Evidence based practice for treatment of sore nipples

[mears]

I am a midwife who has successfully breastfed 4 children throughout my 16 year career, I have seen various recommendations come and go for the treatment of sore nipples. I have recently discovered this site and amazed by the wealth of helpful information and wonder if anyone can help. I know that prevention is better than cure as far as correct latch etc. is concerned, but I am keen to ascertain the best treatment for the poor mums who have succumbed to the dreaded nipple trauma.

I know that moist wound healing is now advocated and in my own hospital the application of jelonet is recommended. Can anybody direct me to the evidence for this recommendation? Does vaseline work just as well? Is jelonet better than Purelan or Lansinoh?

I look forward to hearing from anyone with any info.

[leese]

Hi mears - a midwife too, but not with as much experience as yourself! Anyhow, have never even heard of jelonet - what is it exactly?
In our area, we still recommend Lansinoh to promote healing, or indeed breastmilk rubbed into the nipple (tho' I understand this is now a little controversial?....)
As a customer myself, found Kamillosan worked the best for me. Although I'm sure the Lansinoh I used promoted healing, I was really more concerned with a 'quick fix' at the time, and Kamillosan was very soothing and helpful for me. Look forward to getting an update from you. Whereabouts do you work?

[mears]

Hello Leese,

I work in Ayrshire in Scotland, where are you?

We are 'Baby Friendly' having just passed reassessment but I am not sure where this jelonet treatment came from. There does not seem to be much evidence for it's use but it may just be down to common sense as Jelonet is a paraffin gauze dressing which according to the BNF is used for " the treatment of abrasions, burns and other injuries of skin, and ulcerative conditions".
I originally trained as a nurse and remember putting jelonet on bedsores and leg ulcers etc.

It is significantly more expensive than vaseline I believe and questions are being asked by local GPs regarding it's cost effectiveness. The mothers who use it seem to like it so is that might evidence enough. I can see a randomised controlled trial looming here but perhaps someone has already done one!

[jasper]

Hello Mears and wellcome.
I am also looking with interest for a reliable cure/treatment for sore nipples!
Which of the creams don't need to be wiped off before baby feeds?
With my last baby I wsa given some nipple cream from boots, but the tube advised washing cream off the nipple before feeding which was not very convenient.Anyway if your nipples are sore you don't feel like washing them ten times a day.
Which creams Don't need washing off?
I just got sent cool gel packs from the NCT ccatalogue (£10 a pair +£1 p&p)for cooling sore breasts( can also be heated) and they are helping a bit.
I recently tried Jelonet and was not massively impressed and could not get the gauze squares to stay in place.I think the placebo effect must be quite strong with it because it LOOKS like it must be doing something, as it looks very medicalised.

[robinw]

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[Enid]

rescue remedy cream!!! I am always going on about it but it worked - I'm afraid I never washed it off but just kind of rubbed it off before feeds...I don't even know what is in it so its not a very scientific recommendation I'm afraid..

[mears]

Thanks for the responses so far.

I should have mentioned more than correct latching etc. when referring to prevention of sore nipples but I did not want to get into an indepth conversation regarding prevention. I am an avid breastfeeding supporter and have hundreds of breastfeeding articles and books.
Despite all the good information, some women still get extremely painful/cracked nipples and I feel we are doing them a disservice by not offering a decent proven treatment.

For my first baby I swore by Kamillosan and put it on prophylactically from day one and did not have many problems other than pain at start of feed which soon subsided ( after counting to 10). With my second baby I had undertaken more reading on the subject and realised creams were not necesary and applied expressed breast milk. Baby number 2 was under phototherapy for a number of days and as he was so distressed at times I did not pay enough attention to fixing him and I let poor positioning go. The result was that my nipples were very painful and scabbed but I perseverd with EBM and fresh air and they healed in 2 weeks. Babies 3 and 4 were in neonatal intensive care and lactation was established with a pump and I did not have any nipple problems at all when both babies were able to feed.

I am now questioning whether the abandonment of creams was a good idea given that moist healing is the way to go. I definately agree with this approach as in a previous conversation it was pointed out you would not leave chapped lips exposed and dry.

I have never heard of rescue remedy cream so that is interesting. As a midwife though should I advocate it's use? Does it have a proven track record? If it is not washed off can it cause any harm to the baby? In the days of my kamillosan use (1987) it had peanut extract in it. My sister used it with her last daughter who now has a severe nut allergy. Kamillosan now no longer has peanut extract because of that theoretical complication.

Back then to jelonet. Is this just as Jasper said a 'medicailsed' way of treating the problem? Is it effecive or is it more hassle than it is worth?

[leese]

Hi all!! Hope you're getting on ok jasper - keep thinking about you at odd times of the day!
As a survivor of 'killer nipples', I tried most things. I must say I found Kamillosan very soothing, tho' don't think it did much to promote healing, but didn't really care - just wanted some relief! Tried Lansinoh, but didn't do much for me, except kept sticking to my breast pads - agonies peeling them off again! However, lots of women swear by Lanolin cream don't they.
Found those hot/cold packs good for engorged breasts - very soothing. The savoy cabbage worked too. Heard the latest is grated carrot in you bra - try it Jasper and let us know! You can be our randomised trial.......
Mears' suggestion re: breast milk works wonders too I think. robinw has good point - we should look more into alternatives.
Mears - I work in Bristol. We're hoping to get our baby friendly status this yr - have been trying long enough!

[Crunchie]

I had agonising (?) nipples and hugely engorged breasts and I found cabbage leaves were the best thing since sliced bread (seriously!) as for nipple cream it was just too damn painful to let her suck, so I hac to use nipple shields. Only once the nipples had healed could I let her anywhere near them. Even cream was too painful to put on, so I just air dried if poss.

[buttercup]

even though my ds is now 9 months I will never forget the agony of the first four weeks breast-feeding. I used to cry almost everytime he fed and came to dread feeding. I had every breast feeding expert come and look at my positionning and they all said it was perfect. I was just one of the unlucky ones (engorgement, mastistis etc as well) What saved me, I seem to remember, was expressing milk (alot less painful than feeding) for 24 hours and giving my expressed milk to ds in a bottle. That way I finally had a bit of time to begin healing properly.

[Demented]

Agree with Crunchie about the cabbage leaves. For some reason it was Savoy Cabbage that was recommended to me (don't know if the type makes any difference but Savoy Cabbage certainly leaves an interesting pattern on your boobs). I found it helped to keep them (cabbage leaves that is) in the fridge.

[mears]

Cabbage leaves are definately good but more for breast pain and engorgement. We advocate that at out maternity unit.

I am still none the wiser about Jelonet for treatment of sore nipples. Does anyone have know of evidence supporting it's use?

Thanks, mears

[Crunchie]

Demented, they look so funny after you take out the wilted leaves!!

[Demented]

Yes your boobs end up looking more like a road map and the smell! On the otherhand though what a relief, they work like magic. I always have a laugh to myself in the supermarket when I pick one up as something different to have with the dinner (ds is now 3 but with another one due in 9 weeks no doubt cabbage will be off the menu and in my underwear).