Nipple pain in the first weeks of breastfeeding is so common that it is sometimes assumed to be an inevitable part of the experience. This assumption causes significant harm: it leads many mothers to endure pain that has a solvable cause, and it leads others to stop breastfeeding under the belief that their body is simply not suited to it. The reality is that persistent, significant nipple pain during breastfeeding almost always has a specific cause — and in the vast majority of cases, that cause is latch.
Getting the right support for latch early — in the first days if possible — is the single most important thing you can do to protect both nipple health and your ability to continue breastfeeding. This article covers what causes nipple pain and cracking, how to address it, and how to continue feeding while healing.
The Healthbooq app lets you log which side you fed on, note any pain or difficulty, and track when things improve — which can help you see whether changes in position or latch are making a difference.
What Causes Nipple Pain and Cracking
The most common cause of nipple pain and damage is a shallow latch, in which the baby is attached to the nipple rather than the breast. When the baby feeds from just the nipple tip, they compress it against the hard palate on every suck, which causes friction, distortion, and eventually cracking and bleeding. When the baby is correctly latched — with a wide mouthful of areola as well as nipple, and the nipple positioned at the back of the mouth — the nipple is not subjected to this compression and feeding should not be painful.
The signs of a shallow latch include a nipple that looks pinched, creased, or shaped like a lipstick after the baby comes off; a clicking sound during feeding; visible gaps at the corners of the baby's mouth; and pain that is present throughout the feed rather than easing in the first thirty seconds (a brief initial discomfort as the nipple adjusts its position is common in the early weeks and is not the same as persistent pain).
Other less common causes of nipple pain include tongue tie (a tight frenulum that restricts the baby's tongue movement and prevents effective latching), vasospasm (painful blanching of the nipple after feeds, often precipitated by cold), and nipple infection, including thrush (a burning, stabbing pain often described as deep in the breast and occurring between as well as during feeds).
Addressing Latch
The treatment for latch-related nipple pain is improving the latch — and this is best done with skilled hands-on support from a midwife, health visitor, or lactation consultant. Written descriptions of correct positioning have limited effectiveness because the adjustments needed are subtle, individual, and much easier to demonstrate than to describe. If you are in persistent pain, asking for a latch observation from a qualified person is the most direct path to resolution.
The general principles of a good latch are: the baby's mouth should be wide open, like a yawn, before attaching; the lower lip should flange outward; you should aim the nipple toward the roof of the mouth rather than the centre; and the baby's chin should be pressing into the breast while the nose is clear. If at any point the attachment is painful, it is worth breaking the latch gently — with a clean finger inserted at the corner of the mouth to break the suction — and re-latching, rather than continuing through pain.
Caring for Damaged Nipples
While working on latch, caring for damaged nipple tissue helps healing and reduces the risk of infection. After feeds, applying a small amount of expressed breast milk to the nipple and allowing it to air-dry has antimicrobial properties and supports skin repair. Purified lanolin-based nipple cream or medical-grade nipple ointment can be applied in a thin layer after feeds to prevent further friction and support healing — these do not need to be removed before feeding.
Single-use or reusable gel breast pads can reduce friction against clothing between feeds. Breast shells — plastic cups worn inside the bra that prevent fabric contact with the nipple entirely — can be helpful for particularly sore nipples.
If cracking is severe enough that feeding on the affected side is very painful or causing bleeding, expressing milk from that side for 24 to 48 hours to allow partial healing — while maintaining supply and feeding from the other side — is preferable to stopping breastfeeding entirely. Any expressed milk can be given to the baby.
When to Seek Medical Attention
Signs of nipple infection include skin that is cracked and weeping, redness and warmth spreading into the breast, fever, and flu-like symptoms. Bacterial infection of the nipple tissue or breast (mastitis) requires antibiotic treatment. Nipple thrush — indicated by persistent burning pain, shiny or flaky skin on the nipple, and a baby who is fussy at the breast — requires antifungal treatment for both mother and baby simultaneously to prevent re-infection.
Key Takeaways
Nipple pain and cracking are common in the first weeks of breastfeeding and are almost always caused by suboptimal latch — the baby taking too little breast tissue and compressing the nipple rather than drawing the areola into the mouth. Addressing latch is the treatment, not nipple cream alone. With correct positioning and latch, breastfeeding should not be consistently painful. Nipple cream can support healing but does not fix the underlying cause. If cracking is severe, short temporary breaks with pumping to maintain supply while the nipple heals may be needed. Signs of infection require medical treatment.
