Cracked nipple

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Cracked nipple (nipple trauma or nipple fissure) [1] is a condition that can occur in breastfeeding women as a result of a number of possible causes. Developing a cracked nipple can result in soreness, dryness or irritation to, or bleeding of, one or both nipples during breastfeeding. The mother with a cracked nipple can have severe nipple pain when the baby is nursing. This severe pain is a disincentive for continued breastfeeding. The crack can appear as a cut across the tip of the nipple and may extend to its base. [2] Cracked nipple can develop after the birth of the infant and is managed with pharmacological and nonpharmacological treatment. [3]

Contents

Signs and symptoms

Cracked nipples are classified as a breast disorder. [4] The nipple is not only the structure to deliver milk to the infant, it also contains small, sebaceous glands or Montgomery glands to lubricate the skin of the areola. [5] Cracked nipples are most often associated with breastfeeding and appear as cracks or small lacerations or breaks in the skin of the nipple. [1] [6] In some instances an ulcer will form. [1] The nipple in a nursing mother is in regular contact with a nursing infant. [5] Cracked nipples are trauma to the nipple and can be quite painful. [7] Cracked nipples typically appear three to seven days after the birth. [6] [1]

If the nipples appears to be wedge-shaped, white and flattened, this may indicate that the latch is not good and there is a potential of developing cracked nipples. [8]

Complications

Bacteria can enter the breast through cracked nipples, which increase the risk of mastitis. [9] Candida infection (thrush) of the nipple can also occur, resulting in deep-pink, cracked, and sore nipples. [10] [2]

Contraindications for breastfeeding

Because cracked nipples can result in the infant being exposed to blood, women with certain blood-borne diseases may be advised to stop breastfeeding if they have a cracked nipple. It has been found safe for breastfeeding mothers with hepatitis B and cracked nipples to breastfeed. [11] In the event that a nursing woman experiences cracked and bleeding nipples or breast inflammation within one to two weeks immediately following an acute Toxoplasmosis infection (when the organism is still circulating in her bloodstream), it is theoretically possible that she could transmit Toxoplasma gondii to the infant through her breast milk. Immune suppressed women could have circulating Toxoplasma for even longer periods of time. However, the likelihood of human milk transmission is very small. [12] Transmission risk of HIV increases if the mother has cracked and bleeding nipples. [13] [2] An uncommon infection in the mother, Chagas disease, can be transmitted to the nursing infant via cracked nipples. [14] Women with hepatitis C are advised to abstain from breastfeeding if their nipples are cracked or bleeding. [15] [16]

Cause

Some studies indicate that cracked nipples are caused by poor latch. [17] Yet other causes could be poor positioning, use of a feeding bottle, breast engorgement, inexperience, semi-protruding nipples, use of breast pumps and light pigmentation of the nipples. Breast engorgement is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat. [1]

When the baby is latched on correctly, the nipple is located against the soft palate in the back of the baby's mouth. When the nipple is near the front of the mouth and being pinched against the hard palate, this will cause pain and development of cracked nipples. [8] One cause of painful, cracked nipples is the incorrect positioning and incorrect latching on to the breast by the infant. [7] [6] The baby can create cracked nipples due to the strong sucking pressure, stretching and pulling the nipple, the friction and rubbing of skin to skin. [2] [7] The cause of sore, cracked nipples can also be from a yeast or Candida infection in the baby or the mother or both. Thrush can develop after the use of antibiotics. [2] For first-time breastfeeding mothers, it normally takes a few tries before the latch is right, which can make the nipples tender and sore the first few days. If the nipples become cracked or bleed, the latch may need to be corrected. Women are advised to keep on breastfeeding, as it will actually help the nipples heal. A little breast milk or purified lanolin cream or ointment helps the healing process. [7]

If a feeding bottle is used in addition to breastfeeding, cracked nipples may result because the different sucking techniques required for the bottle and the breast vary. Bottle-feeding babies uses his or her tongue to regulate the flow of milk. This same technique will cause friction on the nipple while breastfeeding. This, in turn, encourages the continued use of the bottle with less time breastfeeding. [1]

