Treatment of Dry Nipples During Exclusive Breastfeeding
Apply highly purified anhydrous (HPA) lanolin to dry nipples after each feeding, as this has been shown to promote faster healing and reduce nipple pain more effectively than other topical treatments. 1
Primary Treatment Approach
- HPA lanolin should be the first-line topical treatment for dry, painful nipples in breastfeeding mothers, as it demonstrates superior healing rates and pain reduction compared to expressed breast milk or no treatment 2, 1
- Apply a thin layer of HPA lanolin to the nipple and areola after each feeding; it does not need to be removed before the next feeding 2, 1
- Continue lanolin application until symptoms resolve, typically within 7-10 days for most women 3
Essential Concurrent Management
Correcting breastfeeding technique is critical, as poor infant positioning or latch is the most common underlying cause of nipple trauma and dryness 3:
- Ensure proper infant positioning with the baby's mouth covering a large portion of the areola, not just the nipple 3
- Verify adequate latch by observing for infant's lips flanged outward, chin touching breast, and rhythmic sucking with audible swallowing 4
- All treatment interventions should be combined with education on proper breastfeeding technique, as this is fundamental to resolution 3, 2
Alternative and Adjunctive Options
If lanolin is unavailable or not tolerated:
- Breast shells combined with lanolin may provide additional benefit by protecting nipples between feedings 2
- Expressed breast milk applied to nipples showed some benefit for pain reduction at 4-5 days in one trial, though this effect was not sustained and was less effective than lanolin 3, 1
- Warm water compresses may provide symptomatic relief, though evidence is limited 5
What NOT to Use
- Avoid hydrogel dressings, as they are associated with significantly higher infection rates and are less effective than lanolin with breast shells 2
- Glycerine gel dressings show no evidence of benefit for nipple pain reduction 3
Important Counseling Points
- Provide anticipatory guidance that nipple pain typically reduces to mild levels within 7-10 days postpartum regardless of treatment, which helps mothers persist through this difficult period 3
- Reassure mothers that continuing exclusive breastfeeding is safe and beneficial during treatment 6, 7
- Most topical treatments including lanolin are compatible with continued breastfeeding and do not require removal before nursing 2, 1
Red Flags Requiring Further Evaluation
Refer for additional assessment if:
- Severe burning or stinging pain radiating into the breast that persists throughout and beyond feedings may indicate nipple candidiasis, requiring antifungal treatment 8
- Nipple trauma not improving after 10-14 days despite proper technique and lanolin use 3
- Signs of breast infection (mastitis) including fever, localized breast tenderness, or systemic symptoms 8
- Cracked or bleeding nipples that worsen despite treatment 2, 8
Common Pitfalls to Avoid
- Do not delay addressing breastfeeding technique while focusing solely on topical treatments—technique correction is foundational 3, 2
- Avoid recommending multiple simultaneous topical agents, as this complicates assessment of effectiveness and may increase infection risk 2
- Do not discourage continued breastfeeding during treatment, as most interventions are compatible with ongoing nursing 6