Management of nipple pain/soreness

Advice mothers on how to improve the baby's position and attachment since in most cases when the baby is well attached the pain decreases

• breastfeeding should be continued
• nipple shells or nipple shields have not been shown to be effective (1)

In cracked nipples, in addition to improving attachment a thin smear of white soft paraffin could be used

• should be applied only to the abrasion
• routine use of creams to prevent nipple trauma or pain is not recommended (2)

The following can be followed to prevent or soothe sore nipples:

• dry the nipples before getting dressed
• changing the breast pads at each feed (if possible use pads without a plastic backing)
• avoid soap since it dries the skin
• wear cotton bras to improve air circulation (3)

In patients with persistent nipple pain despite the above measures, suspect an infection which may be due to:

• candida infection
• bacterial infection - signs such as a yellow discharge or a wound in patients with persistent nipple cracks, a topical antibiotic ointment may be used.

Reference:

• 1. Hoddinott P, Tappin D, Wright C. Breast feeding. BMJ. 2008;336(7649):881-7
• 2. Guidelines and Audit Implementation Network (GAIN) 2009. Guidelines on the treatment, management & prevention of mastitis
• 3. NHS local 2010. Common breast feeding problems