Sore Nipples Research Articles

Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial

BackgroundBiological nurturing is a neurobehavioral approach to breastfeeding support that encourages women to breastfed in a relaxed, laidback position. This approach has the potential to reduce breast problems (e.g., sore nipples), making good latch easier and thus facilitating the initiation of exclusive breastfeeding. However, its effects have not been adequately investigated in a real-life situation. The aim of this randomized controlled trial was to assess the effectiveness of biological nurturing, compared to usual hospital practices, on the frequency of breast problems and on the prevalence of exclusive breastfeeding at discharge from the maternity ward, after 1 week, and at one and 4 months.MethodsOpen randomized parallel controlled trial carried out in a third level maternity ward (IRCCS Burlo Garofolo, Trieste, Italy) between March and December 2018. Two-hundred eight women who planned to give birth at the hospital and who expressed the intention to breastfeed were enrolled during pregnancy and randomized to receive breastfeeding support following either the biological nurturing approach or the usual care protocol based on the WHO/UNICEF 20-h course, in use at the hospital. The primary study outcome was the incidence of breast problems during hospital stay, defined as the presence of one or more of the following outcomes, collected separately: sore nipples, cracked nipples, engorgement and mastitis. The primary analysis was performed by intention to treat. The follow up lasted 4 months.ResultsOne hundred eighty eight out of 208 women (90.3%) were included in the analysis, 90 allocated to the biological nurturing group and 98 to the usual care group. At discharge from the maternity ward, biological nurturing significantly reduced the risk of breast problems (Relative risk [RR] 0.56, 95% Confidence Interval [CI] 0.40, 0.79), including cracked (RR 0.42, 95% CI 0.24, 0.74) and sore nipples (RR 0.59, 95% CI 0.40, 0.88). No statistically significant difference was observed for exclusive breastfeeding at discharge and up to 4 months. No adverse events occurred.ConclusionsThe biological nurturing approach applied in the real-life situation of a third level hospital was effective in preventing breast problems.Trial registrationClinicaltrials.gov NCT03503500. Date of First Submission: 28 March 2018.

Comparison of the Effect of Aloe Vera Extract, Breast Milk, Calendit-E, Curcumin, Lanolin, Olive Oil, and Purslane on Healing of Breast Fissure in Lactating Mothers: A Systematic Reviwe

Background: Sore nipples are a common problem in breast-feeding women which can cause early cessation of breast-feeding. We aimed to evaluate the effect of Aloe Vera extract, breast milk, Calendit-E, Curcumin, Lanolin, Olive oil, and Purslane on healing of breast fissure in lactating mothers. Materials and Methods: All clinical trials evaluating the effect of Aloe Vera extract, breast milk, Calendit-E, Curcumin, Lanolin, Olive oil, and Purslaneon healing of breast fissure in lactating mothers were searched on the online databases of Scopus, EMBASE, Cochrane, Web of Science and Medline with no language or time restrictions using the combination related keywords of Mesh. Study selection was done by two reviews. Results: Six studies were included here with a total sample size of 546 subjects. The results showed that aloe vera gel and Purslane cream are more effective than lanolin ointment for healing sore nipples. Calendit-E cream, and aloe vera gel were more effective than breast-fed milk for treating sore nipples. However, no significant difference was observed between the mother's breast milk group and olive oil. Concerning the limited side effects, as well as greater impact and antimicrobial activity of curcumin in the short term, it was suggested to use curcumin for treating sore nipples. Conclusion: Aloe vera gel and purslane cream, Calendit-E cream, and curcumin can have beneficial effects on improving sore nipples. Usage of these therapeutic methods is suggested to improve sore nipples given their low cost and limited side effects.

The impact of birth-related injury and pain on breastfeeding outcomes

Background Reasons for premature discontinuation of breastfeeding are complex; a variety of social, psychological and physical factors may contribute to a deviation from a mother's breastfeeding plan. Aims To investigate how actual experiences of birth and breastfeeding differed from the mother's pre-birth intentions, and any subsequent perceived impact on breastfeeding experience. Methods Data was collected via an online survey of UK-based women (n=1 000). Findings Respondents faced a variety of challenges when breastfeeding, including nipple soreness and pain, concerns around milk insufficiency, and birth-related pain which impacted their ability to breastfeed comfortably. Predominantly, birth-related pain made breastfeeding difficult rather than preventing it, however 5% of mothers surveyed cited it as contributing to premature cessation of breastfeeding. Conclusions Pain relating to birth may be an under-considered factor in early cessation of breastfeeding. Considering the challenges experienced when establishing and maintaining breastfeeding, it is essential to consider the cumulative pain and discomfort experienced from all sources.

