Background: Persistent nipple pain is one of the most common reasons given by mothers for ceasing exclusive breastfeeding. We aimed to determine the frequency of nipple pain as a reason for consultation, the most common attributed aetiologies, and the effectiveness of the advice and treatment given. Methods: All consultations at the Breast Feeding Centre of Western Australia (WA) were audited over two six-month periods in 2011 (n = 469) and 2014 (n = 708). Attributed cause(s) of nipple pain, microbiology results, treatment(s) advised, and resolution of pain were recorded. Results: Nipple pain was one of the reasons for consultation in 36% of cases. The most common attributed cause of nipple pain was incorrect positioning and attachment, followed by tongue tie, infection, palatal anomaly, flat or inverted nipples, mastitis, and vasospasm. Advice included correction of positioning and attachment, use of a nipple shield, resting the nipples and expressing breastmilk, frenotomy, oral antibiotics, topical treatments, and cold or warm compresses. Pain was resolving or resolved in 57% of cases after 18 days (range 2–110). Conclusion: The multiple attributed causes of nipple pain, possibly as a result of a cascade of events, suggests that effective early lactation management for prevention of nipple pain and early diagnosis and effective treatment are crucial to avoid early weaning.

The ramifications of nipple pain extend far beyond the act of breastfeeding, particularly for women whose pain lasts several months. Given the lack of evidence-based treatments, it is not surprising that pain is a major contributor to premature weaning. Further research into the causes of nipple pain is necessary to enable the implementation of effective interventions, thus reducing further complications such as infection and postnatal depression. Detailed pain analysis may assist in assessing the success of these interventions.

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This study aimed to provide insight into nipple pain in breastfeeding mothers focusing on the microbiology, treatments and subsequent outcomes. For a 6‐month period, data were retrieved from the lactation consultant records of 489 clients of the Breast Feeding Centre of WA. Nipple pain was identified in 36% of the clients. Nipple swabs were collected from 46% of the clients with nipple pain when infection was clinically suspected as the cause. The rate of detected infection was 61%. Staphylococcus species were present in 90% of the positive cultures. Other infective organisms detected were a variant of the Streptococcus species, Acinetobacter baumannii, Pseudomonas stutzeri and Candida. Targeted treatment was provided for 77% of the mothers who were positive. Antibiotic choice included flucloxacillin alone or with a combination of other antimicrobials or antifungals, cephalexin, or cephalosporin, depending on the sensitivity of the organism grown from the swab to antibiotics. Fluconazole was prescribed when candida was detected. The treatment resulted in the nipple pain resolving or resolved in 71% of cases. We conclude that swabbing painful nipples during lactation can provide successful, targeted treatment. Grant Funding Source: Supported by Medela, AG

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