In terms of prevention, warm water compresses are recommended for the prevention of nipple pain, and simply keeping the nipples clean and dry is recommended for the prevention of cracked nipples. In terms of treatment, warm water compresses are recommended for the reduction of nipple pain, and expressed breast-milk reduces the duration of cracked nipples. Hydrogel dressings were associated with a high incidence of infections and their use cannot be recommended. Systemic antibiotics are recommended if a positive culture for Staphylococcus aureus is obtained.
Education for positioning and attachment of the baby to the breast for breast-feeding women needs further studies to assess whether it is more effective as a preventative measure for nipple pain and/or trauma. Warm water compresses warrant further investigation into their effectiveness in nipple pain. Studies assessing the impact of engorgement, pacifiers and feeding bottles on nipple pain and/or trauma are suggested.
Further investigation of the interventions used in many of these studies could be conducted using one intervention at a time in comparison to no treatment. Specific research priorities should include RCTs to assess: (i) lanolin in comparison to no treatment; (ii) lanolin and shells in comparison to no treatment; and (iii) expressed breast-milk in comparison to no treatment.