Cracked nipple
Cracked nipple (nipple trauma or nipple fissure)[1] is a condition that can occur in breastfeeding women as a result of a number of possible causes. Developing a cracked nipple can result in soreness, dryness or irritation to, or bleeding of, one or both nipples during breastfeeding. The mother with a cracked nipple can have severe nipple pain when the baby is nursing. This severe pain is a disincentive for continued breastfeeding. The crack can appear as a cut across the tip of the nipple and may extend to its base.[2] Cracked nipple can develop after the birth of the infant and is managed with pharmacological and nonpharmacological treatment.[3]
Signs and symptoms
Cracked nipples are classified as a breast disorder.
If the nipples appears to be wedge-shaped, white and flattened, this may indicate that the latch is not good and there is a potential of developing cracked nipples.[8]
Complications
Bacteria can enter the breast through cracked nipples, which increase the risk of mastitis.[9] Candida infection (thrush) of the nipple can also occur, resulting in deep-pink, cracked, and sore nipples.[10][2]
Contraindications for breastfeeding
Because cracked nipples can result in the infant being exposed to blood, women with certain blood-borne diseases may be advised to stop breastfeeding if they have a cracked nipple. It has been found safe for breastfeeding mothers with hepatitis B and cracked nipples to breastfeed.[11] In the event that a nursing woman experiences cracked and bleeding nipples or breast inflammation within one to two weeks immediately following an acute Toxoplasmosis infection (when the organism is still circulating in her bloodstream), it is theoretically possible that she could transmit Toxoplasma gondii to the infant through her breast milk. Immune suppressed women could have circulating Toxoplasma for even longer periods of time. However, the likelihood of human milk transmission is very small.[12] Transmission risk of HIV increases if the mother has cracked and bleeding nipples.[13][2] An uncommon infection in the mother, Chagas disease, can be transmitted to the nursing infant via cracked nipples.[14] Women with hepatitis C are advised to abstain from breastfeeding if their nipples are cracked or bleeding.[15][16]
Cause
Some studies indicate that cracked nipples are caused by poor latch.[17] Yet other causes could be poor positioning, use of a feeding bottle, breast engorgement, inexperience, semi-protruding nipples, use of breast pumps and light pigmentation of the nipples. Breast engorgement is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat.[1]
When the baby is
If a
Pain caused by cracked nipples can sometimes lead to the cessation of breast-feeding.
Prevention
The nipples of nursing mothers naturally make a lubricant to prevent drying, cracking, or infections.[5] Cracked nipples may be able to be prevented by:
- Avoid soaps and harsh washing or drying of the breasts and nipples. This can cause dryness and cracking.[19]
- Rubbing a little breast milk on the nipple after feeding to protect it.[7][19][20]
- Keeping the nipples dry to prevent cracking and infection.[21][19]
Treatment
Cracked nipples can be treated with 100% lanolin. Glycerin nipple pads can be chilled and placed over the nipples to help soothe and heal cracked or painful nipples.[21] If the cause of cracked nipples is from thrush, treatment is usually begun with nystatin. If the mother is symptomatic then the mother and the baby can be treated.[2] Continuing to breastfeed will actually help the nipples heal. A little breast milk or purified lanolin cream or ointment helps the healing process.[7] Breastfeeding professionals that include nurses, midwives and lactation consultants are able to assist in the treatment of cracked nipples.[6]
Advice from others is abundant but there have been some treatments that have been identified as not being effective in healing or preventing cracked nipples. These ineffective treatments are keeping the breastfeeding short and using a nipple guard. Keeping the feedings short so that the nipples can rest is not effective in relieving the pain of cracked nipples and it could have a negative effect on the milk supply. Nipple shields do not improve latching on.[8]
Epidemiology
In a survey in New York City, 35% of nursing mothers stopped breastfeeding after one week due to the pain of cracked nipples.[23] Thirty percent stopped breastfeeding between weeks one and three. Another survey of breastfeeding mothers in Brazil reported that there was 25% higher risk of interruption of exclusive breastfeeding when the women had cracked nipples. Mothers with higher education levels were more likely to continue breastfeeding despite the pain of cracked nipples.[1]
Society and culture
The importance of preventing cracked nipples while breastfeeding has been reported.[19] In an informal survey of breastfeeding in the UK, some mothers reported that they stopped breastfeeding because the cracked nipples made it too painful.[24]
See also
- List of cutaneous conditions
References
- ^ PMID 27496088.
- ^ a b c d e f "Management of breast conditions and other breastfeeding difficulties". National Center for Biotechnology and Information, US National Library of Medicine. Retrieved 3 August 2017.
- ^ Henry 2016, p. 120.
- ^ "ICD-10 Version:2016". apps.who.int. Retrieved 4 August 2017.
- ^ PMID 19851461.
- ^ a b c d "Breastfeeding problems". www.nhs.uk. National Health Service (UK). Retrieved 4 August 2017.
- ^ a b c d e f "Common questions about breastfeeding and pain". WomensHealth.gov. 2017-06-09. Retrieved 4 August 2017. This article incorporates text from this source, which is in the public domain.
- ^ a b c "Sore or cracked nipples when breastfeeding, Pregnancy and baby guide". www.nhs.uk. National Health Services (UK). Retrieved 4 August 2017.
- S2CID 24047831.
- ^ "Thrush in newborns: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
- ^ "Hepatitis B and C Infections - Breastfeeding - CDC". www.cdc.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
- ^ "Toxoplasmosis - Breastfeeding - CDC". www.cdc.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
- ^ https://www.cdc.gov/globalaids/resources/pmtct-care/docs/pocketguide.doc This link opens a document that opens rather than a web page. This article incorporates text from this source, which is in the public domain.
- ^ Prevention, CDC - Centers for Disease Control and. "CDC - Chagas Disease - Detailed Fact Sheet". www.cdc.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
- ^ "HCV FAQs for Health Professionals - Division of Viral Hepatitis - CDC". www.cdc.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
- ^ "Breastfeeding vs. Formula Feeding: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
- )
- ISBN 978-1-4511-7653-7.
- ^ a b c d "World Breastfeeding Week: Supporting mothers to reach the six month mark". Retrieved 4 August 2017.
- ^ "Your guide to breastfeeding" (PDF). womenshealth.gov. Archived from the original (PDF) on 2021-04-14. Retrieved 2020-10-29.
- ^ a b "Positioning your baby for breastfeeding: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
- ^ "Roman chamomile: MedlinePlus Supplements". medlineplus.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
- S2CID 41990593.
- ^ "6 Reasons Why You Might Have Stopped Breastfeeding, And That's Okay". 4 August 2017. Retrieved 4 August 2017.
Bibliography
- Henry, Norma (2016). RN maternal newborn nursing : review module. Stilwell, KS: Assessment Technologies Institute. ISBN 9781565335691.
- Dennis, Cindy-Lee; Jackson, Kim; Watson, Jo (2014-12-15). "The Cochrane Library". Cochrane Database of Systematic Reviews (12): CD007366. PMID 25506813.