5.3 General treatment for sore nipples
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![]() Key Points - Case Study EAnna is seven days postpartum. She is unsure whether she can continue to breastfeed her baby, Joshua, because of sore and cracked nipples. The cracks have increased in size since they first developed and it is excruciating to feed Joshua. What is the most likely cause of Anna's sore nipple?
What other conditions may contribute to nipple damage occurring in the first week postpartum?
After careful assessment, it appears that sub-optimal positioning and attachment issues are the cause of Anna's sore and cracked nipples. What is the most appropriate treatment to offer Anna at this stage?
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After careful assessment, it appears that sub-optimal positioning and attachment issues are the cause of Anna's sore and cracked nipples. What is the most appropriate treatment to offer Anna at this stage?
Assess positioning and attachment
- Provide appropriate assistance to ensure optimal attachment at all feeds.
Advice about breastfeeds
- Commence feeds when the infant initiates feeding cues (beginning to root, hands to mouth), rather than waiting until he is very hungry and crying.
- Start feeds on the least sore side. The baby can be swapped to the other side once milk is flowing freely.
- If both sides are very painful, express (preferably by hand) until the milk is flowing freely, and then attach the infant.
- Gently remove the infant from the breast by releasing the suction when he has stopped sucking effectively.
- Suggest using different feeding positions.
Advice about nipple treatment
Lactation aids
Breast shells or nipple airers lift clothing from the nipple and allow air to circulate2, providing pain relief for some women.
Rest nipples
If Anna finds it too painful to continue to breastfeed, she can express her milk (hand expression creates less nipple trauma) for 24 to 48 hours and feed this milk to Joshua with a cup, spoon or bottle. Once the nipples begin to heal, breastfeeds can gradually be reintroduced.
These measures should be used for all women with sore/cracked nipple, regardless of the cause, in conjunction with other treatments if necessary.