Jun 22

Common Concerns About Nursing

Adjustment Soreness

Most women experience some discomfort when first breastfeeding.

Nipples are sensitive and not use to the constant attention a breastfeeding infant gives them.

This pain should be intermittent, transient and mild. This means it lasts for a just a few seconds when breastfeeding starts, nipples do not hurt in between feeds, and the soreness resolves after 7-10 days.

That being said some women have more sensitive nipples than others. Some describe pain from putting on a bra even before pregnancy.

In general, if your discomfort does not fit this pattern another cause should be investigated.

Nipple Trauma

Nipples can become traumatized by breastfeeding developing cracks, friction blisters, abrasions, bruises, and even bleeding.

This is usually caused by a poor latch. A poor latch can be caused by a number of issues including shallow latch, improper placement of infant’s mouth, flat nipples, and tongue-tie.

Given that infant and maternal characteristics affect latch there is no one solution. A nipple shield may be required for flat nipples.

The majority of women benefit the most from proper positioning and a deep latch.

The sooner this can be learned the better as once the trauma occurs nursing can be painful until it heals.

Another cause of nipple trauma may be from a breast pump.

The flange should not rub on the nipple and the suction power should be well-tolerated.

Contact Dermatitis

Some women have very sensitive skin and develop an irritation from the creams they apply to their skin, even hypoallergenic lanolin.

Other women leak a lot and develop skin breakdown from constantly being wet.

Frequently changing pads and air-drying may help, just like with diaper rash.

Milk Bleb/Milk Blister

A milk bleb forms when skin grows over the end of a milk duct.

When the infant nurses the blister bulges out as milk tries to escape. Sometimes the blister pops from the nursing. A mother can also gently rub over it with a washcloth.

Clogged Duct

A milk duct can also be clogged with hard, dry milk.

This can occur anywhere along the milk duct but if close to the nipple a mother may notice a white chalky like substance protruding. It can be gently pulled out or rubbed away.

Hand expression may also be needed to build up pressure behind the clog.


This is an area where we still have a lot to learn.

Traditionally women with burning, deep pain were told they might have a yeast infection.

This may be true for women whose infant has thrush and the mom has shiny, scaly nipples, but newer studies are finding more evidence for bacterial infections.

A recent study of over 500 women found only a few with yeast and many more with Staph and Strep. The term subacute mastitis is being used to differentiate from the woman with a red breast and fever.

The best treatment for these women is still being investigated but may include antibiotics or probiotics.

Preventing sore nipples and heading off breast pain will help you be successful at breastfeeding. Watch these great videos for more information on both of these subjects.

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Michelle Leff Associate Professor of Clinical Pediatrics at UC San Diego