Difficulties in breastfeeding: Easy solution by Oketani breast massage

Background: Breastfeeding is universally recommended feeding method for promoting child survival. Many mothers in developing countries do not practice optimum breastfeeding due to difficulties in the breast that may lead to temporary or permanent cessation of breastfeeding. Oketani breast massage approach is one such technique to overcome those difficulties for successful lactation to promote child growth. The aim of this study was to assess the difficulties in breastfeeding and mother’s expression on benefits of Oketani breast massage.
 Methods: A cross sectional study was conducted at lactational management center (LMC) in the Institute of Child Mother Health (ICMH), Dhaka, Bangladesh during March to August 2015. A total of 98 mothers (having 0-12 month’s old children) who had breast problems or difficulty in breastfeeding were included in the study. The mothers agreed to undertake Oketani massage. This is a breast massage that promotes breast milk production and helps the lactating mothers to overcome certain difficulties in the breast. Mothers who received Oketani massage were interviewed using a semi-structured questionnaire.
 Results: Ninety-eight mothers were interviewed for this study. About two-thirds (66.3%) of babies were girls of which 57.1% were less than 2 months. More than two-thirds (78.6%) mother ages were more than 25 years. Half of the mothers completed secondary school certificate (SSC) in which non-working (63.3%) mothers were more than working mother (36.7%). The proportion of exclusive breastfeeding practice was 50.0%. Most common difficulties included breast engorgement (22.4%), followed by sore nipple (17.3%) and insufficient milk (14.3%). After receiving Oketani massage mother’s perception of getting confidence improved to 80.6%. About 69% said that the baby can be fed well, 61.2% felt that there was increase in breast milk production and 56.1% mothers expressed feeling good after the massage. Study findings revealed that Breast feeding significantly improved with the Oketani breast massage (p=0.001).
 Conclusion: Oketani massage is considered as a useful technique to build confidence and improved milk secretion among mothers facing difficulty during lactation. A multicentre study with detailed assessment of quality, the quantity of breastmilk as well as baby’s growth and nutritional assessment is recommended.

Effects of both Aloe Vera gel and breast milk on the improvement of nipple soreness in lactating women—A randomized controlled trial

BackgroundNipple soreness is an ordinary disturbance during the lactating period. With high prevalence of nipple soreness and its effects on lactating, there is evidence that Aloe Vera gel as an anti-inflammatory and anti-infection herb may be an appropriate treatment. PurposeThe purpose of this study is to determine the effect of Aloe Vera gel on improving nipple soreness in lactating women. MethodsThis randomized controlled trial was conducted on 110 primiparous lactating women randomly separated into two groups. In the Aloe Vera gel group, women applied 0.5 cc of Aloe Vera gel and the control group applied four drops of their own milk on their nipple and areola after each feeding. Then, the two groups were checked on days 10 and 14 postpartum. The visual analogue scale for pain intensity and Amir Scale for the severity of damage, and the existence or lack of nipple discharge was also recorded. The data were analyzed by the SPSS21software. ResultsThe mean intensity of pain and nipple damage before treatment and 10 days after delivery and before treatment and 14 days after delivery in the intervention group had a significant difference (P <0.001). In comparison of nipple discharge between the two groups before treatment and 10days after delivery and before treatment and 14 days after delivery, indicated a significant difference (P<0.001). ConclusionAccording to the study, it seems that Aloe Vera gel can improve nipple soreness.