Pain caused by cracked nipples can sometimes lead to the cessation of breast-feeding. [1] In addition to cracks, blisters or ulcers can form. [18]

Prevention

The nipples of nursing mothers naturally make a lubricant to prevent drying, cracking, or infections. [5] Cracked nipples may be able to be prevented by:

Roman chamomile is sometimes used as a remedy in alternative medicine to treat cracked nipples by a topical application. However, there is no scientific evidence for its efficacy, and is in fact considered unsafe for use during pregnancy. [22]

Treatment

Cracked nipples can be treated with 100% lanolin. Glycerin nipple pads can be chilled and placed over the nipples to help soothe and heal cracked or painful nipples. [21] If the cause of cracked nipples is from thrush, treatment is usually begun with nystatin. If the mother is symptomatic then the mother and the baby can be treated. [2] Continuing to breastfeed will actually help the nipples heal. A little breast milk or purified lanolin cream or ointment helps the healing process. [7] Breastfeeding professionals that include nurses, midwives and lactation consultants are able to assist in the treatment of cracked nipples. [6]

Advice from others is abundant but there have been some treatments that have been identified as not being effective in healing or preventing cracked nipples. These ineffective treatments are keeping the breastfeeding short and using a nipple guard. Keeping the feedings short so that the nipples can rest is not effective in relieving the pain of cracked nipples and it could have a negative effect on the milk supply. Nipple shields do not improve latching on. [8]

Epidemiology

In a survey in New York City, 35% of nursing mothers stopped breastfeeding after one week due to the pain of cracked nipples. [23] Thirty percent stopped breastfeeding between weeks one and three. Another survey of breastfeeding mothers in Brazil reported that there was 25% higher risk of interruption of exclusive breastfeeding when the women had cracked nipples. Mothers with higher education levels were more likely to continue breastfeeding despite the pain of cracked nipples. [1]

Society and culture

The importance of preventing cracked nipples while breastfeeding has been reported. [19] In an informal survey of breastfeeding in the UK, some mothers reported that they stopped breastfeeding because the cracked nipples made it too painful. [24]

See also

Related Research Articles

<span class="mw-page-title-main">Nipple</span> Part of the breast

The nipple is a raised region of tissue on the surface of the breast from which, in lactating females, milk from the mammary gland leaves the body through the lactiferous ducts to nurse an infant. The milk can flow through the nipple passively, or it can be ejected by smooth muscle contractions that occur along with the ductal system. The nipple is surrounded by the areola, which is often a darker colour than the surrounding skin.

<span class="mw-page-title-main">Mastitis</span> Medical condition

Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.

<span class="mw-page-title-main">Breast engorgement</span> Medical condition

Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. It is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat or inverted. Sometimes it may lead to striae on nipples, mainly a preceding symptom of septation mastitis.

Breast pain is the symptom of discomfort in either one or both breasts. Pain in both breasts is often described as breast tenderness, is usually associated with the menstrual period and is not serious. Pain that involves only one part of a breast is more concerning, particularly if a hard mass or nipple discharge is also present.

<span class="mw-page-title-main">Inverted nipple</span> Medical condition

An inverted nipple is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated. Both women and men can have inverted nipples.

<span class="mw-page-title-main">Nipple shield (breastfeeding)</span>

A nipple shield is a nipple-shaped sheath worn over the areola and nipple during breastfeeding. Modern nipple shields are made of soft, thin, flexible silicone and have holes at the end of the nipple section to allow the breast milk to pass through.

Overactive let-down (OALD) is the forceful ejection of milk from the breast during breastfeeding. In some women it occurs only with the first let-down in a feeding, occasionally women may have multiple strong letdowns during a feeding. OALD can make breastfeeding difficult and can be the source of some breastfeeding complications. It may also be known as hyper milk-ejection. A woman may have OALD in addition to an oversupply of breastmilk. The physical or medical cause of an overactive let-down is still unknown. Whether mothers with OALD have a higher overall milk volume – or a strong reaction to the hormone oxytocin also remains to be seen.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

<span class="mw-page-title-main">Breastfeeding</span> Feeding of babies or young children with milk from a womans breast

Breastfeeding, also known as nursing, is the process where breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommend that breastfeeding begin within the first hour of a baby's birth and continue as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.

