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Healing Tips for Nipple Cracks or Abrasions

JULY 27, 2011. Posted in: BF CONCERNS: MOTHER

By Kelly Bonyata, BS, IBCLC

The following measures can be very helpful if the skin on the nipple is broken for any reason (cracked nipple due to improper latch or thrush, a bite, milk blister, etc.).

Keep in mind that one of the most important factors in healing is to correct the source of the problem.

Continue to work on correct latch and positioning, thrush treatment, etc. as you treat the symptoms, and talk to a La Leche League Leader and/or board certified lactation consultant (IBCLC) if what you’re doing is not working.

During the nursing session | After nursing | Between nursings | Additional information

During the nursing session

• Breastfeed from the uninjured (or less injured) side first. Baby will tend to nurse more gently on the second side offered.
• The initial latch-on tends to hurt the worst – a brief application of ice right before latching can help to numb the area.
• Experiment with different breastfeeding positions to determine which is most comfortable.
• If breastfeeding is too painful, it is very important to express milk from the injured side to reduce the risk of mastitis and to maintain supply. If pumping is too painful, try hand expression.

After nursing

Salt water rinse

This special type of salt water, called normal saline, has the same salt concentration as tears and should not be painful to use.

To make your own normal saline solution:

Mix 1/2 teaspoon of salt in one cup (8 oz) of warm water. Make a fresh supply each day to avoid bacterial contamination. You may also buy individual-use packets of sterile saline solution.

• After breastfeeding, soak nipple(s) in a small bowl of warm saline solution for a minute or so–long enough for the saline to get onto all areas of the nipple. Alternately, put the saline solution into a squeeze bottle and squirt it on gently; use plenty of saline, making sure to get it on all areas of broken skin.
• Avoid prolonged soaking (more than 5-10 minutes) that “super” hydrates the skin, as this can promote cracking and delay healing.
• Pat dry very gently with a soft paper towel.
• If baby objects to the taste of the residual salt from the saline rinse, rinse directly before nursing by dipping nipple(s) into a bowl of plain water. Pat dry gently.

After the salt water rinse

• Apply expressed breastmilk to the nipples to promote healing–this can be done in addition to other treatments.
• To promote “moist wound healing” (this refers to maintaining the internal moisture of the skin, not keeping the exterior of the skin wet) apply a medical grade lanolin ointment (e.g., Lansinoh, Purelan), soft paraffin/vaseline  or a hydrogel dressing (e.g., ComfortGel, Soothies).
• If you have thrush, follow the saline soak with an antifungal ointment or other thrush treatment.
• If needed, apply an antibiotic ointment (e.g. Bactroban/mupirocin, Polysporin) or Dr. Jack Newman’s All Purpose Nipple Ointment(APNO; an antibiotic/anti-inflammatory/anti-yeast combo) sparingly after each feeding.
  • Per Hale, Bactroban ointment (mupirocin; lactation risk category L1/safest), available only by prescription, may be the best choice for nursing mothers.
  • Of the over-the-counter treatments, Polysporin (Polymyxin B Sulfate and Bacitracin Zinc) may be preferred for topical use in the nipple area of nursing moms over antibiotic ointments containing neomycin (such as Neosporin or triple antibiotic ointment). Neomycin carries a small risk (1-2% of the general population) of contact dermatitis (seeThe Role of Topical Antibiotics in Dermatologic Practice by J.J. Leyden, MD).
  • It is not necessary to wash small amounts of antibiotic or APNO ointment from the nipple prior to nursing, even if baby nurses again within minutes (see Dr. Jack Newman’s Sore Nipples handout). If too much ointment was used and there is an obvious amount remaining when baby is ready to nurse again, gently wipe the excess off with a damp cloth.

Between nursings

• Keep nipples exposed to air when possible. When wearing a bra, use fresh disposable pads (change when damp). Some mothers use breast shells to protect the nipple from the dampness and friction of the bra.
• If there is a specific injury–like a bite–cold compresses (ice packs over a layer of cloth) may help: 20 minutes on, 20 minutes off; repeat as needed.
• Ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) is compatible with breastfeeding.
• Once a day, use a non-antibacterial, non-perfumed soap to gently clean the wounded area, then rinse well under running water. Using soap on the nipple area is not recommended unless the skin is broken.

Contact your health care provider if you notice:Fever, inflammation/redness, swelling, oozing, pus, or other signs of infection. It is possible to have multiple infections (both fungal and bacterial). If the nipple is obviously infected, then talk to your health care provider about the possibility of using an oral (systemic) antibiotic. One study indicated that topical antibiotics and good breastfeeding techniques might not be sufficient if infection is present. (See Livingstone V, Stringer LJ. The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study. J Hum Lact. 1999 Sep;15(3):241-6.) See also Oral antibiotic use for sore, cracked nipples.)

Additional information

Treatment of Sore, Cracked, or Bleeding Nipples by Becky Flora, IBCLC

Sore Nipples by Jack Newman, MD, FRCPC

Nipple Pain by Paula Yount

Sore Nipples in the Breastfeeding Mother from Lactation Education Resources

Barton A. Oral Antibiotics and Positioning Are Effective in Decreasing Morbidity in Breastfeeding Mothers. Critically-Appraised Topic from University of Michigan Evidence-Based Pediatrics Web Site, February 14, 2000.

Buchanan P, Hands A, Jones W.  Assessing the evidence: Cracked Nipples and Moist Wound Healing. Paisley, Scotland: The Breastfeeding Network, March 2002.

Leyden JJ. The Role of Topical Antibiotics in Dermatologic Practice. Medscape Continuing Medical Education Clinical Update; June 25, 2003.

Livingstone V, Stringer LJ. The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study. J Hum Lact. 1999 Sep;15(3):241-6.

Martin J. Nipple Pain: Causes, Treatments, and Remedies. Leaven. February-March 2000;36(1):10-11.

Morland-Schultz K, Hill PD. Prevention of and therapies for nipple pain: a systematic review. J Obstet Gynecol Neonatal Nurs. 2005 Jul-Aug;34(4):428-37.

Wren AF. Moistness: The Secret of Healing Sore and Cracked Nipples.

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