HUBUNGAN ANTARA TEHNIK MENYUSUI DAN PERAWATAN PAYUDARA DENGAN PUTING SUSU PADA IBU NIFAS PRIMIPARA

Nipple blisters can be caused by trauma to the nipple during breastfeeding, but it can also cause cracks and the formation of a gap - a gap. The incidence of sore nipples caused by several factors including improper feeding techniques and lack of breast care. This study aims to investigate the relationship between breastfeeding and breast care techniques with incidence of sore nipples. This research was conducted in June 2017 and BPS BPS Meiyuni Siti Hotijah Bangkalan. This research uses a checklist approach Sectional Cros. Subjects studied were maternal postpartum primipara 1-40 day total of 36 people. The sampling technique used was simple random sampling. Statistic test used lambda. The results showed breastfeeding technique in the category of pretty 16 respondents (44.4%) and treatment of breast category fairly 18 respondents (50%), while the incidence of sore nipples in the category were 18 respondents (50%). Statistical test results showed the value of breastfeeding technique p Value (0.019) &lt;α (0.05) means that there is a correlation technique of breastfeeding on the incidence of sore nipples, while for the treatment of breast statistical result p value Value (0.047) &lt;α (0.05 ) means that there is a relationship to the incidence rate of breast care sore nipples. This research is expected to provide knowledge to prevent the incidence of sore nipples in a mannerappropriate feeding techniques and treatment of breast good.

Effect of Breast Milk versus Lanolin on Healing of Sore Nipple among Postnatal Lactating Mothers

statistically significant difference between the two groups in favor of the breast milk in caring of

Maternal challenges of exclusive breastfeeding and complementary feeding in Ghana.

Mothers are recommended to exclusively breastfeed their infants for the first six months of their lives. Also, after the sixth month, breastfeeding should continue with added complementary foods to the diets of children. Studies designed to sought the views of mothers on breastfeeding practices are limited. The aim of this study was to explore challenges to breastfeeding practices by considering spatial, societal and maternal characteristics in Ghana. Twenty mothers aged 15–49 years were interviewed purposively in selected communities within two regions of the country. Thematic content analytical procedures were applied to interpret and present findings. Challenges (to both exclusive breastfeeding and complementary feeding) spanned across spatial (home and work places), societal, and maternal characteristics. Key themes identified were in relation to household chores, work schedules, family influence, low breast milk production, swollen breasts or sore nipples, access to food items and preparation or giving foods. Addressing these challenges would require co-creation of supportive environments between couples and significant others as well as tackling institutional barriers that obstruct adequate breastfeeding among mothers. On complementary feeding, there is the need to form community health volunteers help educate mothers more on how to appropriately use local foods to feed their children.

Frenotomy for tongue-tie (frenulum linguae breve) showed improved symptoms in the short- and long-term follow-up.

To evaluate clinical manifestations of tongue-tie as well as short-term and long-term outcomes following frenotomy. In this retrospective study, for 329 patients (295 infants and 34 children) who underwent frenotomy between 2011 and 2017, symptoms, short-term and long-term outcomes were evaluated. Of the 295 infants (median age six weeks), 199 (=60%) showed inadequate breastfeeding. Symptoms were painful or sore maternal nipples, poor weight gain, dribbling milk from the corner of the mouth, reduced milk supply, inadequate latch during bottle-feeding and maternal mastitis. In the 34 children, predominant symptoms were articulation disorders, misaligned teeth and problems with swallowing solid food. Of the 141 patients with short-term feedback, 86% reported improvement, 13% an unchanged situation. In a former premature, the reported worsening of symptoms ('breath spells') are likely related to prematurity. Of the 164 patients where the questionnaire for long-term outcome was provided, 82% reported improvement, 16% an unchanged situation. For two infants worsening was reported, referring to refusal to drink from breast or bottle for two hours after the procedure and fever for one day, respectively. Frenulum breve is a potential cause of breastfeeding difficulties and can be treated safely and efficiently by frenotomy.

Experience of Sore Nipple and the Remedies Used among Postnatal Mothers

Objective: To assess the experience of postnatal mothers regarding sore nipples, to explore the remedies adopted for sore nipple symptom relief and to compare the experience of primipara and multipara mothers regarding sore nipples. Method: An explorative survey design was adopted and 200 postnatal mothers were selected by purposive sampling technique. The data were collected by administering demographic proforma, semi structured questionnaire on experience of sore nipple and remedies adopted for the management of sore nipple. Results and Conclusion: The study findings revealed that, 120 (60%) mothers developed sore nipple problem within one week. Pain persisted for more than one week for 120 (60%) mothers. Majority of the mothers, 180 (90%) used remedial measures for the relief of pain. Most of the primi para mothers, 160 (80%) expressed it as “very severe” “horrible” and “intolerable” pain compared to multipara mothers. The study concluded that despite of having sore nipple, all the mothers continued breast feeding, so that baby will not be deprived of its nutrition.

