The mother with persistent sore nipples should get rid of the soft shields
and start operating on the premise that clean and dry is what heals sore
nipples best. (See WHO guidelines).  Not 'dried out' but dry,  as in: not
all macerated like a gummy cut under a wet bandaid. If you have a cut on
your finger that defies healing you must consider whether 1) it is infected
2) have you removed the source of the trauma.  I would tell this mother to
soap up her hands with non-antibacterial, non-perfumed soap once a day in
the shower and gently to cleanse her nipples.  She should rinse carefully
under running water.  After breastfeeding or pumping, she should irrigate
the wounds with a normal saline solution.  She can mix a bowl of warm water
with a little salt in it and dip and swish, or put the saline solution in a
squeeze bottle and squirt clean.  Then apply a little topical antibiotic
cream that the doctor can give her or which she can buy.  She should AVOID
antibiotic creams containing neomycin (such as Neosporin). In a day or so
the clean, decontaminated, debrided cuts will heal the same way every other
cut she's ever had on her body has healed once it is cleaned out and briefly
medicated.  If she stays sore after this, it is because she has a primary
latch problem.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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