EpistemisCracks in the nipple during breastfeeding
Specialty: Gynecology and breast.
Why it occurs
- Incorrect attachment technique or attachment of the infant to the breast (main cause)
- Short lingual frenulum in infants (ankyloglossia)
- Improper use of breast pumps (excessive suction pressure or incorrect cup size)
- Added fungal infection (candidiasis of the nipple and ducts)
- Atopic or contact dermatitis exacerbated by constant humidity
Initial workup
Direct observation of a breastfeeding feeding by a midwife or qualified advisor to evaluate attachment. Microbiological culture of the crack or breast milk if bacterial (Staphylococcus aureus) or fungal (Candida albicans) infection is suspected and does not respond to usual measures. Evaluation of the infant's oral cavity to rule out ankyloglossia.
red flags
Intolerable pain that interrupts breastfeeding, persistent active bleeding during sucking, signs of bacterial superinfection (presence of pus, meliceric scabs, erythema that extends to the areola), maternal fever or new-onset painful axillary lymphadenopathy.
Standard management
- Ultra pure modified lanolin — apply a thin layer on the nipple and areola after each feeding; does not require rinsing before breastfeeding again
- Mupirocin 2% ointment — apply after feedings if there are signs of bacterial superinfection, remove gently before taking for a maximum of 5-7 days
- Miconazole oral gel (apply to the nipple and in the infant's mouth if candidiasis/thrush is diagnosed) (note: the fundamental pillar of treatment is the immediate correction of the infant's attachment).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 5
- Treatment options
- 3