Nipple shield use does not impact sucking dynamics in breastfeeding infants of mothers with nipple pain

Coentro, Viviane Silva; Perrella, Sharon L.; Lai, Ching Tat; Rea, Alethea; Dymock, Michael; Geddes, Donna T.

doi:10.1007/s00431-020-03901-3

Cited by 2 publications

(3 citation statements)

References 26 publications

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“…55,92 In a study which randomized nipple shield use in a group of 20 mothers with nipple pain and 28 without breastfeeding problems, nipple shields improved maternal comfort and did not impact milk removal or sucking strength in the pain group. 93 Nipple shields may have a role at the same time as primary interventions are applied in the following three presentations: 1. Severe pain and/or damage 2.…”

Section: Key Strategy 1: Eliminate Repetitive Mechanical Micro-traumamentioning

confidence: 99%

Re-thinking lactation-related nipple pain and damage

Douglas

2022

Womens Health (Lond Engl)

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Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple–areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple–areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.

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Section: Key Strategy 1: Eliminate Repetitive Mechanical Micro-traumamentioning

confidence: 99%

Re-thinking lactation-related nipple pain and damage

Douglas

2022

Womens Health (Lond Engl)

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“…Strength of recommendation C. • A 2015 systematic review and 2021 review conclude that nipple shield use substantially benefits breastfeeding when problems emerge, in measurable outcomes and in reports by mothers [ 20 , 31 ]. • A 2021 study randomized nipple shield use in 20 mothers with nipple pain compared to 28 without, finding nipple shields improved maternal comfort; did not impact milk removal or sucking strength in the pain group [ 32 ]. • Nipple shield use often masks failure to address underlying problems of positional instability or conditioned dialling up at the breast [ 6 ] but may be effective adjunct support for nipple pain and damage, concurrent with fit and hold repair.…”

Section: Introductionmentioning

confidence: 99%

“…• A 2021 study randomized nipple shield use in 20 mothers with nipple pain compared to 28 without, finding nipple shields improved maternal comfort; did not impact milk removal or sucking strength in the pain group [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

Does the Academy of Breastfeeding Medicine’s Clinical Protocol #36 ‘The Mastitis Spectrum’ promote overtreatment and risk worsened outcomes for breastfeeding families? Commentary

Douglas

2023

Int Breastfeed J

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Background In 2022 the Academy of Breastfeeding Medicine (ABM) published Clinical Protocol #36: The Mastitis Spectrum, which aims to update clinical approaches to management of benign lactation-related breast inflammation. The protocol has been timely because of the exponential increase in knowledge about the human milk microbiome over the past decade. This Commentary aims to continue respectful debate amongst clinicians and researchers within the Academy of Breastfeeding Medicine and more broadly, confident that we share a fundamental commitment to promote breastfeeding and support the well-being of lactating women, their infants and their families. Analysis Although Clinical Protocol #36 offers advances, it does not fulfil the principles of best practice implementation science for translation of evidence into clinical guidelines. Clinical Protocol #36 inaccurately represents studies; misrepresents theoretical models as proven aetiologies; does not consistently attribute sources; does not reliably apply the SORT taxonomy; and relies upon single case reports. As a result, various recommendations in Clinical Protocol #36 lack an evidence-base or credible underlying theoretical model. This includes recommendations to use ‘lymphatic drainage’ massage, therapeutic ultrasound, and oral lecithin. Similarly, based on a contestable theoretical model which is presented as fact, Clinical Protocol #36 makes the recommendation to either reduce frequency of milk removal or to maintain current frequency of milk removal during an episode of breast inflammation. Although Clinical Protocol #36 limits this advice to cases of ‘hyperlactation’, the diagnosis ‘hyperlactation’ itself is undefinable. As a result, this recommendation may put breastfeeding women who present with breast inflammation at risk of worsened inflammation and decreased breast milk production. Conclusion Clinical Protocol #36 offers some advances in the management of breast inflammation. However, Clinical Protocol #36 also exposes clinicians to two international trends in healthcare which undermine health system sustainability: overdiagnosis, including by over-definition, which increases risk of overtreatment; and antibiotic over-use, which worsens the crisis of global antimicrobial resistance. Clinical Protocol #36 also recommends unnecessary or ineffective interventions which may be accessed by affluent patients within advanced economies but are difficult to access for the global majority. The Academy of Breastfeeding Medicine may benefit from a review of processes for development of Clinical Protocols.

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Nipple shield use does not impact sucking dynamics in breastfeeding infants of mothers with nipple pain

Cited by 2 publications

References 26 publications

Re-thinking lactation-related nipple pain and damage

Re-thinking lactation-related nipple pain and damage

Does the Academy of Breastfeeding Medicine’s Clinical Protocol #36 ‘The Mastitis Spectrum’ promote overtreatment and risk worsened outcomes for breastfeeding families? Commentary

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