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      <h1 id="top">5.3 General treatment for sore nipples</h1>
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            <td class="body"><img src="images/key_icon.gif" class="icon" alt="" /><h3>Key Points - Case Study E</h3>
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			Anna is seven days postpartum. She is unsure whether she can continue to breastfeed her baby, Joshua, because of sore and cracked nipples. The cracks have increased in size since they first developed and it is excruciating to feed Joshua. What is the most likely cause of Anna's sore nipple?
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		<dl><dt><a href="topic_5-1.html"><cite>Topic 5.1: Sore nipples</cite></a></dt><dd class="topic-paragraph">Nipple tenderness is common in the first seven to ten days postpartum. Nipple cracks, grazes or significant pain indicates nipple trauma, usually associated with sub-optimal positioning and attachment.</dd></dl>
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			What other conditions may contribute to nipple damage occurring in the first week postpartum?
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		<dl><dt><a href="topic_5-2.html"><cite>Topic 5.2: Factors causing nipple damage</cite></a></dt><dd class="topic-paragraph">Other factors that cause nipple pain and damage in the first week postpartum are: engorgement; inverted nipples and other nipple variations; tongue-tie and palatial variations and abnormalities in the infant; infant neurological problems; inappropriate use of lactation aids; and high intra-oral pressure.</dd></dl>
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			After careful assessment, it appears that sub-optimal positioning and attachment issues are the cause of Anna's sore and cracked nipples. What is the most appropriate treatment to offer Anna at this stage?
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		<dl><dt><a href="topic_5-3.html"><cite>Topic 5.3: General treatment for sore nipples</cite></a></dt><dd class="topic-paragraph">The most important factor in the treatment of sore or cracked nipples is to ensure optimal attachment at all breastfeeds. There is no evidence that any particular topical treatment is effective in preventing or relieving nipple cracks or pain. Occasionally, breastfeeding needs to be suspended until the nipples begin to heal, with the mother expressing her milk and feeding it to her baby with a cup, spoon or bottle.</dd></dl>
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			After careful assessment, it appears that sub-optimal positioning and attachment issues are the cause of Anna's sore and cracked nipples. What is the most appropriate treatment to offer Anna at this stage?
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      <div class="section" id="Assess_positioning_and_attachment"><h2>Assess positioning and attachment</h2>
		<ul><li>Provide appropriate assistance to ensure optimal attachment at all feeds.</li></ul>
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      <div class="section" id="Advice_about_breastfeeds"><h2>Advice about breastfeeds</h2>
		<ul><li>Commence feeds when the infant initiates feeding cues (beginning to root, hands to mouth), rather than waiting until he is very hungry and crying.</li><li>Start feeds on the least sore side. The baby can be swapped to the other side once milk is flowing freely.</li><li>If both sides are very painful, express (preferably by hand) until the milk is flowing freely, and then attach the infant.</li><li>Gently remove the infant from the breast by releasing the suction when he has stopped sucking effectively.</li><li>Suggest using different feeding positions.</li></ul>
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      <div class="section" id="Advice_about_nipple_treatment"><h2>Advice about nipple treatment</h2>
		<ul><li>Warm water compresses provide some pain relief between feeds<sup><a href="#note1">1</a></sup>.</li><li>Breast milk left to dry on the nipple may also be beneficial and is simple and readily available<sup><a href="#note1">1</a></sup>.</li><li>There is no evidence that any particular topical treatment is effective in preventing or relieving nipple pain or cracks<sup><a href="#note1">1</a></sup>.</li></ul>
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      <div class="section" id="Lactation_aids"><h2>Lactation aids</h2>
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			Breast shells or nipple airers lift clothing from the nipple and allow air to circulate<sup><a href="#note2">2</a></sup>, providing pain relief for some women.
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      <div class="section" id="Rest_nipples"><h2>Rest nipples</h2>
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			If Anna finds it too painful to continue to breastfeed, she can express her milk (hand expression creates less nipple trauma) for 24 to 48 hours and feed this milk to Joshua with a cup, spoon or bottle. Once the nipples begin to heal, breastfeeds can gradually be reintroduced.
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			These measures should be used for all women with sore/cracked nipple, regardless of the cause, in conjunction with other treatments if necessary.
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      <div id="footnotes">
        <h3>Notes</h3>
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          <li id="note1"><a href="references.html#more05a" title="See full details">#</a> Moreland-Schultz K et al. (2005) Prevention of and therapies for nipple pain: a systematic review</li>
          <li id="note2"><a href="references.html#brod04a" title="See full details">#</a> Brodribb W (2004) Breastfeeding Management</li>
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      <h1>Breastfeeding Essentials</h1>
      <ol>
        <li>0.1 <a href="topic_0-1.html">Introduction</a></li>
        <li>1.0 <a href="topic_1-0.html">Case Study A (Joanne)</a><ol><li>1.1 <a href="topic_1-1.html">Discussing breastfeeding</a></li><li>1.2 <a href="topic_1-2.html">What information to give</a></li><li>1.3 <a href="topic_1-3.html">Effects of Breastfeeding alternatives</a></li><li>1.4 <a href="topic_1-4.html">Common breastfeeding concerns</a></li><li>1.5 <a href="topic_1-5.html">Breast examination</a></li><li>1.6 <a href="topic_1-6.html">Contraindications to breastfeeding</a></li><li>1.7 <a href="topic_1-7.html">Conditions related to lactation outcomes</a></li><li>1.8 <a href="topic_1-8.html">Medications</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Case Study B (Joanne)</a><ol><li>2.1 <a href="topic_2-1.html">Preparation Before Birth</a></li><li>2.2 <a href="topic_2-2.html">Birthing Factors that Affect Breastfeeding</a></li><li>2.3 <a href="topic_2-3.html">Management After Birth</a></li><li>2.4 <a href="topic_2-4.html">Poor Attachment</a></li><li>2.5 <a href="topic_2-5.html">Hypoglycaemia</a></li><li>2.6 <a href="topic_2-6.html">Relationship between Jaundice and Breastfeeding</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Case Study C (Joanne)</a><ol><li>3.1 <a href="topic_3-1.html">Early problems</a></li><li>3.2 <a href="topic_3-2.html">Risk of SIDS</a></li><li>3.3 <a href="topic_3-3.html">Contraception</a></li><li>3.4 <a href="topic_3-4.html">Milk composition</a></li><li>3.5 <a href="topic_3-5.html">Slowing of growth</a></li><li>3.6 <a href="topic_3-6.html">Introducing solids</a></li><li>3.7 <a href="topic_3-7.html">Weaning</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">Case Study D (Sally)</a><ol><li>4.1 <a href="topic_4-1.html">Initial assessment</a></li><li>4.2 <a href="topic_4-2.html">Milk production</a></li><li>4.3 <a href="topic_4-3.html">Causes of inadequate infant growth</a></li><li>4.4 <a href="topic_4-4.html">Increasing milk supply</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Case Study E (Anna)</a><ol><li>5.1 <a href="topic_5-1.html">Sore nipples</a></li><li>5.2 <a href="topic_5-2.html">Factors causing nipple damage</a></li><li class="current">5.3 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_5-3.html">General treatment for sore nipples</a></li><li>5.4 <a href="topic_5-4.html">Further causes of nipple pain</a></li><li>5.5 <a href="topic_5-5.html">Mastitis – diagnosis</a></li><li>5.6 <a href="topic_5-6.html">Mastitis – treatment and complications</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">In conclusion</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
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