Potential predictors of nipple trauma from an in-home breastfeeding programme: A cross-sectional study

Factors associated to nipple trauma in lactation period: a systematic review

“…33 Inadequate technique in breastfeeding, including the handling and the positioning between mother and child was also associated to breast problems in other studies. 12,[35][36][37] In this aspect, intervention actions are essential to prevent the appearance of nipple injuries. 34,36,38 In this current study, the set of variables that has been identified as potential predictors were classified in hierarchical levels, according to the proximity of the factor exposure with the outcome.…”

“…51 The local or general lactational mastitis is joined to nipple trauma. 12 The authors emphasized this because it is a retrospective study and they did not allow the determination of cause and effect. Other studies have related nipple fissure to the development of lactational mastitis.…”

“…23 At the proximal intermediate level constituted by the characteristics of childbirth care, an association to nipple injury was observed: the use of anesthesia at childbirth, 32 gestational age between 37 and 40 weeks 32 and the presence of breastfeeding in the first hour of life. 34 At the proximal level constituted of maternal and newborns characteristics and the health care services related to postpartum and the process of maternal breastfeeding, the variables identified as factors associated to nipple trauma were: semi-protruding and/or malformed nipples, 32 inadequate positioning between mother and child during breastfeeding, 7,12,[35][36][37] incorrect handling of the infant to the mother's breast, 7,12,33,[36][37][38] presence of breast engorgement, 34 nipple pain, 33 lactational mastitis, 12 baby bottle feeding 39 and/or pacifier. 39 …”

“…[5][6][7][8][9] Nipple traumas are characterized by erythema, edema, cracks, fissures, blisters, abrasions and ecchymoses. [10][11][12] In relation to the types of nipple injuries, there is no consensus as regarding to the degree of impairment of the tissue layer on the nipple-areola region. 13,14 The lack of clinical definition for nipple trauma results in disagreements, up to a point that its diagnosis and treatment may be compromised.…”

“…14 It is suggested that in the context of assisting nursing mothers, nipple trauma may be defined as an alteration in the normal anatomy of the nipple skin with the presence of a primary lesion caused by the modification of the color or thickness and not only as a solution of continuity on the skin. 14 The location of the lesion is observed in the upper part of the body and around the base of the nipple, more often found at the tip of the nipple 10,12,15 involving dermis and epidermis with the presentation in the form of linear ulceration or curved. 13 The woman presents symptoms of severe pain on the nipples during breastfeeding.…”