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Healing Tips for Nipple Cracks or Abrasions
By Kelly Bonyata, BS, IBCLC
The following measures can be very helpful if the skin on the nipple
is broken for any reason (cracked nipple due to improper
latch or thrush,
a bite,
milk
blister, etc.).
Keep in mind that one of the most important
factors in healing is to correct the source of the problem.
Continue to work on correct latch and positioning, thrush treatment,
etc. as you treat the symptoms, and talk to a La
Leche League Leader and/or board certified lactation consultant
(IBCLC) if what you're doing is not working.
During the nursing session
| After nursing | Between
nursings | Additional information
- Breastfeed from the uninjured (or less injured) side first.
Baby will tend to nurse more gently on the second side offered.
- The initial latch-on tends to hurt the worst - a brief application
of ice right before latching can help to numb the area.
- Experiment with different breastfeeding positions to determine
which is most comfortable.
- If breastfeeding is too painful, it is very important to express
milk from the injured side to reduce the risk of mastitis and
to maintain supply. If pumping is too painful, try hand
expression.
Salt water rinse
This special type of salt water, called normal saline, has
the same salt concentration as tears and should not be painful to
use.
To make your own normal saline solution:
Mix 1/2 teaspoon of salt in one cup (8 oz) of warm water. Make a
fresh supply each day to avoid bacterial contamination. You may
also buy individual-use packets of sterile saline solution.
- After breastfeeding, soak nipple(s) in a small bowl of warm
saline solution for a minute or so--long enough for the saline
to get onto all areas of the nipple. Alternately, put the saline
solution into a squeeze bottle and squirt it on gently; use plenty
of saline, making sure to get it on all areas of broken skin.
- Avoid prolonged soaking (more than 5-10 minutes) that "super"
hydrates the skin, as this can promote cracking and delay healing.
- Pat dry very gently with a soft paper towel.
- If baby objects to the taste of the residual salt from the saline
rinse, rinse directly before nursing by dipping nipple(s) into
a bowl of plain water. Pat dry gently.
After the salt water rinse
- Apply expressed breastmilk to the nipples to promote healing--this
can be done in addition to other treatments.
- To promote "moist wound healing" (this refers to maintaining
the internal moisture of the skin, not keeping the exterior of
the skin wet) apply a medical grade lanolin ointment (e.g., Lansinoh,
Purelan), soft
paraffin/vaseline
or a hydrogel dressing (e.g., ComfortGel, Soothies).
- If you have thrush, follow the saline soak with an antifungal
ointment or other
thrush treatment.
- If needed, apply an antibiotic ointment (e.g. Bactroban/mupirocin,
Polysporin) or Dr. Jack Newman's All
Purpose Nipple Ointment (APNO; an antibiotic/anti-inflammatory/anti-yeast
combo) sparingly after each feeding.
- Per Hale, Bactroban ointment (mupirocin; lactation risk
category L1/safest), available only by prescription, may be
the best choice for nursing mothers.
- Of the over-the-counter treatments, Polysporin (Polymyxin
B Sulfate and Bacitracin Zinc) may be preferred for topical
use in the nipple area of nursing moms over antibiotic ointments
containing neomycin (such as Neosporin or triple antibiotic
ointment). Neomycin carries a small risk (1-2% of the general
population) of contact dermatitis (see
The
Role of Topical Antibiotics in Dermatologic Practice by
J.J. Leyden, MD).
- It is not necessary to wash small amounts of antibiotic
or APNO ointment from the nipple prior to nursing, even if
baby nurses again within minutes (see Dr. Jack Newman's Sore
Nipples handout). If too much ointment was used and there
is an obvious amount remaining when baby is ready to nurse
again, gently wipe the excess off with a damp cloth.
- Keep nipples exposed to air when possible. When wearing a bra,
use fresh disposable pads (change when damp). Some mothers use
breast shells to protect the nipple from the dampness and friction
of the bra.
- If there is a specific injury--like a bite--cold compresses
(ice packs over a layer of cloth) may help: 20 minutes on, 20
minutes off; repeat as needed.
- Ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) is compatible
with breastfeeding.
- Once a day, use a non-antibacterial, non-perfumed soap to gently
clean the wounded area, then rinse well under running water. Using
soap on the nipple area is not recommended unless the skin
is broken.
Contact your health care provider
if you notice:
Fever, inflammation/redness, swelling, oozing, pus, or other
signs of infection. It is possible to have multiple infections
(both fungal and bacterial).
If the nipple is obviously infected, then talk to your
health care provider about the possibility of using an oral
(systemic) antibiotic. One study indicated that topical
antibiotics and good breastfeeding techniques might not
be sufficient if infection is present. (See
Livingstone V, Stringer LJ. The
treatment of Staphyloccocus aureus infected sore nipples:
a randomized comparative study. J Hum Lact. 1999 Sep;15(3):241-6.)
See also Oral
antibiotic use for sore, cracked nipples.) |
Page last modified:
10/10/2005
Written: 12/27/02
Treatment
of Sore, Cracked, or Bleeding Nipples by Becky Flora, IBCLC
Sore
Nipples by Jack Newman, MD, FRCPC
Nipple
Pain by Paula Yount
Sore
Nipples in the Breastfeeding Mother from Lactation Education
Resources
Moist
Wound Healing for nipple damage in breastfeeding mothers from
Lactation Education Resources
Barton A. Oral
Antibiotics and Positioning Are Effective in Decreasing Morbidity
in Breastfeeding Mothers. Critically-Appraised Topic from University
of Michigan Evidence-Based Pediatrics Web Site, February 14, 2000.
Buchanan P, Hands A, Jones W.
Assessing
the evidence: Cracked Nipples and Moist Wound Healing. Paisley,
Scotland: The Breastfeeding Network, March 2002.
Leyden JJ. The
Role of Topical Antibiotics in Dermatologic Practice. Medscape
Continuing Medical Education Clinical Update; June 25, 2003.
Livingstone V, Stringer LJ. The
treatment of Staphyloccocus aureus infected sore nipples: a randomized
comparative study. J Hum Lact. 1999 Sep;15(3):241-6.
Martin J. Nipple
Pain: Causes, Treatments, and Remedies. Leaven. February-March
2000;36(1):10-11.
Morland-Schultz K, Hill PD. Prevention
of and therapies for nipple pain: a systematic review. J Obstet
Gynecol Neonatal Nurs. 2005 Jul-Aug;34(4):428-37.
Wren AF. Moistness:
The Secret of Healing Sore and Cracked Nipples.
