Can I breastfeed with cracked nipples?

Dear Doctor,

My baby girl is three days old and I’m having trouble breastfeeding because my nipples are cracked. It is so painful. I used nipple cream as recommended by a friend but it didn’t work. Also, is it even okay to try to feed a baby with cracked nipples? What causes this and what should I do? I really want to breastfeed my child. Keisha

Dear Keisha,

Did your nipples crack recently or have they been like this for some time? Is there associated itching and or eruptions over and around the nipples?

A new mother can develop cracked nipples, one to three days after delivery due to breastfeeding. It happens in about 30 to 35 per cent of new mothers.  The baby exerts suction on the nipples, pulls it and twists it which causes cracks in the soft tissues of the nipple. Risk increases when the baby is not latched properly on the nipples.  Engorgement of the breasts and nipples due to filling of milk ducts and sacs during breastfeeding also contributes to cracking.

Cracked nipples, along with blisters, can be due to eczema of the nipples. Allergy to some body care product used around the nipples can cause itching and cracking. It can be due to thrush over the nipples, where cracking is associated with itching, with or without rashes.

Cracks also appear due to undue dryness. This could be due to overall dryness of the skin, like it is with exposure to dust, heat or cold, medical disorders like hypothyroidism, lack of adequate amount of Vitamin B. complex, and etcetera.

Cracked nipples carry risk of introducing infection in the breasts, which can be bacterial, viral or fungal. Bacterial infection can manifest as red, painful, pus filled swelling of the breast tissue and or milk ducts (depending on the part affected). There may be associated fever.  Viral infection would produce less dramatic symptoms. Fungal infection can produce rashes, flaking of skin around nipples and itching along with cracking.

Treatment consists of adequately lubricating the nipples. This can be done with 100 per cent lanolin. Cotton pads soaked in glycerine can be put over nipples. Rubbing a small amount of breast milk over the nipples after breastfeeding helps to prevent dryness and cracking.

Avoid use of soap or body care products with harsh chemicals over and around the nipples to prevent dryness. In case of suspected allergy, try changing the body care product used.  Nylon bras can induce and aggravate eczema over the nipples and around it. Hence, one should avoid them. Soft cotton bras are always better. In case of thrush, antifungal treatment is useful.

Avoid breastfeeding while the nipples are cracked. It is painful for the mother. Also, it carries risk of introducing infection both in the mother as well as the baby.  Any blood borne infection like hepatitis B or C or HIV, if present in the woman, can be transmitted to the baby via breastfeeding if nipples are cracked. Small bleeding can always occur due to cracking and the germs be passed on to the baby, along with blood.

Dr. Rachna   Pande is a specialist in internal medicine.