When should you see a doctor about painful breastfeeding?

Brief tenderness can occur while feeding is being established, but ongoing pain warrants attention. Shallow attachment, positioning problems, nipple cracks, or breast fullness can make feeds painful. A blocked milk duct may cause a tender area, while mastitis can present with breast pain, warmth, redness, and feeling unwell. Nipple thrush may cause burning nipple pain during or after feeds. The symptom alone cannot identify the cause.

Check that your baby’s mouth takes in much of the areola, not only the nipple, and break suction gently if attachment is painful. Offer feeds regularly and vary positions so pressure is not always on one area. Avoid forceful massage or suddenly stopping feeds. Keep nipples clean and dry, and seek a Lactation Consultation if pain continues or attachment is difficult. A clinician can examine you and your baby and advise on treatment.

Contact a doctor promptly for fever, chills, marked tiredness, a hot or increasingly red breast, a worsening tender area, pus, or symptoms that do not improve with feeding adjustments. Seek urgent care if you feel very unwell, become faint, or develop rapidly worsening breast swelling. Painful breastfeeding is not a reason to stop feeding without advice; a clinician can help protect milk removal and comfort.

Could my baby’s attachment be causing the pain? Are my nipple cracks or breast changes signs of infection? Should I change feeding positions or express milk? What symptoms should prompt another review, and is a lactation referral appropriate?