Persistent Pain with Breastfeeding
Abnormal latch/suck dynamic
Disorganized or dysfunctional latch/suck
Infant biting or jaw clenching at the breast
Breast pump trauma/misuse
- Atopic dermatitis (eczema): This condition occurs in women with an atopic tendency and may be triggered by skin irritants and other factors such as weather and temperature change.
- Irritant contact dermatitis: Common offending agents include friction, infant (oral) medications, solid foods (consumed by the infant), breast pads, laundry detergents, dryer sheets, fabric softeners, fragrances, and creams used for nipple soreness.
- Allergic contact dermatitis: Common offending agents include lanolin, antibiotics (topical), chamomile, vitamins A and E, and fragrances.
Mammary Paget’s disease (Paget’s disease of the nipple)
- Both Staphylococcus sp and Candida can be found on nipples and in breast milk of women with no symptoms.
- Additional theories suggest a role for virulence traits that make detection and elimination of potentially causative microbes extremely difficult. These include biofilm formation, consisting of bacteria alone.
- or mixed species of Staphylococcus sp and Candida,
- as well as intracellular infection by small colony variants.
Superficial bacterial infection in setting of skin trauma
Bacterial dysbiosis and lactiferous duct infection
- History of similar symptoms during prior lactations
- Previous episodes of acute mastitis
- Nipple cracks or lesions
- Recent treatment with antifungals and/or antibiotics
- Nipple and breast milk cultures
- Wound culture if crack/fissure present
- Human milk does not inhibit growth of Candida in fungal cultures.
- Some authors have not found a correlation between symptoms and Candida sp identification,
- while others have,
- including one study using PCR technology.
- A predisposition to Candida infections
- Thrush in the infant’s mouth or in the diaper (nappy) area (monilial rash)
- Recent use of antibiotics in mother or child
- Herpes simplex infection (HSV) that either predates lactation or is acquired from a breastfeeding child can infect the breast or nipples. HSV infection of the breast or nipple skin can result in neonatal transmission during breastfeeding, putting the infant at significant risk for morbidity and mortality.
- Culturing the blisters to confirm the diagnosis is optimal. Mothers should not breastfeed on the affected side and expressed milk should be discarded until the lesions have healed.
- In the chronic pain literature, pain disorders are associated with catastrophization, reduced psychological acceptance, depression, and anxiety, and these psychological factors are associated with diminished treatment response.
- This literature suggests that mothers who present with breast allodynia, particularly in the setting of other chronic pain syndromes, may benefit from psychological therapy designed to treat chronic pain, given findings from studies of other chronic pain conditions.
Recurrent plugged (blocked) ducts
Persistent Pain with Breastfeeding
January 1, 2016
Last Updated Month/Year
June 9, 2022
External Publication Status
Country of Publication
To provide evidence-based guidance in the diagnosis, evaluation, and management of breastfeeding women with persistent nipple and breast pain.
Target Patient Population
Breastfeeding women experiencing pain
Health Care Settings
Ambulatory, Emergency care, Home health, Hospital, Outpatient
Nurse midwife, nurse, nurse practitioner, physician, physician assistant
D001942 - Breast Feeding, D017443 - Skin Diseases, Eczematous, D011565 - Psoriasis
lactation, Breastfeeding, Lactation, painful breastfeeding