"Breastfeeding is supposed to hurt at first" is one of the more damaging pieces of folk wisdom out there. Some sensitivity in the very first days, while you and your baby are both learning, is genuinely common. Real pain — sharp, persistent, or getting worse — almost always has an identifiable, fixable cause.
Why it happens
The most common cause by far is latch: when a baby doesn't take in enough of the areola along with the nipple, it can cause pain and even cracking. The CDC is direct about this: breastfeeding should not be painful once your baby is properly latched.
Fixing the common causes
The AAP recommends washing with warm water only (no soap, which dries and irritates skin), varying your baby's position at each feed, letting nipples air out between feedings, and applying a small amount of colostrum, breast milk, or medical-grade purified lanolin if needed. Notably, the AAP specifically warns that over-the-counter creams and lotions generally don't help, and can sometimes make things worse.
If those steps don't resolve it within the first one to two weeks, or if you notice cracked or damaged skin, that's the point to bring in a lactation consultant or your doctor — a hands-on assessment of positioning and latch is often the fastest fix.
Engorgement, plugged ducts, and mastitis
Engorgement — breasts becoming firm, full, and uncomfortable as your milk supply establishes in the first weeks — is common and usually eases with regular feeding, warm showers, cold compresses, or expressing just enough milk to relieve the pressure (expressing more than that can actually increase your supply and prolong the problem).
A plugged duct shows up as a tender, warm area with a palpable lump, usually helped by gentle massage and continued nursing on that side. Mastitis is a step further — inflammation, sometimes with infection, that can bring fever and flu-like symptoms alongside a hot, tender area on one breast. The World Health Organization's guidance on mastitis emphasizes that the underlying driver is usually inefficient milk removal, not infection alone — which is why the recommended approach is to keep breastfeeding (or expressing) through it rather than stopping, alongside any treatment your doctor prescribes.
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See a doctor if breast pain comes with fever, a red or wedge-shaped tender area, or symptoms that aren't improving within 12 to 24 hours — signs consistent with mastitis. If you've started antibiotics for it and aren't better within 48 hours, go back for reassessment rather than waiting it out.
Thrush
A fungal infection can also cause nipple pain — deep pink, burning nipples in the parent, often paired with white patches inside the baby's mouth. This needs antifungal treatment from a provider rather than home remedies.