Breastfeeding plays a significant role in child survival, nutrition and development as well as in maternal health. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life, to be followed by continued breastfeeding along with complementary foods for up to 2 years or beyond.1

However, nearly 96% of mothers experience sore, painful nipples during breastfeeding and stop breastfeeding before they intend to.2 Literature points to a strong correlation between the onset of nipple soreness and the positioning and latch-on of the nursing baby at the breast.2 Correct positioning and latch have been described as important treatment options for cracked, sore and painful nipples. Improvement is often seen with improvement of the infant’s latch.3 Mothers can choose from several different positions to breastfeed their babies, including laid back breastfeeding or biological nurturing, cross cradle hold, cradle hold, rugby or football hold and side lying position.4

Lanolin-based nipple ointments and other creams are often used to reduce pain and promote healing of sore nipples; however, there is conflicting evidence on the effectiveness of such formulations.2

A study employed three different treatment protocols and compared healing, change in nipple pain, and mothers satisfaction with treatment for sore nipples. Ninety-four breastfeeding women were enrolled in the study. Group 1 consisted of 31 mothers randomized into the lanolin/shells, assessment, and education and corrective interventions group. Group 2 included 33 mothers randomized into the glycerin gel, assessment, and education and corrective interventions group. Group 3 consisted of 30 mothers randomized into the assessment and education and corrective interventions group. Almost all participants had less nipple pain after the intervention. Nipple condition, as rated by the midwives, was also reported to improve. The pain rating of all three groups was also reduced. In this study, assessment and education and corrective interventions were common to all three groups. Effective care and perinatal education for nursing mothers with sore nipples should therefore include assessment of breastfeeding positioning and latch-on, in association with education and corrective interventions using a guidance tool, whether or not commercial preparations are used.2

Natural emollients are also effective and safe to be used in nursing mothers for the management of dry, sore and cracked nipples during breastfeeding. Coconut oil and kokum butter are two such natural emollients that can be used to heal sore, painful nipples.

Coconut oil has antifungal and antibacterial properties.5 Topical application of coconut oil forms a chemical barrier on the skin and protects it and also heals infections. It moisturizes and softens dry skin and repairs cracked, sore, dry nipples from nursing.6

Kokum butter, another natural emollient, can also be used for the prevention and treatment of sore nipples. Kokum has a cooling effect and can be directly applied to skin rashes, burns and dry skin. Kokum butter has soothing properties and acts as an astringent. It is used to treat fissures and cracked skin.7 Kokum is used topically for ulcerations, fissures and chapped skin, as well as to treat wounds and sores associated with inflammation.8 On account of its emollient property, kokum butter is used as a natural moisturizer to keep the skin supple and silky smooth and it can be employed for effective treatment of severely dry skin, ulceration and fissures.9

Therefore, appropriate positioning and latch-on of the nursing baby at the breast and use of natural emollients can go a long way in reducing the burden of sore and painful nipples in breastfeeding mothers.

References

1. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services 2017. Available from: http://apps.who.int/iris/bitstream/handle/10665/259386/9789241550086-eng.pdf;jsessionid=E10792261C748980B9DAD2A2195EF8F7?sequence=1.
2. Cadwell K, Turner-Maffei C, Blair A, et al. Pain Reduction and Treatment of Sore Nipples in Nursing Mothers. J Perinat Educ. 2004 Winter; 13(1): 29–35.
3. Walker M. Are There Any Cures for Sore Nipples? Clinical Lactation 2013;4(3), http://dx.doi.org/10.1891/2158-0782.4.3.106.
4. Positioning and Attachment of Baby to the Breast - Fact sheet for Health Care Professionals. Available from: https://www.breastfeeding.ie/Uploads/Positioning-and-attachment-of-baby-to-the-breast.pdf.
5. Buck ML, Amir LH, Donath SM. Topical Treatments Used by Breastfeeding Women to Treat Sore and Damaged Nipples. Clinical Lactation 2015;6(1), http://dx.doi.org/10.1891/2158-0782.6.1.16.
6. Raj JA, Magesh L. Medicinal Use of Coconut. International Journal of Science and Research 2017;6(6):1898-1900.
7. Hartvig K. Healing Spices: 50 Wonderful Spices, and How to Use Them in Health-giving Foods and Drinks. Watkins Media Limited, London; 2016.8. Nadkarni KM. Dr. K. M. Nadkarnis Indian Materia Medica Volume 1. Popular Prakashan, Mumbai.9. Swami SB, Thakor NJ, Patil SC. Kokum (Garcinia Indica) and its Many Functional Components as Related to the Human Health: A Review. Journal of Food Research and Technology 2014;2(4):130-142.