Persistent Pain with Breastfeeding

Often cited as the most common cause of sore nipples, suboptimal positioning of the infant during a breastfeed can lead to a shallow latch and abnormal compression of the nipple between the tongue and palate. (, )

The ability of an infant to properly latch and breastfeed is dependent, among other factors, on prematurity, oral and mandibular anatomy, muscle tone, neurological maturity, and reflux or congenital abnormities, as well as maternal issues such as milk flow, breast/ nipple size, and engorgement. Infants who are premature, have low oral tone, and reflux/aspiration or congenital anomalies that may be at risk for disorganized suckling. (III)

Ankyloglossia, recognized in 0.02– 10.7% of newborns, involves the restriction of tongue movement (projection) beyond the lower gum due to an abnormally short or thickened lingual frenulum. Poor tongue movement may lead to difficulty attaining a deep latch and is frequently associated with maternal nipple pain. (, )

Infants who bite or clench their jaws while breastfeeding may cause nipple damage and breast pain. Conditions that may lead to this behavior include clavicle fractures, torticollis, head/neck or facial trauma, mandibular asymmetry, oral defensiveness or aversion (e.g., infants force-fed with ridged nipples [teats]), tonic bite reflex, nasal congestion, a response to an overactive milk ejection reflex, and teething. (III)

Because of the widespread use of breast pumps in many countries and the variability of consumer education, literacy, and support, there is significant potential for harm from breast pump use. In a survey in the United States, 14.6% of 1844 mothers reported injuries related to pump use. (II-2)