Breastfeeding, Nipple Blanching, and Vasospasms

Nipple blanching is a term used to describe painful, white nipples. Blanching can be the result of a vasospasm, when the blood vessels constrict and spasm, or from any other situation that temporarily stops the blood from flowing to the nipples.

When this happens, the nipples turn pale or white, and there may be a painful, burning sensation. Then, once the flow of blood returns, the nipples may look blue, pink, or red, and the burning usually turns into throbbing pain.

Causes of Nipple Blanching

The most common cause of nipple blanching in breastfeeding women is a poor latch. If your baby is not latching on correctly, the pressure of her mouth against your nipple can prevent blood from flowing to the area. In most cases, if you fix the baby's latch, the blanching will not return. However, if your nipples continue to burn and turn white after you have checked and adjusted your breastfeeding technique, then there may be another underlying cause.

Other causes include:

• Caffeine and Smoking: Caffeine and nicotine are drugs that cause the blood vessels to become more narrow.
• Medications: Certain drugs that constrict the blood vessels can cause blanching. These drugs include antihistamines and medications that treat low blood pressure and some respiratory conditions.
• Nipple Trauma: Damage from sore nipples or previous breast surgery can cause blanching.
• Raynaud's Phenomenon: Raynaud's is a medical condition that's sometimes associated with autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis. When there's a change in temperature from warm to cold, it can cause blanching and pain in the fingers, toes, nose, ears, and nipples.
• Stress and Exhaustion: Fatigue and emotional stress are factors that have been linked to nipple blanching.
• The Baby Clamping Down on Your Breast: If your baby has a very strong suck, or if they are teething or biting on your nipples, the compression can cut off the blood flow to the area.
• Unknown: Sometimes the cause is not known.

Prevention and Treatment

If you experience blanching, but it doesn't cause pain or interfere with breastfeeding, you may not have to do anything at all. But if you have pain or feeding difficulty, you may try these tactics:

• Avoid caffeine and smoking. Eliminating caffeine from your diet may help. If you smoke, try to quit or smoke less, and stay away from second-hand smoke.
• If the pain becomes too much while you're breastfeeding, break the suction of the latch and remove your child from your breast.
• If you have sore, cracked nipples, treat them. Once sore nipples heal, blanching will often stop.
• Make sure your baby is latching on properly. If you aren't sure your baby is breastfeeding correctly, call your doctor, a lactation consultant, or a local breastfeeding group for assistance.​
• Try to stay warm. Breastfeed in a warm place and try to keep your breasts warm, especially after feedings. Dress in warm clothes, and place a warm compress on your nipples before and after you breastfeed.

Vasospasms and Thrush

Thrush is a yeast infection that also causes burning pain in the breasts and nipples. Since thrush has similar symptoms but is a more common breastfeeding problem, vasospasms can be misdiagnosed as thrush.

If your health care provider believes you have thrush, you will receive a prescription for antifungal medication. Thrush will get better with that treatment. However, if it's vasospasms, the nipple blanching and burning will continue.