The Effect of nipple soreness treatment with Purslane Cream and Lanolin on Frequency and duration of Breastfeeding in nursing mothers: A Randomized Clinical Trial

Background & aim: Despite the global efforts to promote breastfeeding, women report some problems leading to stop breastfeeding in the early postpartum. Nipple soreness is considered as one of the main causes of early breastfeeding discontinuation. Treatment of this problem could keep breastfeeding for a prolonged period of time. Therefore, the present study aimed to investigate the effect of nipple pain treatment with lanolin and purslane cream on frequency and duration of breastfeeding. Methods: This double-blinded, randomized clinical trial was conducted on 86 breastfeeding women with nipple soreness who attended healthcare clinics in Mashhad, Iran, in 2016. The participants were randomly allocated to two equally sized group (43 in each), receiving purslane cream and lanolin for eight days. The correct method of breastfeeding and using the cream were trained to both groups. The nipple pain score was measured before intervention and on the third and eighth days post-intervention using a numeric pain rating scale. The subjects were also trained to record the duration and frequency of breastfeeding during the study period. Data were analyzed by SPSS version 22 using t-test, Fisher's exact test, Chi-square, and Wilcoxon tests. Results: Two study groups were identical in terms of the pain intensity before intervention. There was a significant difference concerning the pain intensity between the two groups on days 3 and 8. The pain intensity in the purslane cream group was significantly lower than the lanolin group (p <0.001). The frequency of breastfeeding in the purslane group after the fourth day was significantly higher than the lanolin group (P=0.017). However, there was no significant difference between the two groups regarding the duration of breastfeeding (P=0.423). Conclusion: Improving nipple pain by purslane cream can promote the frequency of breastfeeding. As a result, it can be considered as an effective agent in treatment of nipple soreness in nursing mothers.

Deep breast pain during lactation: a case-control study in Sweden investigating the role of Candida albicans

BackgroundDeep breast pain during lactation, with or without accompanying nipple pain and soreness continues to be anecdotally linked to infection by Candia albicans despite lack of robust evidence in the literature that Candida albicans is the cause of women’s breast symptoms.MethodsA case-control study of breastfeeding women in Sweden with (n 35) and without (n 35) symptoms that may be attributable to Candida albicans was carried out. The symptoms were radiating, burning and penetrating or non-penetrating breast pain with or without associated nipple pain during or after breastfeeding. The primary aim of the study was to test the hypothesis that breastfeeding women with symptoms commonly associated with Candida albicans infection will have a growth of Candida albicans in their breast milk significantly more often than women without these symptoms. A secondary aim was comparison of breastfeeding self-efficacy, measured by the BSES-SF (Breastfeeding Self Efficacy Scale –Short Form), between cases and controls.ResultsNone of the women in the control group and eight of the women in the case group showed a growth of Candida albicans in their breast milk (p < 0.01), which confirms the hypothesis. There were no statistically significant differences in severity or type of symptoms between those in the case group with and without growth of Candida albicans in their breast milk. Results of the BSES-SF measurement showed no statistically significant differences between cases and controls. However, when analyses were stratified for parity, multiparous controls showed statistically significant higher scores for breastfeeding self-efficacy than multiparous cases.ConclusionsNeither clinical symptoms nor microbial cultivation appear to be reliable means for making a diagnosis of Candida albicans infection of the breast. Skilled breastfeeding consultants should offer support and help with positioning, attachment and identification of physical impediments to successful breastfeeding. Professionals should be aware that it is possible that uncertainty in the breastfeeding situation may to some extent account for mothers’ breast symptoms. The ISRCTN (International Standard Randomised Controlled Trial Number) identity for this case-control study is ISRCTN88839993. The study was retrospectively registered on 30 November 2016.

The Effect of Zizyphus Jujube Fruit Lotion on Breast Fissure in Breastfeeding Women.

