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Abstract Traumatic breastfeeding experiences can lead a subset of mothers to develop moral injury and subsequent clinical presentations such as depression, anxiety and post-traumatic stress disorder (PTSD). However, to date, no clinical conceptualisation has been utilised to formulate or guide treatment for breastfeeding trauma reactions, leaving a gap for clinicians. In this clinical guidance paper, we present a cognitive formulation of breastfeeding trauma, drawing from the cognitive model of moral injury in PTSD. The paper aims to support cognitive behavioural therapists to conceptualise breastfeeding trauma through the lens of moral injury where appropriate, and provide treatment guidance through an illustrative case study. Key learning aims (1) To increase awareness of the impact that negative breastfeeding experiences can have on an individual, including moral injury, and/or the development of mental health conditions such as PTSD and depression. (2) To support mental health clinicians, perinatal health professionals, infant feeding professionals, and antenatal educators in their understanding of breastfeeding trauma. (3) To propose a conceptualisation of understanding and treating traumatic breastfeeding experiences, drawing from an existing formulation model for moral injury in PTSD, using cognitive therapy. (4) To emphasise the importance of individualised assessment, formulation and therapy when working with individuals who have experienced traumatic breastfeeding experiences.