<My only validation this am, was when my niece called with sore nipples 18 hours after baby born, was that the nurse gave her saline to soothe them. Saline soaks and compresses were my standard of care when I was a hospital LC in mid 80's! >

This has at times driven me WACKO, Pat.

Starting with the use of the word "sore". As an adjective, it means "tender, painful". As a noun, it means "wound", last time I checked the dictionary. At any rate, it indicates the need for some prompt detective work, visualization between and right after latch attempts, etc. well beyond simplistic offering of some surface treatment based only on the mother's use of the word "sore".

So I make a point of asking WIC mothers when phone counseling "Can you SEE any sort of skin damage, redness or skin changes anywhere on or near the nipple???" IME, if there is no visible damage, then surface treatment of any kind has more of a "placebo" effect than anything else. The mother, believing it will help, because she was told it will, is tenderly attending to her nipples and any confidence she gains from it is mainly psychological. 

The one thing that is definitely not included in that "diagnosis" is for Raynaud's symptoms: immediate protection from exposure to evaporation/cooler air temperature, by covering the nipple, and application of dry heat on the outside of the covering. And that, in itself, would require further inquiry as to the various timing  possibilities and length of time, and observation for possible color changes (white, then to red or white, then to blue, then to red) during and after the pain. Possibly too early at 18 hours ?????

OTOH, skin damage indicates a need to consider physical friction from shallow latching, possible tongue tie, etc. or excessively strong vacuum, sometimes from babies, and even from pumps at times.

65 years ago we routinely handed out a type of nipple cream that shall remain nameless and is probably off the market now. It did in fact have a numbing agent in it, and gave the mothers some symptomatic relief from nipple pain, but was later found to have the effect of also numbing the baby's tongue!!!

As a plug, there is no harm in explaining the value of softening the areola right before latching, explaining RPS. 

kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/‎

It can't harm anything, and might be useful for anticipatory guidance for the further challenges nipples may be exposed to as breast swelling from edema and/or swelling from L-2 will often be arriving near or soon after hospital discharge.

I know I'm preaching to the choir, and she is lucky to have you in her corner;-)

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC     Dayton OH 

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