Ointments and salves

It’s common for breastfeeding mothers to experience sore nipples in the early days after birth. In most cases, the new mothers are experiencing “new baby” soreness. What’s a mother to do? Well, before you reach for a nipple cream or ointment, stop. 

Consider: It might be better for you to massage a few drops of your milk onto your nipples, and seek help for positioning and latch before you buy any commercial products. Whether any creams or ointments actually help with sore nipples is debatable. Before you try them, consider the following:

1. Creams and ointments on nipples will not cure poor latch

Cracked or otherwise traumatized nipple skin signals poor positioning and latch. Ask an experienced professional to take a look and help you, before your nipples start to feel so painful you consider giving up. Breastfeeding shouldn’t — and doesn’t have to — be like that. 

2. “Hypoallergenic” products are not allergy-free

Remember, hypoallergenic means that a product has been manufactured in a way that reduces the possibility of an allergic response. It doesn’t mean it eliminates allergies, and allergic reactions are still a serious possibility. 

In a room of experienced lactation consultants at my Comprehensive Lactation Review Course preparing for their 10-, 20-, or 30-year IBLCE Exam, at least one or two experienced IBCLCs — every city, every year — tell me they have seen an allergic reaction on the nipples after lanolin has been used. I’m not surprised. 

Let me be quick to say: The condition they report may or may not have been formally diagnosed as such. Even if it is, we can’t necessarily jump to the conclusion that it’s a cause-and-effect relationship.

But personally? If I had an allergy to wool, I would stay away from a lanolin-based nipple cream.

3. Use any product sparingly

Pharmacist Wendy Jones, PhD, cautions that these products should be used sparingly. If you need to wipe or wash off excess nipple cream before the next feeding, you probably applied too much. More product isn’t necessarily more beneficial, and it might even exacerbate a problem. On our show together, Dr. Jones talked about the difference between “supple” and “soggy.” 

Remember, too, that washing nipples is likely to cause more dryness, and consequently, more skin damage.

4. Look for proof of effectiveness in resolving sore nipples

Some studies claim that some of the available creams, oils, ointments, or balms prevent or cure sore nipples. Across the board, they seem to be small studies, with questionable designs. I find these studies unconvincing, and my observations when caring for many breastfeeding mothers over the years leaves me highly skeptical. Dr. Jones concurs.

Here’s another thing: Many mothers tell me they’ve been instructed to put lanolin cream on the inside of the flange while pumping. I’m unaware of any evidence to support that recommendation. However, I’m aware of anecdotal reports that suggest that lanolin cream isn’t good for the pump.

5. Avoid nipple creams or ointments that contain alcohol

Here in the US, creams and lotions often contain alcohol. Alcohol has antibacterial properties. But it removes not only “bad” bacteria, but also the “friendly” bacteria, which could set you up for a yeast infection. 

It also has a drying effect on the skin, leaving you at greater risk for cracked skin and, again, infection.

6. Avoid those that taste or smell “funny”

Babies are much more sensitive to tastes and smells than adults. Nursing babies instinctively seek the smell of their mother’s milk, which a 2001 study by Varendi and Porter show helps to guide them to their mother’s breast. (There are many studies on this topic!) 

If the smell of the nipple cream or ointment overpowers that of your milk, your baby may feel frustrated and pull away from the nipple. And, if the cream or ointment has a peculiar taste, it will turn the baby off.

7. Some may include “surprise” ingredients

Review the ingredients before buying a nipple cream. Might your baby ingest some of it? Does it contain preservatives? Gluten? Genetically-modified organisms (GMOs)? Parabens (which could cause an allergic reaction)? Does the nipple cream contain animal products or use animal testing? (Did you know that lanolin products are derived from sheep’s wool?) Read before you buy, so you really know what you’re getting. 

8. Avoid products that don’t go smoothly onto nipples

If the product doesn’t glide onto your nipples, it’s likely that you will be tugging on your nipple skin when you apply it. 

Thicker, stickier creams — including lanolin creams
— don’t glide on well. They can be difficult to get out of the tube or jar, and to get off your hands. They can also leave greasy stains on your clothing.

9. Be sure to keep the lid on fluid products between uses

Okay, thicker-textured products can be difficult to get out, but those with a lighter texture can make create a leaky mess. 

And beware of contamination issues, if you are somehow using the same product on the baby’s bottom.

10. Keep it simple

It’s only in the last half-century or so that special creams for sore nipples have been developed. 

Rather than reach for something from the pharmaceutical aisle, why not reach for something safe and available in your kitchen cupboard — olive oil. You can apply it to cracked nipples, and even on the inside the flange while pumping. It has been used to dress wounds for centuries. It glides on smoothly, and research has shown that it has antioxidant and antimicrobial properties, and poses no threat to nursing babies. (And I suggest using olive oil on the inside of the flange.)

Olive oil readily sinks into the skin, and there’s no need to wipe it off prior to breastfeeding. While it’s possible to have an allergy to anything, including olive oil, I’ve never met anyone who did.

Petroleum jelly (the popular brand here is Vaseline) can also be highly effective in healing cracked nipples. Wow! It’s effective, simple, cheap, and has multiple uses! (I learned this from Wendy Jones, too! There’s a wealth of information on her website.)

11. Beware of essential oils

To be clear, I like essential oils, and use them myself. However, as we learned from my interview with expert aromatherapist Lea Harris, there are a number of essential oils that should be avoided while breastfeeding, so be careful. 

I hope you’ll consider these factors before using any nipple cream, ointment, butter, or balm. There are dozens of products to choose from which may be less objectionable and more effective than the popularly-known ones — including your own milk! And, very often, the first strategy should be getting professional help to achieve optimal positioning and latch.

Have you used a nipple ointment or cream? What was your experience? Tell me in the comments below!

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