Nipple fissure is a common problem during breastfeeding. Zizyphus Jujube Fruits is one of the oldest medicinal plants which can heal wounds through its antimicrobial and anti-inflammatory properties. This study aimed to determine the effect of jujube lotion on the recovery of breast fissure. This double-blind clinical trial recruited 100 primiparous lactating women who were randomly divided into two groups. In Jujube group, mothers used 0.5 mL of Fruit Lotion, and in control group mothers applied 4-5 drops of their breast milk five times a day, after breastfeeding. Both groups were examined on the 7th and 14th days after childbirth. The damage severity was assessed using the Amir scale and the presence or absence of nipple discharge was recorded. A significant difference was observed between the two groups in the extent of nipple damage before intervention on the 3rd day after childbirth and after intervention on the 7th and 14th days after childbirth (P = 0/02، P = 0/000). No significant difference was observed in sore nipple discharge between the two groups before the study and on the 7th day, while a statistically significant difference was observed between the two groups on the 14th day (P = 0/1, P = 0/01). The finding of this study revealed that the Zizyphus jujube fruits lotion heals nipple fissure faster and better than breast milk.

Postpartum Morbidities and the Influential Factors in Gonabad, Iran (2016)

Introduction: Postpartum morbidities are among the most important health problems across the world. However, the frequency and types of these morbidities remain unclear. The present study aimed to evaluate postpartum morbidities and the influential factors in the women in Gonabad city, Iran. Methods: This cross-sectional study was conducted in Gonabad city, located in the northeast of Iran, during 2015-2016. Subjects included 158 pregnant women referring to the community health center in Gonabad for prenatal care. Data on the pregnancy period were collected using the general health questionnaire (GHQ-28) and demographic questionnaires, and the scale of postpartum morbidities was used two months after delivery. Data analysis was performed in SPSS version 16 using the Kolmogorov-Smirnov test and Chi-square at the significance level of P<0.05. Results: The most common postpartum morbidities included pain in the C-section sutures (69), fatigue (50), backache (46.5), episiotomy pain (46.5), and sleep disturbance (44.4). Moreover, statistically significant correlations were observed between headaches and feeding method (P=0.038), constipation and low maternal age (P=0.027), flatulence and mode of delivery (P=0.018), pain in C-section sutures and high maternal age (P=0.017), episiotomy pain and low maternal age (P=0.008), urinary frequency and maternal occupation (P=0.029), sore nipples and low maternal age (P=0.013), sore nipples and exclusive breastfeeding (P=0.040), and dysuria and neonatal weight (P<0.0001). Conclusion: According to the results, the most common postpartum morbidities were pain in C-section site, fatigue, backache, episiotomy pain, and sleep disturbance. Considering the high frequency of these morbidities, it is recommended that accurate postpartum examinations be performed, focusing on the timely diagnosis and treatment of these problems.

Community pharmacists’ services for women during pregnancy and breast feeding in Kuwait: a cross-sectional study

ObjectivesThis study was designed to identify the services provided by community pharmacists in Kuwait and their views regarding self-care in pregnancy and lactation. In addition, it determined the pharmacists’ recommendations...

SPN Position Statement: The Role of Pediatric Nurses in the Promotion and Protection of Human Milk and Breastfeeding

SPN Position Statement: The Role of Pediatric Nurses in the Promotion and Protection of Human Milk and Breastfeeding

Why Chinese mothers stop breastfeeding: Mothers' self-reported reasons for stopping during the first six months.

The reasons why mothers in mainland China stop breastfeeding before their infants were six months old was investigated. Five hundred sixty-two mothers within two to three days after delivery in a hospital in Guangzhou, China, were followed up via telephone interview at one, four, and six months postpartum between January and August 2015 to assess their infant's feeding patterns and mother's reasons for breastfeeding cessation. Measures included the questionnaire about sociodemographic, psychosocial, and perinatal characteristics, the Breastfeeding Outcome Questionnaire and the Breastfeeding Self-efficacy Scale-Short Form. Compared with mothers who continued breastfeeding for at least six months, the mothers who stopped breastfeeding were less likely to have attended the perinatal classes, used more inhospital formula, and were less self-efficacious regarding breastfeeding and less intention to exclusive breastfeeding. The reasons that 180 mothers stopped breastfeeding before their infants were six months old were analyzed with content analysis. The reasons given for breastfeeding cessation were insufficient milk supply, medical reasons, lactational factors, and return to work. Lactational factors were nipple soreness and mastitis. In order to prolong breastfeeding, pregnant women should be encouraged to attend more prenatal classes. Attendance would enhance self-efficacy and intention to breastfeed longer. Strategies helping working mothers to continue breastfeeding are also needed.

