When Breastfeeding Hurts: Position, Trauma & the Tongue‑tie Pathway
Feeding a newborn is meant to feel mostly comfortable. If it hurts, that’s a sign something needs a tweak — not that you’re doing it wrong. Often, a few simple changes to positioning and latch ease the pain within a day or two. If soreness sticks around, this guide helps you spot patterns, protect your nipples while they heal, and know when to ask for extra support — including how tongue‑tie is assessed and treated in the UK. The aim is straightforward: comfortable feeds, good milk transfer, and a calmer experience for you and your baby.
A deep latch usually feels softer: wide mouth, flanged lips, chin tucked into the breast.
Why does feeding hurt?
Breastfeeding pain is usually multi‑factor: how your baby attaches, your posture, nipple and skin condition, your baby’s oral function and body tension, and the wider context (fatigue, stress hormones, birth experience). The goal isn’t to “toughen up”; it’s to remove the cause and support healing.
Common contributors
Shallow latch: Nipple is compressed against the hard palate; lipstick‑shaped or blanched on release.
Sub‑optimal positioning: Hunching towards baby, baby’s body twisted, or chin not leading into the breast.
Nipple/skin factors: Dryness, friction, previous damage, or vasospasm (colour changes, burning pain after feeds).
Baby’s body tension: Stiffness through neck/jaw; difficulty turning to one side or opening wide.
First‑line fixes: positioning & latch
Small changes can bring big relief quickly.
Positioning principles
Bring baby to you. Uncurl your shoulders, support your back, and let your lap/arms carry baby’s weight.
Nose‑to‑nipple start. Tummy‑to‑tummy. Let baby tip their head slightly back so the chin leads into the breast.
Aim for a deep latch. Look for a wide mouth, flanged lips, more areola visible above than below, chin snug to the breast, and rhythmic swallowing.
Try these positions:
Laid‑back (biological nurturing) — uses gravity to help baby’s chin lead and can feel softer on sore nipples.
Cross‑cradle — gives you more guidance with a small baby.
Side‑lying — helpful at night; keep pillows behind you (not under baby).
Adjust during the feed. If it pinches beyond a few seconds, break the seal gently with a clean finger, reposition, and re‑latch.
Quick comfort add‑ons
Warm compresses before feeds; cool after.
Air‑dry after feeds; a few drops of expressed milk can soothe the skin.
Consider nipple shields short‑term with skilled guidance if damage is significant, while you improve latch.
When pain points to something more
Your body
Cracks, bleeding, scabs, or blanching/colour change (possible vasospasm/Raynaud’s).
Deep, shooting breast pain after feeds (vasospasm or infection).
Localised redness, heat, flu‑like symptoms (possible mastitis) — seek prompt care.
Your baby
Feeds are long (40–60+ minutes) with limited swallowing.
Comes off and on repeatedly or slips from the breast.
Clicking sounds or dribbling during feeds.
Slow weight gain or fewer wet/dirty nappies than expected.
As you adjust positioning, observe: note swallows, the shape and colour of your nipples after feeds, and nappy output. If pain remains high or transfer seems poor despite good positioning, book an infant‑feeding assessment and ask for a functional oral exam.
A trauma‑aware lens
Pain and stress can feed each other. A difficult birth, separation, or previous trauma can affect let‑down, milk flow, and your capacity to keep experimenting.
Two‑minute reset before a feed
Feet on the floor, unclench your jaw, lengthen the out‑breath (hum or sigh).
Roll your shoulders, let the chair or bed carry you.
Name 3 things you can see, 2 you can feel, 1 you can hear.
Partner/support role Sit at eye level, validate (“It’s not your fault that it hurts”), bring water/snack, soften the environment (dim lights, silence notifications), and help with settling between sides.
If flashbacks or panic arise, pause if needed, hand baby to your partner for a moment, and use the grounding steps. Trauma‑informed help can sit alongside feeding support.
Tongue‑tie (ankyloglossia): what to know
Tongue‑tie is when the tissue under the tongue restricts movement enough to affect breastfeeding. Not every visible frenulum is a problem, and not every breastfeeding issue is tongue‑tie — but for some dyads, division (frenulotomy) helps.
Signs that warrant assessment
For you: ongoing nipple trauma, crushing pain, misshapen nipples after feeds, recurrent blocked ducts.
For baby: poor seal, early fatigue, clicking/dribbling, prolonged or very frequent feeds, reflux‑like symptoms, slow weight gain.
Balanced view
Assessment should include function, not just appearance.
Body tension, birth factors and positioning can mimic tie‑like symptoms.
Decision‑making is shared: your goals, baby’s function, risks/benefits, and available support.
Typical UK pathway
Skilled breastfeeding assessment (e.g., IBCLC/infant‑feeding specialist) to optimise latch and positioning first.
If restriction is still suspected — especially if pain hasn’t eased within 48–72 hours of good attachment — referral for tongue‑tie assessment (NHS infant‑feeding team or reputable private provider).
If division is offered: discussion of benefits/risks, consent, immediate post‑procedure feed, and follow‑up support.
Aftercare: gentle wound care if advised, plenty of comfortable feeds, and strategies to avoid over‑working sore nipples.
Protecting nipples while you heal
Start on the more comfortable side to trigger let‑down.
Keep latch adjustments gentle and frequent; avoid “pushing through” sharp pain.
Limit pumping if it worsens pain; if you do pump, check flange size and suction are comfortable.
Over‑the‑counter pain relief compatible with breastfeeding can help you continue; follow local guidance and your GP/pharmacist’s advice.
When to seek urgent help
Fever, flu‑like symptoms with a painful, red area of the breast (possible mastitis).
Baby is too sleepy to rouse for feeds, has fewer than expected wet nappies, or is not gaining weight.
Severe, unrelenting nipple or breast pain.
Resources & Signposts (UK)
National Breastfeeding Helpline (24/7): 0300 100 0212
Local Infant Feeding Teams (via Health Visitor/GP)
Find an IBCLC (International Board Certified Lactation Consultant)
