When Breastfeeding Hurts More Than Expected

Breastfeeding may not always be as easy as some people make it sound. For many new mums, it comes with challenges—and pain can be one of them. A little soreness in the first few days is common as your body adjusts, but if it keeps hurting every time you feed, something might not be quite right.

Ongoing nipple pain isn’t something you should just put up with. It can be a sign that your baby’s latch isn’t working well or that there’s another issue, like tongue-tie getting in the way, as Dr Ellie Nadian explains. The good news is, there’s help out there—and you don’t have to keep guessing what’s wrong.

Common Reasons for Nipple Pain During Breastfeeding

If breastfeeding is hurting more than you expected, there may be a reason behind it. There are a few common reasons why breastfeeding might be painful, and identifying the cause early often leads to quick relief. Here are some of the usual causes mums come across in the early weeks.

Poor Latch or Positioning

When a baby doesn’t latch on deeply enough, it can put too much pressure on the nipple. This often leads to pinching pain during feeds or soreness that lingers between feeds. Adjusting the way your baby is positioned or getting help with the latch can often ease the pain quickly.

Tongue-Tie (Ankyloglossia)

If your baby has tongue-tie, their tongue can’t move freely enough to breastfeed well. This can lead to shallow latching, making feeds painful for you and tiring for your baby. Tongue-tie is more common than people realise and can be treated once it’s picked up.

Thrush or Other Infections

A burning, itchy, or stinging feeling during or after feeds might be caused by thrush—a common yeast infection. It can develop on your nipples or in your baby’s mouth and needs treatment to clear up. Sometimes, it’s mistaken for latch problems, so it’s worth getting it checked.

Engorgement or Blocked Ducts

When your breasts are too full or a milk duct gets blocked, it can make feeding painful. You might feel a hard lump, or the area may look red and feel warm to the touch. Keeping milk flowing regularly and gently can help prevent it from getting worse.

Cracked or Sore Nipples

Dryness, friction from a poor latch, or even just feeding frequently in the early days, can cause nipples to crack or bleed. This can make every feed feel sharp and uncomfortable. Letting nipples air dry, using a gentle cream, and improving the latch usually helps them heal.

Understanding Tongue-Tie

Tongue-tie is when the thin bit of tissue under a baby’s tongue (called the frenulum) is tighter or shorter than usual. This can make it harder for the tongue to move the way it needs to during breastfeeding. Some babies with tongue-tie struggle to latch properly or stay latched, which can lead to long feeds, fussiness, and sore nipples for the mum. Not all tongue-ties cause problems, but when they do, it’s something that can usually be helped once it’s picked up.

Signs Your Baby Might Have a Tongue-Tie

Some babies with tongue-tie show clear signs during feeding, while others might be more subtle. If you’ve been struggling or something just doesn’t feel right, these are some signs that could point to tongue-tie.

Difficulty Latching or Staying Latched

If your baby often slips off the breast or has trouble getting a good latch from the start, it might be because their tongue can’t move well enough to hold on properly. This can lead to long, tiring feeds for both of you.

Clicking Sounds During Feeding

If you hear clicking or smacking sounds while your baby is feeding, it might be a sign they’re losing suction. This can happen when the tongue isn’t able to stay in the right position during sucking.

Poor Weight Gain

If your baby isn’t putting on weight as expected, and feeding seems to take a long time or leaves them unsettled, tongue-tie could be making it hard for them to get enough milk. It’s always worth checking if feeding is less effective than it should be.

Heart-Shaped or Notched Tongue Tip

When your baby sticks out their tongue, and it looks heart-shaped, or there’s a little notch in the middle, it might be caused by a tight frenulum pulling the tongue back. This can be a visual clue that tongue movement is restricted.

Nipple Pain or Damage in the Mother

If your nipples are cracked, sore, or hurting badly during and after feeds, even though you’ve worked on latch and positioning, it could be because your baby’s tongue isn’t moving properly. A tight tongue can cause extra friction and shallow latching, which leads to pain.

Diagnosing Tongue-Tie

If your baby is struggling to latch or you’re dealing with ongoing nipple pain, a detailed feeding assessment can help figure out if tongue-tie is the cause. Our Brisbane Paediatric Dentist will look at both the structure and function of the tongue, not just how it looks, but how it moves and works during breastfeeding.

Here are the common tools and methods used:

1. Clinical Feeding Observation

Before anything else, a dentist or lactation consultant will usually watch your baby breastfeed. They’re checking for signs like poor latch, clicking sounds, milk leaking, or early fatigue during feeds. These clues often say more than what the tongue looks like.

2. Hazelbaker Assessment Tool (HATLFF)

This is a scoring system that looks at two things:

• Tongue appearance: How the frenulum looks (length, thickness, position).
• Tongue function: How well your baby can lift their tongue, stick it out, and move it during feeding.

A low score in this assessment may suggest that a tongue-tie is limiting movement and affecting breastfeeding.

Note: Not every clinician uses this tool, and some believe it shouldn’t be used alone to decide if a procedure is needed.

