Cracked nipples during breastfeeding

O92.1

• Description
• General measures
• Medicine treatment
• Referral

DESCRIPTION

The areola and nipple are protected by the secretion of a lubricant from Montgomery’s glands. Cracked nipples may lead to infection and mastitis.

Causes of cracked nipples include:

• poor positioning of the baby and incorrect attachment to the breast
• removing the baby from the breast before suction is broken
• the four signs of good attachment are:
  • chin touching breast (or very close)
  • mouth wide open
  • lower lip turned outward
  • more areola visible above than below the mouth

GENERAL MEASURES

• Apply expressed breast milk to the nipples between feeds and air dry.
• If too painful, express the milk and nurse the baby on the other breast until improvement.
• Keep areola and nipple clean and dry.
• Avoid use of soap, creams and lotions on the nipples.

MEDICINE TREATMENT

• Zinc and castor oil ointment
  • Apply between feeds.

If oral thrush is present, treat neonate with:

• Nystatin solution, oral. See Candidiasis, oral (thrush) .

REFERRAL

No improvement after 2 days.