there are ways you can figure it out. According to KellyMom, my go-to for breastfeeding answers and advice, there are four kinds of "transient soreness" (typical nipple pain that only lasts for a short time) that do not signal a problem:

• Pain or discomfort only when your baby latches on. It is usually mild discomfort, but some describe it as severe, depending on how they feel pain. However, the pain/discomfort should not continue throughout your nursing session and should not be present in between feedings. 
• Nipple pain that peaks (is at its worst) around three days after the start of breastfeeding, but then subsides and is gone in about two weeks. Since it can be difficult to determine how long your pain will last, be sure that it also meets the other criteria in this list. 
• The skin on and around your nipple is not cracked, blistered, or bleeding. 
• Your nipple's appearance is mostly the same before and after a feeding -- that is, it's not flattened, creased, or pinched. If you're unsure and you're experiencing pain or discomfort, contact a professional.

If you check off all of the above and you're still concerned about the discomfort or pain you're experiencing, don't wait it out -- call an IBCLC (International Board Certified Lactation Consultant) or breastfeeding consultant. A professional can help you determine if the pain you're experiencing is temporary and normal or if it's caused by an underlying problem that should be corrected. 

Now let's look at the kinds of pain that is problematic and should not be ignored. While the following kinds of pain are not considered "normal," unfortunately they can be common. In other words, many breastfeeding parents may experience these types of pain, but this kind of pain usually signals a problem. 

• Pain so intense it makes you want to avoid or dread breastfeeding (pain you might describe as severe, really bad, intense, or excruciating)
• Pain that lasts throughout the feeding session
• Pain that continues in between feedings
• Nipples that are cracked, blistered, or bleeding
• Pain that lasts beyond the first two weeks

If you're experiencing any of these symptoms, contact an IBCLC or breastfeeding counselor to get to the source of your pain and fix it. Some people are good at "overriding" or withstanding/enduring intense pain, so if you're not measuring your pain as high, but the kind pain you're experiencing meets any of the other criteria, contact a professional. 

Causes of Nipple Pain When Breastfeeding

As for the causes of the kind of problematic pain discussed above, it's often caused by how a baby latches onto your nipple or suckles at your nipple. A shallow latch, improper placement of baby's lips while latched, strong/aggressive suckling, or baby clamping down at your nipple can all cause pain and nipple skin damage. The shape of your nipples can also cause pain, especially if you have flat or inverted nipples or long or very large nipples. There could also be other underlying issues for nipple pain during breastfeeding, which is why it's important to contact someone who can properly evaluate your issues and suggest effective treatment. 

For more information on nipple pain and other breastfeeding questions, check out the resources at KellyMom. You can also take a breastfeeding class during pregnancy to better understand the mechanics and possible issues encountered with breastfeeding. 

Have you experienced nipple pain? What helped most?