From the Guidelines
Cracked nipples from breastfeeding can negatively impact milk supply and transfer, and it is essential to address the issue promptly to prevent decreased milk production. When nipples become cracked, the pain often causes mothers to shorten feedings or change their baby's latch position, which can reduce milk removal and subsequently decrease milk production. According to the most recent evidence 1, breastfeeding should not be restricted unless the nipples are cracked or bleeding. To address this issue, mothers should continue breastfeeding while treating the cracked nipples. Some key points to consider:
- Applying purified lanolin or medical-grade hydrogel dressings after feedings can promote healing.
- Expressing a few drops of breast milk and allowing it to dry on the nipples also provides natural antibacterial protection.
- Proper positioning and latch technique are crucial—ensure the baby takes a large portion of the areola, not just the nipple.
- Between feedings, allowing nipples to air dry and changing breast pads frequently helps prevent moisture buildup.
- Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain. It is also important to note that, as stated in 1, in those with cracked or bleeding nipples, breast milk should be expressed and discarded. However, this does not necessarily mean that breastfeeding should be stopped entirely, but rather that precautions should be taken to prevent any potential transmission of infection. Addressing cracked nipples quickly is important because continued pain can lead to reduced breastfeeding frequency, inadequate breast emptying, and ultimately decreased milk production. If symptoms worsen or include signs of infection like fever or pus, mothers should consult a healthcare provider promptly, as antibiotics may be necessary.
From the Research
Impact of Cracked Nipples on Milk Supply and Transfer
- Cracked nipples can cause pain for the mother and feeding difficulties for the baby, which may lead to early cessation of breastfeeding 2.
- The risk factors associated with cracked nipples include fair skin, history of nipple cracks, first breastfeeding, and normal weight or no obesity 2.
- Treatment of cracked nipples varies according to the period of breastfeeding and the maternity ward, with common treatments including oils, hydrophilic gel, and maternal milk 2.
Effectiveness of Interventions for Cracked Nipples
- Prophylactic peppermint gel has been shown to be effective in preventing nipple cracks and is more effective than lanolin and placebo 3.
- A systematic review found that warm water compresses are recommended for the prevention of nipple pain, and expressed breast-milk reduces the duration of cracked nipples 4.
- Systemic antibiotics are recommended if a positive culture for Staphylococcus aureus is obtained, as optimal breastfeeding techniques and topical antibiotics ointment may fail to heal most infected, sore, cracked nipples 5.
Management of Nipple Pain and Trauma
- Education for positioning and attachment of the baby to the breast for breastfeeding women needs further studies to assess whether it is more effective as a preventative measure for nipple pain and/or trauma 4.
- Warm water compresses warrant further investigation into their effectiveness in nipple pain, and studies assessing the impact of engorgement, pacifiers, and feeding bottles on nipple pain and/or trauma are suggested 4.
- The use of hydrogel dressings is not recommended due to the high incidence of infections associated with their use 4.