II. Causes

  1. Normal for first several days after birth
    1. Resolves in first week if positioning is ok
  2. Infant factors
    1. Incorrect infant positioning or latching on
    2. Incorrect infant Tongue positioning
    3. Infant with strong clench
  3. Local Dermatitis
    1. Thrush
    2. Eczema
    3. Contact Dermatitis (soaps, detergents)
  4. Other causes
    1. Breast Pump difficulties
    2. Breast engorgement
    3. Nipple vasospasm (e.g. Raynaud's of the nipple)

III. Complications

  1. Fissures
  2. Superinfection with yeast or Bacteria (including Mastitis)
  3. Cessation of Breast Feeding

IV. Management

  1. Avoid irritants (soaps, detergents, lotions)
  2. Proper Infant latch-on and positioning
    1. Baby should latch onto areola (not nipple)
    2. See Lactation Resources for proper technique
  3. Soothing home remedies to apply to nipples
    1. Warm moist compresses
    2. Moist Wound Healing with moisture barrier
    3. Express a smaller amount of Breast Milk and massage over nipple before and after each feeding
  4. Topical Ointments or Lotions
    1. Lanolin (Lansinoh)
  5. Consider yeast over-growth (Candida)
    1. Consider topical Clotrimazole or Miconazole applied to mother's nipples
    2. Treat Thrush in infant if present

V. Management: Disproved remedies

  1. Warmed tea bags
    1. Not helpful and may cause nipple drying, cracking
    2. Lavergne (1997) J Obstet Gynecol Neonatal Nurs 26 [PubMed]
  2. Drying Breast (e.g. hair blower)
  3. Topical agents not recommended by La Leche
    1. Masse Breast Feeding cream
    2. Bag Balm (Veterinary product)
      1. Washed off before nursing
  4. Nipple Shields
    1. No longer recommended

VI. References

  1. (2016) Presc Lett 23(12): 71
  2. La Leche League Breast Feeding Information
    1. http://www.lalecheleague.org/bfinfo.html

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