9 causes of breastfeeding pain & self-help tips

Breastfeeding pain – here is what you can do

1. Breast engorgement

There are many causes of breast engorgement, however the most common causes are incorrect positioning and attachment, missing a feed, feeding baby on a schedule, expressing too frequently, being unable to breastfeed your baby for any reason or weaning from the breast too quickly. In basic terms there is an imbalance between the amount of breastmilk being made and that being removed from the breast. Symptoms of breast engorgement include your breasts feeling heavy, hard, warm and sensitive – as if they are about to burst!

Solution: Breast engorgement will usually improve if you carry on breastfeeding. To help overcome breast engorgement firstly check in with your midwife/health professional to ensure baby is positioning and attached correctly at the breast to enable effective milk transfer. Aim to breastfeed every 1.5-2 hours during the day and every 2-3 hours during the night. Allow your baby to finish feeding at one breast before transferring to the other. Avoid the use of bottles and dummies.

Use a nursing bra that doesn’t restrict your breasts, vary your breastfeeding position, keep your breasts warm and always get your baby to feed from the painful breast first.

Massage the breast lightly during feeding to encourage emptying of the milk ducts. Contact your midwife/health visitor if your breastfeeding pain has not improved after a day or two.

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2. Breast infection or inflammation/Mastitis

If you have flu-like symptoms, such as a high temperature, and feel tired and achy, with a painful breast that’s swollen and hard, you may have a breast infection or inflammation, also known as mastitis. Usually only one breast will be affected. Mastitis is most often caused by a build up of milk in the breast and often leads on from unresolved engorgement. It can also be caused by baby not being correctly latched at the breast or infrequent feeds.

Solution: If you experience mastitis be sure to speak with your midwife or health visitor to ensure baby is correctly positioned or attached at the breast.

Try to get as much rest as you can. Make sure that you eat and drink properly. Continue to breastfeed, using the affected breast first. Massage the breast lightly when feeding.

If experiencing flu like symptoms visit your GP as you may need antibiotics to resolve the problem. Mastitis can also change the taste of breastmilk and on occasions babies may refuse to breastfeed. If this occurs, it will be important to pump from the affected breast until resolved.

Sore nipples is the most common complication associated with breastfeeding and the most common reason women stop breastfeeding.

3. Sore nipples

Sore nipples may be a sign that your baby isn’t positioned and attached properly at the breast. Sore nipples is the most common complication associated with breastfeeding and the most common reason women stop breastfeeding. It most commonly occurs in the first few weeks after birth.

Solution: Ask your midwife or health visitor to observe a feed to ensure baby is positioned and attached correctly at the breast. Try using different feeding positions. Ask your midwife or health visitor to check for a tongue tie, which may be impacting on the way baby is latched at the breast. Use a lanolin based nipple cream to help heal the nipples and consider using nipple shields whilst feeding to provide an extra layer of protection. You can also massage a little breast milk over your nipples and areolas after breastfeeding as this has a healing effect.

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4. Thrush infections

Breastfeeding pain is sometimes caused by a thrush infection, when the Candida organisms naturally present in your baby’s mouth multiply excessively and cause a fungal infection that spreads to your nipples, areolas and milk ducts. A fungal infection may cause an irritated, burning and itching sensation in your nipples/areolas. Your nipples may develop blisters and cracks, and your areolas may become swollen, weepy and flaky.

A thrush infection in your milk ducts may cause pain, burning and itching inside your breast. If thrush is the cause of your pain you will also notice your baby has thrush, this will look like a white coating on the roof of the mouth and tongue.

Solution: If you suspect either you or your baby have oral thrush then speak with your GP or Health Visitor, who will be able to prescribe medication for both yourself and your baby. It is important that you are both treated to prevent recurrence.