Mammary candidiasis: A medical condition without scientific evidence?

Many physicians, midwives and lactation consultants still believe that yeasts (particularly Candida spp.) play an important role as an agent of nipple and breast pain despite the absolute absence of scientific proofs to establish such association. In this context, the objective of this study was to investigate the microorganisms involved in sore nipples and/or painful “shooting” breastfeeding by using a variety of microscopy techniques, as well as culture-dependent and–independent identification methods. Initially, 60 women (30 diagnosed as suffering “mammary candidiasis” and 30 with no painful breastfeeding) were recruited to elucidate the role of their pumps on the milk microbial profiles. After realizing the bias introduced by using such devices, manual expression was selected as the collection method for the microbiological analysis of milk samples provided by 529 women with symptoms compatible with “mammary candidiasis”. Nipple swabs and nipple biopsy samples were also collected from the participating women. Results showed that the role played by yeasts in breast and nipple pain is, if any, marginal. In contrast, our results strongly support that coagulase-negative staphylococci and streptococci (mainly from the mitis and salivarius groups) are the agents responsible for such cases. As a consequence, and following the recommendations of the US Library of Medicine for the nomenclature of infectious diseases, the term “mammary candidiasis” or “nipple thrush” should be avoided when referring to such condition and replaced by “subacute mastitis”.

Incidence and Risk Factors of Mastitis in Shiraz, Iran: Results of a Cohort Study.

Approximately one in five Western women who breastfeed are likely to experience acute mastitis. This study investigated the incidence and risk factors of acute mastitis in a cohort of Iranian women. Subjects were 672 participants of the Shiraz Infant Feeding Study conducted between June 2014 and March 2015. Mothers were recruited from the maternity ward and followed up at 1, 3, 4, and 6 months postpartum to obtain information on their breastfeeding practices and experiences. The occurrence of acute mastitis in the first 26 weeks postpartum was self-reported and the occurrence of acute mastitis in the first 4 weeks and between 5 and 12 weeks postpartum was treated as separate outcomes. The risk factors for acute mastitis were explored using multivariable logistic regression analysis. In total, 130 mothers (19.3%, 95% confidence interval: 16.3-22.3%) experienced at least one episode of acute mastitis. Having expressed breast milk and use of a pacifier were significantly associated with acute mastitis in both the first 4 weeks and between 5 and 12 weeks postpartum. Persistent problems with cracked or sore nipples, or engorged breasts, and a reduction in breastfeeding were associated with acute mastitis between 5 and 12 weeks. The incidence of acute mastitis experienced by this cohort of Iranian women is similar to that reported for women in Western countries. The risk factors of acute mastitis identified in this study are potentially modifiable and could be prevented or ameliorated with adequate support and anticipatory guidance provided in the early postpartum period.

Perceptions and experiences of using a nipple shield among parents and staff \u2013 an ethnographic study in neonatal units

BackgroundPreterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only as a device to help mothers with sore nipples, but also to facilitate the infant’s latch on to the breast. However, the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England.MethodsAn ethnographic study was undertaken where observations and interviews were conducted in four neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis.ResultThe global theme was developed and named, ‘Nipple shield in a liminal time’. This comprised of two organizing themes: ‘Relational breastfeeding’ and ‘Progression’. ‘Relational breastfeeding’ was underpinned by the basic themes, ‘good enough breast’, ‘something in between’ and ‘tranquil moment’. ‘Progression’ was underpinned by the basic themes, ‘learning quicker’, ‘short-term solution’ and ‘rescue remedy’. Although breastfeeding was seen primarily as a nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time as mothers and their infants are “in between” phases and the outcome, in terms of breastfeeding, is yet to be realized.ConclusionThis study demonstrates parents’ and staffs’ perceptions of the nipple shield as a short term solution to help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother and baby’s own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore, we need to emphasise the importance of the ‘relational’ whilst understanding the need for ‘progression’. Holding these in balance may be the key to appropriate use of the nipple shield.