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5.3 General treatment for sore nipples

Key Points - Case Study E

Anna 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?

Topic 5.1: Sore nipples
Nipple tenderness is common in the first seven to ten days postpartum. Nipple cracks, grazes or significant pain indicates nipple trauma, usually associated with sub-optimal positioning and attachment.

What other conditions may contribute to nipple damage occurring in the first week postpartum?

Topic 5.2: Factors causing nipple damage
Other factors that cause nipple pain and damage in the first week postpartum are: engorgement; inverted nipples and other nipple variations; tongue-tie and palatial variations and abnormalities in the infant; infant neurological problems; inappropriate use of lactation aids; and high intra-oral pressure.

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?

Topic 5.3: General treatment for sore nipples
The most important factor in the treatment of sore or cracked nipples is to ensure optimal attachment at all breastfeeds. There is no evidence that any particular topical treatment is effective in preventing or relieving nipple cracks or pain. Occasionally, breastfeeding needs to be suspended until the nipples begin to heal, with the mother expressing her milk and feeding it to her baby with a cup, spoon or bottle.

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

Advice about breastfeeds

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.

Notes

  1. # Moreland-Schultz K et al. (2005) Prevention of and therapies for nipple pain: a systematic review
  2. # Brodribb W (2004) Breastfeeding Management