3. Coryllos Classification System

This system describes where the frenulum is attached under the tongue:

• Types 1 and 2 are near the tip (easier to see).
• Types 3 and 4 are further back (sometimes called “posterior tongue-tie”).

This helps explain the location, but again, it doesn’t decide treatment. Function is always more important than appearance.

A Balanced Approach

A proper diagnosis isn’t just about following a checklist. It involves:

• Looking at how your baby feeds.
• Understanding your pain or challenges.
• Checking if tongue movement is actually restricted.

If breastfeeding is going well and there’s no pain, even a visible tongue-tie might not need treatment. But if there are clear signs that feeding is affected, further steps, like a frenotomy, may be discussed.

Treatment Options for Tongue-Tie

If your baby is having a hard time feeding and tongue-tie is confirmed, there are different ways to manage it. Treatment depends on how much the tie is affecting feeding and what the paediatric dentist sees during the assessment.

Non-Surgical Approaches

Sometimes, a full release isn’t needed right away. Paediatric dentists or lactation consultants may first suggest working on latch and positioning, using feeding tools like nipple shields, or doing some gentle tongue exercises. These non-surgical steps can sometimes improve feeding enough to avoid a procedure, especially if the tie is mild.

Surgical Approaches

If feeding isn’t improving or the tongue can’t move freely even with support, the dentist may suggest a small procedure to release the tight tissue.

Depending on your baby’s needs, this may be a frenotomy or a frenectomy.

Frenotomy

A frenotomy is a quick procedure where the tight bit of tissue under the tongue (the frenulum) is gently snipped to free up movement.

How it’s done:

Your baby’s tongue is lifted, and the frenulum is cut with sterile scissors. The whole procedure takes just a few seconds and is often done without anaesthetic for babies under six months. Some clinics use a numbing gel, but not always.

How it can help with breastfeeding:

Once the tongue has more freedom to move, babies can latch more deeply and feed more effectively. Many mums notice a difference in pain and feeding within a day or two.

How long until things improve:

Some babies feed better right after the procedure. For others, it may take a few days to adjust and for the latch to improve fully. Support from a lactation consultant after the release can really help during this time.

Does it hurt?

The procedure is quick, and babies may cry more from being held still than from pain. Bleeding is usually light and stops within minutes. Most babies settle quickly once they’re back on the breast.

Frenectomy

Frenectomy is a broader removal of tissue that may be needed if the frenulum is thick and fibrous or if the child is older.

How it’s done:

A frenectomy involves fully removing the frenulum, the tight band of tissue under the tongue, rather than just snipping it. This procedure often involves local or Sleep Dentistry in Brisbane through general anaesthesia if needed, and sometimes requires sutures. Laser frenectomy is one variation that uses a fine laser beam to cut and cauterise at the same time, reducing bleeding. However, with infants, a simple scissors snip is usually sufficient. Healing takes longer than a frenotomy, with specific aftercare to prevent reattachment or scarring.

Laser procedures may offer a slightly faster recovery due to reduced tissue trauma.

How it can help with breastfeeding:

By giving the tongue a full range of motion, a frenectomy can solve long-standing latch problems and help babies feed more comfortably. It’s especially helpful when other treatments haven’t worked.

How long until things improve:

Improvement might be seen quickly, but babies may still need time and support to adjust their latch. Gentle guidance from a breastfeeding professional can help get things on track after the procedure.

Does it hurt?

Babies might be unsettled during and shortly after, but pain is usually mild. Some kids’ dentists use numbing gel or local anaesthetic, depending on the baby’s age. Healing tends to be fast, especially in younger babies.

In some cases—such as more complex procedures or with older children—Sleep Dentistry Brisbane (general anaesthesia) may be used if the dentist decides that it is necessary. Brisbane Dental Sleep Clinic explains that with sleep dentistry, dental procedures can feel less scary.

Scissors or Laser? What to Know About Tongue-Tie Release Techniques

Tongue-tie can be treated using either scissors or a laser to release the tight tissue under the tongue. Both options can work well, but each one comes with its own considerations:

Scissors Frenotomy

This is the most common way to treat tongue-tie in young babies.

• The procedure involves gently lifting your baby’s tongue and making a quick, precise cut to the frenulum using sterile scissors.
• In most cases, no anaesthetic is needed for babies under six months. Some providers may use a small amount of numbing gel if needed.
• Bleeding is usually minimal and stops quickly with light pressure.
• Right after the procedure, your baby is typically encouraged to breastfeed. This helps calm them, soothes the area, and also helps stop any bleeding naturally.
• Healing usually happens over one to two weeks, and stitches aren’t needed.

Why many providers choose scissors:

• It’s very quick to do
• Low-cost
• Doesn’t require complicated equipment
• When done by someone experienced, complications are rare

Laser Frenectomy

A laser can also be used to release the tongue-tie.