Breastfeeding and medications is the description of the medications that can be used by a breastfeeding mother, and the balance between maternal health and the safety of the breastfeeding infant. Medications, when administered to breastfeeding mothers, almost always are transferred to breast milk, albeit usually in small quantities. The degree of impact on the nursing infant varies, with many medications posing minimal risk. Nonetheless, informed decision-making and professional guidance is needed.

<span class="mw-page-title-main">Infant food safety</span>

Foodborne illness is any illness resulting from the food spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food. Infant food safety is the identification of risky food handling practices and the prevention of illness in infants. Foodborne illness is a serious health issue, especially for babies and children. Infants and young children are particularly vulnerable to foodborne illness because their immune systems are not developed enough to fight off foodborne bacterial infections. In fact, 800,000 illnesses affect children under the age of 10 in the U.S. each year. Therefore, extra care should be taken when handling and preparing their food.

The postpartum physiological changes are those expected changes that occur in the woman's body after childbirth, in the postpartum period. These changes mark the beginning of the return of pre-pregnancy physiology and of breastfeeding. Most of the time these postnatal changes are normal and can be managed with medication and comfort measures, but in a few situations complications may develop. Postpartum physiological changes may be different for women delivering by cesarean section. Other postpartum changes, may indicate developing complications such as, postpartum bleeding, engorged breasts, postpartum infections.

A blocked milk duct is a blockage of one or more ducts carrying milk to the nipple for the purpose of breastfeeding an infant that can cause mastitis. The symptoms are a tender, localised lump in one breast, with redness in the skin over the lump. The cause of a blocked milk duct is the failure to remove milk from part of the breast. This may be due to infrequent breastfeeding, poor attachment, tight clothing or trauma to the breast. Sometimes the duct to one part of the breast is blocked by thickened milk. A blocked milk duct can be managed by improving the removal of milk and correcting the underlying cause.

<span class="mw-page-title-main">Latch (breastfeeding)</span> The way a baby fastens onto the breast while breastfeeding

Latch refers to how the baby fastens onto the breast while breastfeeding. A good latch promotes high milk flow and minimizes nipple discomfort for the mother, whereas poor latch results in poor milk transfer to the baby and can quickly lead to sore and cracked nipples. In a good latch, both the nipple and a large portion of the areola are in the baby's mouth.

A nipple bleb is a blister on the nipple that can be filled with serous or other fluid. It may be pink or light yellow. It is thin-walled and may appear as a small blister, more than 5 mm in diameter. It can also be referred to as a bulla. Some clinicians may also include milk blisters as a type of bleb. In addition, a blocked Montgomery gland may also be called a nipple bleb though its cause is different than a milk or serous-filled bleb on the nipple. In some cases the bleb may be associated with an adjacent blocked sebaceous cyst.

Nipple confusion is the tendency of an infant to unsuccessfully adapt between breast-feeding and bottle-feeding. It can happen when the infant is put back onto breast-feeding. Nipple confusion can turn into nipple refusal in which the infant refuses both the bottle and breastfeeding.

In breastfeeding women, low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nutritional needs of her infant.

Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.

<span class="mw-page-title-main">Establishment of breastfeeding</span>

Establishment of breastfeeding refers to the initiation of providing breast milk of mother to baby. According to the World Health Organization(WHO), breastfeeding is the best way to provide nourishment, including essential nutrients, energy and antibodies, to infants and toddlers. The start of breastfeeding is supported by the milk production which depends on the development of internal and external breast structure and hormonal control on milk secretion. Besides milk supply, adopting the correct approach of breastfeeding helps build up the maternal bond, which in turn promotes breastfeeding. Not only does nursing strengthen the mother-child relationship, but it also improves the intelligence and immunity of breastfed children and diminishes breastfeeding mothers' risks to have ovarian and breast cancer.

