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Cracks in the nipple during breastfeeding: how to prevent and cure them

Breastfeeding is not always easy. Cracks are undoubtedly one of the most frequent problems. Many mothers even think that having cracks is the usual thing: ” Breastfeeding well, well, with the typical cracks at the beginning .” ” The cracks better, I’m already making callus .”

But the reality should be very different: the cracks are not, at all, normal and their appearance reflects that there is a problem with breastfeeding. Breastfeeding should not, in any case, be painful.

What are nipple cracks?

Cracks in the nipple are nothing more than wounds, “cracks”, lesions on the skin caused by latching and / or inadequate suction by the baby. They often bleed; this is important to know because sometimes we see blood in the baby’s mouth or in vomit or spitting up.

Also the baby’s stools may have a darker color for this reason. The fact of having cracks that bleed is not an impediment to breastfeeding , our baby can drink that milk even if it contains a little blood.

How do I prevent cracks from appearing?

We have said that cracking is not a necessary step in establishing lactation. If the latch on of the baby and its suction are correct, no cracks should appear. And that, how do we know? There are some signs that allow us to identify a good hitch .

One of the most important facts is that we do not have pain ; We may notice some discomfort the first days due to nipple hypersensitivity, but it should not hurt. When babies are well latched on, their mouth is wide open , containing much of the areola, and their lips are everted (especially the lower one). In addition, his chin is close to the mother’s breast (the nose often as well) and we see that the cheeks are filled in (if there is a dimple in the cheek, it is likely that he is not making a good suction).

It is also important that the baby’s head and body are aligned . When finished sucking, the nipple should come out square / rounded; If at the end of the shot it is shaped like lipstick or is injured (cracks), the hook was not adequate.

There are occasions when babies have anatomical characteristics that make the appearance of cracks almost inevitable, for example, the short sublingual frenulum. It is a “web” that anchors the tongue to the base of the mouth and limits its movements. With less movement of the tongue, it cannot properly make the waving movements to express milk and injures the nipple.

Babies with a frenulum should be evaluated by an expert professional. Specific breastfeeding positions, such as wheelie , can improve latching; and, if the frenulum interferes with breastfeeding, cutting it (frenotomy) should be considered.

If I already have cracks, how do I heal them?

Unfortunately , as of today, there is no magic remedy to heal cracks . But one thing is clear: it is essential to solve the cause that originated them, generally a bad hitch .

There are many remedies that have been tried for cracks, as they are a very common problem. However, there is none that shows, to this day, scientific evidence that it works.

In 2014, the Cochrane journal did a review of the literature and analyzed various studies comparing glycerin gel dressings, lanolin breast protectors, lanolin alone or multifunctional ointment. Lanolin is a yellowish fatty substance produced by the sebaceous glands of woolly animals and makes a film / coating on the nipple. In this review, no significant differences were seen between the different treatments. In the Breastfeeding Clinical Practice Guide published in 2017, the experts also do not find quality scientific evidence for any treatment .

Some guides recommend applying a few drops of your own breast milk on the wound; however, other experts believe that this could facilitate infection. My advice: leave the nipples air dry as long as possible and do not apply any topical treatment on them . The collecting cups or shells can help because they leave the nipple in the air and allow us to go dressed.

In the event that the pain is unbearable, you can do delayed breastfeeding for a few days until the cracks improve. To do this, we extract the milk from the breast or from the affected breasts, preferably manually as the breast pump could further damage the nipple. With frequent extraction we will maintain milk production. In addition, the expressed milk can be given to the baby in different ways (as we explain here): finger-syringe (finger-feeding), cup, bottle …

Nipple shields can also reduce pain in some cases, but it is important that we make sure that the size is correct, they are well placed and the baby latch on is appropriate.

Lastly, good breast hygiene is important to prevent the cracks from becoming infected. It is enough to wash it with soap and water daily. If signs of infection appear (the area becomes red and hot, fever appears …) do not hesitate to consult.

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