Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments.

Jacqueline Kent,Marnie Rowan,Georgia Mather-Mccaw,Catherine Hardwick,Elisa Chia,Kyle Fairclough,Elizabeth Ashton,Donna Geddes,Katherine Navarro,Courtney Scott,Lalitha Menon

doi:10.3390/ijerph121012247

Abstract

Background: Persistent nipple pain is one of the most common reasons given by mothers for ceasing exclusive breastfeeding. We aimed to determine the frequency of nipple pain as a reason for consultation, the most common attributed aetiologies, and the effectiveness of the advice and treatment given. Methods: All consultations at the Breast Feeding Centre of Western Australia (WA) were audited over two six-month periods in 2011 (n = 469) and 2014 (n = 708). Attributed cause(s) of nipple pain, microbiology results, treatment(s) advised, and resolution of pain were recorded. Results: Nipple pain was one of the reasons for consultation in 36% of cases. The most common attributed cause of nipple pain was incorrect positioning and attachment, followed by tongue tie, infection, palatal anomaly, flat or inverted nipples, mastitis, and vasospasm. Advice included correction of positioning and attachment, use of a nipple shield, resting the nipples and expressing breastmilk, frenotomy, oral antibiotics, topical treatments, and cold or warm compresses. Pain was resolving or resolved in 57% of cases after 18 days (range 2–110). Conclusion: The multiple attributed causes of nipple pain, possibly as a result of a cascade of events, suggests that effective early lactation management for prevention of nipple pain and early diagnosis and effective treatment are crucial to avoid early weaning.

Highlights

Persistent nipple pain is one of the most common reasons given by mothers for ceasing exclusive breastfeeding [1,2]
We identified the most common attributed aetiologies of nipple pain, the advice and/or treatment given to the mothers to alleviate the pain, and the effectiveness of the advice and treatment
It is possible that there were no presentations of these skin conditions during the audit period, but it would be surprising if there were no cases of strong infant suction given that McCellan et al [15] found that two thirds of mothers with chronic nipple pain had infants that exerted significantly stronger vacuums compared to infants of breastfeeding mothers without pain

Summary

Introduction

Persistent nipple pain is one of the most common reasons given by mothers for ceasing exclusive breastfeeding [1,2]. Breastfeeding pain has been expressed as a concern for mothers, in the immediate post-partum period, but for over one-third of mothers at two weeks and one month after birth [3,4]. It is not just painful, but can cause psychological distress and interfere with general activity, mood, sleep, and bonding between mother and infant [5,6]. We aimed to determine the frequency of nipple pain as a reason for consultation, the most common attributed aetiologies, and the effectiveness of the advice and treatment given. Conclusion: The multiple attributed causes of nipple pain, possibly as a result of a cascade of events, suggests that effective early lactation management for prevention of nipple pain and early diagnosis and effective treatment are crucial to avoid early weaning

Results

Discussion

Conclusion