Literature review for - Flourish Paediatrics

Incidence of nipple pain/trauma
No evidence base was developed for the incidence of nipple pain/trauma due to the lack of
quality studies.
In her review on lactation Neifert states that transient nipple pain attributed to suction injury
of the skin usually begins on the second postpartum day, increases between 3 and 5 days, and
then markedly improves. No specific treatment is usually required (Neifert 1999).
Neifert articulates that severe nipple pain and trauma that continues after the first few days
post partum should not be considered a normal part of breastfeeding. Persistent nipple
discomfort is usually linked to incorrect breastfeeding technique or possibly due to infant oral
anatomy or feeding habits e.g. abnormal sucking. In line with this view (Tait 2000) reports
that poor positioning of the infant and/or poor latch-on is believed to be the most common
cause of persistent sore nipples. In addition sore nipples can be aggravated by inappropriate
nipple skin care, climate variables, and unique skin sensitivity (Neifert 1999).
Academy of Breastfeeding Medicine Protocols
Nipple pain is a problem of the early period of breastfeeding. ABM Protocols 5 and 7
recognise the importance of nipple pain to the mother and the need to address this issue
before discharge from hospital. The most commonly used strategy is to ensure correct
attachment and if needed to express breastmilk on a temporary basis
“Women need help to ensure that they are able to position and attach their babies at the
breast. Those delivered by caesarean section may need additional help from nursing staff to
attain comfortable positioning. A trained observer should assess and document the
effectiveness of breastfeeding at least once every 8–12 hours after delivery until mother and
infant are discharged. Peripartum care of the couplet should address and document infant
positioning, latch, milk transfer, baby’s daily weight, clinical jaundice, and all problems
raised by the mother, such as nipple pain or the perception of an inadequate breastmilk
supply”(Academy of Breastfeeding Medicine 2008).
“Before leaving the hospital breastfeeding mothers should be able to
a. Position the baby correctly at the breast with no PAIN during the feeding
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