Breastmilk medicine refers to the non-nutritional usage of human breast milk (HBM) as a medicine or therapy to cure diseases. Breastmilk is perceived as an important food that provides essential nutrition to infants. It also provides protection in terms of immunity by direct transfer of antibodies from mothers to infants. The immunity developed via this mean protects infants from diseases such as respiratory diseases, middle ear infections, and gastrointestinal diseases. HBM can also produce lifelong positive therapeutic effects on a number of chronic diseases, including diabetes mellitus, obesity, hyperlipidemia, hypertension, cardiovascular diseases, autoimmunity, and asthma.

References

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  2. 1 2 3 4 5 6 "Management of breast conditions and other breastfeeding difficulties". National Center for Biotechnology and Information, US National Library of Medicine. Retrieved 3 August 2017.
  3. ↑ Henry 2016, p. 120.
  4. ↑ "ICD-10 Version:2016". apps.who.int. Retrieved 4 August 2017.[ dead link ]
  5. 1 2 3 Doucet, Sébastien; Soussignan, Robert; Sagot, Paul; Schaal, Benoist (23 October 2009). "The Secretion of Areolar (Montgomery's) Glands from Lactating Women Elicits Selective, Unconditional Responses in Neonates". PLOS ONE. 4 (10): e7579. Bibcode:2009PLoSO...4.7579D. doi: 10.1371/journal.pone.0007579 . PMC   2761488 . PMID   19851461.
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  7. 1 2 3 4 5 6 "Common questions about breastfeeding and pain". WomensHealth.gov. 2017-06-09. Retrieved 4 August 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  8. 1 2 3 "Sore or cracked nipples when breastfeeding, Pregnancy and baby guide". www.nhs.uk. National Health Services (UK). Retrieved 4 August 2017.
  9. ↑ Kinlay, Joanne R.; O'Connell, Dianne L.; Kinlay, Scott (April 2001). "Risk factors for mastitis in breastfeeding women: results of a prospective cohort study". Australian and New Zealand Journal of Public Health. 25 (2): 115–120. doi: 10.1111/j.1753-6405.2001.tb01831.x . ISSN   1326-0200. PMID   11357905. S2CID   24047831.
  10. ↑ "Thrush in newborns: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 3 August 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  11. ↑ "Hepatitis B and C Infections - Breastfeeding - CDC". www.cdc.gov. Retrieved 3 August 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  12. ↑ "Toxoplasmosis - Breastfeeding - CDC". www.cdc.gov. Retrieved 3 August 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  13. ↑ https://www.cdc.gov/globalaids/resources/pmtct-care/docs/pocketguide.doc This link opens a document that opens rather than a web page. PD-icon.svg This article incorporates text from this source, which is in the public domain .
  14. ↑ Prevention, CDC - Centers for Disease Control and. "CDC - Chagas Disease - Detailed Fact Sheet". www.cdc.gov. Retrieved 3 August 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  15. ↑ "HCV FAQs for Health Professionals - Division of Viral Hepatitis - CDC". www.cdc.gov. Retrieved 3 August 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  16. ↑ "Breastfeeding vs. Formula Feeding: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 3 August 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  17. ↑ Pediatrics, American Academy Of; Joan Younger Meek, M.D; Yu, Winnie (2011-07-26). American Academy of Pediatrics new mother's guide to breastfeeding. Meek, Joan Younger,, Scherer, Winnie,, American Academy of Pediatrics (Second, Bantam books trade paperback ed.). New York. ISBN   9780553908237. OCLC   816891128.{{cite book}}: CS1 maint: location missing publisher (link)
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  23. ↑ Ahluwalia, I. B. (2005-12-01). "Why Do Women Stop Breastfeeding? Findings From the Pregnancy Risk Assessment and Monitoring System". Pediatrics. 116 (6): 1408–1412. doi:10.1542/peds.2005-0013. ISSN   0031-4005. PMID   16322165. S2CID   41990593.
  24. ↑ Gallagher, Sophie (4 August 2017). "6 Reasons Why You Might Have Stopped Breastfeeding, And That's Okay". HuffPost. BuzzFeed, Inc. Retrieved 4 August 2017.

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