From the Guidelines
To alleviate nipple discomfort during lactation, it is recommended to use over-the-counter pain relievers like ibuprofen, as it is considered safe to use during breastfeeding 1.
Key Recommendations
- Ensure proper latch technique to prevent nipple compression against the hard palate
- Apply expressed breast milk or medical-grade lanolin to sore nipples after feeding
- Use cold compresses or gel pads between feedings for relief
- Begin each feeding on the less sore side and vary nursing positions to reduce pressure on specific areas
- Consider using silicone nipple shields with professional guidance for temporary protection
- Air-dry nipples briefly after feeding and change breast pads frequently to maintain dryness
- Hydrogel dressings can promote healing for cracked nipples
Important Considerations
- If severe pain, bleeding, or signs of infection occur, consult a healthcare provider or lactation consultant promptly
- Most nipple discomfort is caused by improper positioning or latch issues
- The use of NSAIDs like ibuprofen, diclofenac, and naproxen is considered safe during lactation, as they have been extensively used and have low levels of detection in breast milk 1
Additional Guidance
- It is essential to support the woman's choice to continue breastfeeding, regardless of the age of the infant, and consider the impact of interrupting lactation on the woman and the infant 1
- In cases where breastfeeding is interrupted, the risk of necrotising enterocolitis in pre-term infants should be considered if breast milk is replaced with formula milk 1
From the Research
Alleviating Nipple Discomfort during Lactation
Nipple discomfort is a common issue faced by lactating mothers, and several studies have investigated ways to alleviate this discomfort. The following are some of the key findings:
- HPA lanolin has been shown to be effective in reducing nipple pain and promoting healing of nipple trauma 2.
- Expressed breastmilk has also been used to treat nipple pain, but its effectiveness is not as well-established as HPA lanolin 2, 3.
- Warm water compresses have been recommended for the prevention and treatment of nipple pain, and may be associated with reduced pain intensity 3, 4.
- Education on proper latch-on and positioning is crucial in preventing nipple pain, and anticipatory guidance regarding the high incidence of early postpartum nipple pain can also be helpful 4, 5.
- Other treatments that have been studied include tea bag compresses, heat, vitamin A, collagenase, dexpanthenol, hydrogel therapy, and glycerin gel therapy, but their effectiveness is not as well-established 5.
Comparison of Topical Agents
Several studies have compared the effectiveness of different topical agents in alleviating nipple discomfort. The findings include:
- HPA lanolin was found to be more effective than expressed breastmilk in reducing nipple pain and promoting healing of nipple trauma 2.
- No significant differences were found among groups using USP-modified lanolin, warm water compresses, and expressed breast milk with air drying in terms of pain intensity, pain affect, or duration of breastfeeding 3.
- A systematic review found that no single intervention offered a dramatic effect in terms of treating pain and/or trauma in breast-feeding women, but warm water compresses and expressed breast-milk may have some benefits in reducing pain and increasing comfort 4.
Recommendations for Practice
Based on the available evidence, the following recommendations can be made:
- HPA lanolin can be recommended for the treatment of nipple pain and trauma 2.
- Warm water compresses can be recommended for the prevention and treatment of nipple pain 3, 4.
- Education on proper latch-on and positioning is crucial in preventing nipple pain, and anticipatory guidance regarding the high incidence of early postpartum nipple pain can also be helpful 4, 5.
- Further research is needed to determine the effectiveness of other interventions, such as lanolin, shells, and expressed breast-milk, in comparison to no treatment 4.