• The laser works by cutting and sealing (cauterising) the tissue at the same time.
• It’s often chosen for older children or when the frenulum is thick, fibrous, or might bleed more than usual with scissors.
• Because the laser seals as it cuts, there may be less bleeding, and some parents report that their child seems to have less swelling or discomfort afterwards.
• It does require specialised equipment, protective eyewear, and extra training for the clinician.

Some providers believe healing might be a bit quicker with laser, though research hasn’t shown a big difference overall between the two methods.

There are also some risks to be aware of. If the laser isn’t used correctly and by a professional, there’s a small chance of heat-related injury (thermal damage), which is why the procedure should only be done by a properly trained professional. The cost may also be slightly higher because of the equipment involved.

Which Method Is Better?

For infants, especially those younger than six months, most Australian experts recommend scissors as the first choice. It’s quick, safe, and works very well for most babies. Laser is generally used for more complex situations, like older children, very thick frenula, or when the tie has come back after a previous release.

What matters most isn’t whether the provider uses scissors or a laser — it’s how skilled and experienced they are with the procedure. Both techniques can work well when done properly.

The current view (2024–2025) among Australian professionals is that scissors should remain the go-to method for most babies under six months, with laser used selectively when there’s a good reason.

How Tongue-Tie Is Assessed and Treated in Australia

Australian healthcare providers follow well-established guidelines when it comes to assessing and treating tongue-tie. These guidelines are designed to protect families from unnecessary procedures while still making sure babies who truly need help get it early.

Here’s what you need to know:

1. It’s About Function, Not Just Appearance

Just because your baby has a visible frenulum (the thin tissue under the tongue) doesn’t mean it needs to be cut. What really matters is whether it’s causing problems, especially with breastfeeding.

If your baby is feeding well and you’re not in pain, even if a tie is visible, treatment usually isn’t needed.

2. A Feeding Assessment Comes First

If tongue-tie is suspected, the first step is to get a proper feeding assessment from someone trained in breastfeeding support — usually a lactation consultant, child health nurse, or a maternal and child health clinician.

They will watch your baby breastfeed and look for signs that the tongue-tie is actually causing a problem.

Your GP or paediatrician can also be involved, but a specialist in infant feeding is usually the first person to consult.

3. Try Non-Surgical Support Before Jumping to a Procedure

Before going ahead with a procedure, it’s important to try other approaches first:

• Make sure your baby’s positioning and latch are as good as they can be
• Use nipple shields if needed
• Treat any infections like thrush
• Manage breast issues like engorgement or blocked ducts
• Protect your milk supply through pumping if your baby can’t feed effectively yet

Many breastfeeding issues improve with good support, even if there’s a tongue-tie present.

4. Only Treat If the Tie Is Clearly Causing Problems

If, after trying all of the above, your baby is still struggling to feed, and you’re still in pain, then a tongue-tie release (frenotomy) might be recommended.

This should be based on clear signs that the tongue isn’t moving well enough to breastfeed properly, not just how the frenulum looks.

Tongue-tie release should never be done “just in case” or only because someone noticed a tie during a check-up.

5. Scissors Are Usually Best for Infants

For babies under six months, most Australian experts recommend using scissors to release the tie.

It’s quick, safe, and works well for most babies. Laser may be considered in some cases, like if the tie is unusually thick or if the baby is older, but it’s not necessary in most situations.

6. Be Cautious About Unproven Procedures

Some providers may suggest releasing lip ties or even cheek ties to “improve” breastfeeding, especially if your baby has already had a tongue-tie cut. But current evidence doesn’t support these extra procedures, and they may do more harm than good.

Also, be careful with vague diagnoses like “posterior tongue-tie” — if your baby is feeding well, a deeper or less visible tie may not need any treatment.

7. Understand the Risks and the Importance of Experience

Frenotomy is generally safe, but like any minor surgery, it still carries some small risks, such as:

• Bleeding
• Infection
• Reattachment of the tissue if it heals too tightly

That’s why it’s important to choose a provider who has training and experience with this specific procedure.

8. Support After the Procedure Matters Just as Much

After the tie is released, your baby might still need help learning how to latch in a new, deeper way. This is completely normal.

Breastfeeding support is still essential at this stage.

Gentle, guided tongue movement (through feeding and, when recommended, exercises) is usually enough to prevent the tissue from healing back in the same restricted way.

Avoid aggressive “wound stretching” — it can cause more distress than benefit and is not supported by current evidence.

9. Avoid Overdiagnosis and Overtreatment

In recent years, there’s been a big increase in tongue-tie procedures in Australia — not all of them necessary.

More awareness is a good thing, but sometimes it leads to overtreatment. The current guidelines are designed to find the right balance:

• Only treat when a tongue-tie is clearly causing feeding problems
• Avoid releasing every frenulum that looks a little tight

This careful approach keeps babies safe and makes sure the families who truly need help get the right care at the right time.

Gentle Tongue-Tie Assessments in Brisbane

Not sure if tongue-tie is the problem? We’re here to help you figure it out. Breastfeeding shouldn’t be a painful guessing game. If you’re worried about tongue-tie or feeding challenges, we’re here to assess things gently and clearly. Call us today: (07) 3343 4880.