What you also can do: Fungi thrive in damp conditions, so try to air your breasts frequently and be meticulous about your hand hygiene. Use breast pads to keep the inside of your bra dry and clean. Sterilise pacifiers, nipple shields, reusable breast pads, your baby’s teething toys, feeding bottles, etc. on a daily basis. Also wash your underwear, bra and towels frequently.

5. Leaking breasts

It’s normal for a new mum’s breasts to leak milk at first. This often happens while you’re feeding your baby from the other breast.

Solution: Breastfeed frequently. The more often you breastfeed, the less chance that your breasts will leak. If you’re leaking a lot, there are special breast shells that you can get to collect the milk. If you leak even when you’re not breastfeeding, you can buy breast pads to put in your bra.

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6. A baby who bites

Ouch! It can really hurt when your baby bites your nipple. It may even make you reluctant to breastfeed. Biting most often occurs when your baby is starting to teeth, which can be anywhere from 3 months onwards.

Solution: Stop breastfeeding every time your baby bites to show that it hurts. Be ready to insert your finger gently into the corner of your baby’s mouth to loosen their grip on your nipple. Tell your baby in a firm voice “no” and then continue to feed.

When your baby refuses to feed, it could be their way of telling you that something is wrong.

7. When your baby refuses to feed

When your baby refuses to feed, it could be their way of telling you that something is wrong. Your baby may have a cold or an ear infection or could be experiencing the discomfort of teething. The flow of your milk may also be slower. Or your baby may simply be distracted by other things.

Solution: If you suspect that your baby is ill, contact your GP or Health Visitor. But if you think that your baby is easily distracted, try breastfeeding in a calm space with subdued lighting. You could also consider using a breastfeeding necklace, which helps to keep your baby focused at the breast.

Also try to breastfeed when your baby is very tired, vary your breastfeeding position, stand or walk while you breastfeed, and give your baby plenty of skin-to-skin contact. If you think baby is refusing to feed because of teething issues, apply a little teething gel prior to feeding to help numb the gums.

8. Too little milk

It is very rare to have too little milk. But it’s understandably stressful when your baby seems to be feeding all the time, yet doesn’t gain weight, or when your breasts don’t seem as full as they did at first. This is often due to breastfeeding too little, which may impair the letdown reflex. It could also be due to incorrect positioning and attachment, tongue tie, supplementing with formula, the use of medications or previous breast surgery.

Solution: Increase your milk production through a lot of skin-to-skin contact with your baby and by breastfeeding more frequently. This stimulates the hormone oxytocin, which is important for milk production. If possible take to bed with your baby and spend 24 hours focusing purely on skin to skin, feed every 2hrs during the day and every 3 hours during the night. Switch sides every 5 minutes so both breasts are being stimulated, pump for 15-20 minutes after each feed.

If the feeling that your baby is not getting enough milk is stressful for you, don’t hesitate to contact your midwife, health visitor or breastfeeding specialist.

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9. Too much milk

If you’re producing too much milk, your baby may struggle to empty your breasts, which may constantly feel tight and uncomfortable. This may be caused by a strong let-down reflex. Your baby may find it difficult to feed when your milk comes too fast and in large quantities. Oversupply can also be caused by too frequent pumping or not emptying one breast before moving onto the other.

Solution: Oversupply will normally settle down by itself over time. You can try block breastfeeding, which involves feeding only from one breast for a period of 3-5 hours. Contact your midwife, health visitor or breastfeeding specialist to get specific advice about this method. It’s based on the principle that a full breast doesn’t produce milk, and this is one way for you to decrease your milk production and milk quantity.

If you have a strong let-down reflex, you can express some milk by hand before you let your baby feed, so the milk doesn’t flow as fast. Gently massage your milk ducts to release the pressure. Also try different breastfeeding positions. Lying on your side or holding the baby more upright while you breastfeed may help to reduce the pressure.

Sources: babycenter.com, womenshealth.gov

This article is reviewed by Katie Hilton, qualified midwife and health visitor, UK.