Painful Letdown: How to Cope

If breastfeeding pain is making you cringe, here are some steps you can take to ease your discomfort. Find out the causes and treatment of painful letdown.

While breastfeeding your baby, do you feel a sudden rush of burning pain in your breast as soon as your milk starts to flow? Sure, pain and motherhood seem to go hand in hand sometimes, but is a painful letdown reflex normal? Experts say the answer isn’t as simple you might think.

What Is a Letdown, and How Is It Supposed to Feel?
‘Letdown’ is technically the milk ejection reflex (MER). The pathway for the nerve that controls the MER runs through the brain, therefore infant sucking or thoughts about your baby can trigger letdown.

A lot of women can’t feel letdown at all, and those who do normally describe it as a pins and needles feeling or as pressure. The feeling should disappear within a few seconds, and experiencing letdown should stop occurring all together after the first month or two of breastfeeding.

Although it may feel uncomfortable for some women, if the sensation goes beyond pressure and discomfort, it may be a sign of something atypical going on. A mother who experiences painful letdown — a burning or stabbing pain, or nipple pain — should see a doctor.

Ease the Pain

Treatment for painful letdown will depend on what’s causing the pain. Here are some potential causes and how you should handle them:

  1. An Overabundance of Milk and Fast Milk Ejection Reflex

    This situation isn’t dangerous but could be the culprit. If an overabundance of milk and fast MER is at fault, try changing positions to slow the flow of the milk. For example, a lactation consultant might suggest leaning back while breastfeeding, in a reclined position, to force the milk to work against gravity. You should also make sure to avoid getting overly full; substituting a normal feeding for a bottle of formula can exacerbate the situation.

  2. A Bacterial or Fungal Infection

    If the mother has experienced relatively painless letdowns in the past and painful letdown is a recent development, the cause could be a bacterial or fungal infection in the milk ducts. Some infections present with redness, but others are subclinical infections, meaning that they don’t present with obvious clinical symptoms and are therefore harder to diagnose.

    Painful letdown can also be a symptom of thrush or a side effect of previous breast reduction surgery. If an infection is causing the pain, a course of antibiotics or alternative remedies can address the problem. Ibuprofen is safe to use in the short term to provide some relief until the infection or inflammation has been treated.


Mothers with a painful letdown reflex should consult a certified lactation consultant for help determining the cause and potential treatment. If antibiotics or other medical interventions are needed, the lactation consultant would notify your doctor, who can prescribe whatever’s necessary.


* This article is for general informational purposes only. It is not intended nor implied to be providing medical advice and is not a substitute for such advice. The reader should always consult a health care provider concerning any medical condition or treatment plan. Neither nor the author assumes any responsibility or liability with respect to use of any information contained herein.


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