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
    4. Ankyloglossia (tight frenulum or Tongue tied)
  3. Maternal factors
    1. Breast Pump difficulties
    2. Breast engorgement
    3. Nipple vasospasm (e.g. Raynaud's of the nipple)
    4. Flat or inverted nipples
  4. Local Dermatitis
    1. Thrush or Candidiasis
    2. Eczema
    3. Contact Dermatitis (soaps, detergents)
  5. Infection
    1. Cellulitis
    2. Breast abscess
    3. Mastitis

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. See LATCH Score for Breastfeeding Assessment
    2. See Lactation Technique for proper technique
    3. Baby should latch onto as much of areola as possible (not nipple)
    4. Consider Ankyloglossia (Tongue tied with short frenulum)
  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) has similar efficacy to expressed Breast Milk
    2. Hydrogel Dressings (more effective than Lanolin)
  5. Consider yeast over-growth (Candida)
    1. Consider topical Clotrimazole or Miconazole applied to mother's nipples
    2. Consider oral Fluconazole 150 mg every 48 hours for 2 doses
    3. Treat Thrush in infant if present
  6. Consider Impetigo management
    1. Mupirocin (Bactroban) applied three times daily for 5-7 days
  7. Consider Dermatitis or Eczema management
    1. Rinse infants mouth between eating solids and Breast Feeding
    2. Eliminate any topical irritants or allergans
    3. Consider medium potency Topical Corticosteroid (e.g. triamcinolone 0.1% twice daily for 7 days)

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. Resources

VII. References

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