title: Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Chemistry & Biochemistry, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia. Jacqueline.Kent@uwa.edu.au.
authors.forename: Jacqueline C
authors.initials: JC
authors.lastname: Kent
authors.affiliation: Breast Feeding Centre of WA, King Edward Memorial Hospital for Women, 374 Bagot Rd, Subiaco WA 6008, Australia. Liz.Ashton@health.wa.gov.au.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ashton
authors.affiliation: Breast Feeding Centre of WA, King Edward Memorial Hospital for Women, 374 Bagot Rd, Subiaco WA 6008, Australia. CatherineMeria.Hardwick@health.wa.gov.au.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Hardwick
authors.affiliation: School of Chemistry & Biochemistry, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia. Marnie.Rowan@uwa.edu.au.
authors.forename: Marnie K
authors.initials: MK
authors.lastname: Rowan
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia. Elisa.Chia@health.wa.gov.au.
authors.forename: Elisa S
authors.initials: ES
authors.lastname: Chia
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia. fairck01@gmail.com.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Fairclough
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia. Lalitha.Menon@health.wa.gov.au.
authors.forename: Lalitha L
authors.initials: LL
authors.lastname: Menon
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia. cscott9294@gmail.com.
authors.forename: Courtney
authors.initials: C
authors.lastname: Scott
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia. 20930736@student.uwa.edu.au.
authors.forename: Georgia
authors.initials: G
authors.lastname: Mather-McCaw
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia. 20953365@student.uwa.edu.au.
authors.forename: Katherine
authors.initials: K
authors.lastname: Navarro
authors.affiliation: School of Chemistry & Biochemistry, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia. Donna.Geddes@uwa.edu.au.
authors.forename: Donna T
authors.initials: DT
authors.lastname: Geddes
mesh_terms: D000328:Adult; D001941:Breast Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D001942:Breast Feeding; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009035:Mothers; D009558:Nipples; D010146:Pain / Q000453:epidemiology* / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement; D011446:Prospective Studies; D011482:Protective Devices / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
keywords: breastfeeding; diagnosis; nipple pain; treatments