Deciding to nurse your baby doesn't mean that you'll always have to have a special nipple cream or ointment on hand. Some mothers never require anything to apply to their nipples. Others, on occasion, may find a certain cream soothing. And in some cases, the right type of cream or ointment may actually prevent drying and cracking of the nipple and help speed healing. Other antibacterial ointments and antifungal ointments may be necessary as part of a care plan to treat these types of infections if they should occur.

Because anything you apply to the nipple area may be ingested by the baby, it's important to use only those products that are known to be safe or which absorb so quickly into the skin that only minute amounts are left on the surface. Washing the area to remove a cream or ointment that might be harmful to the baby is not acceptable either as this results in naturally occuring antibacterial and lubricating properties to be removed from the breast which can result in over-drying.

Any all-purpose breast or nipple cream sold over-the-counter which has any other ingredients besides 100% lanolin should be avoided. Other ingredients may be toxic to the baby. This would include the populuar Masse Breast/Nipple Cream sometimes given out in hospitals as well as Vitamin E in any form and Bag Balm. No other lotions or creams, normally used on other parts of the body as moisturizers, should be applied to the nipple area.

In recent years research has concluded that not only is a 100% pure lanolin ointment or cream soothing to new mothers' nipples but it can also prevent nipple trauma by maintaining the internal moisture of the skin. For this same reason, it may also speed healing when nipple trauma is already present. An additional benefit of lanolin is that it does not have to be washed off prior to nursing as it is non-toxic and safe for the baby. Most babies seem to have no difficulty with any "after-taste" after lanolin application either.

Lanolin can be applied after every feeding if desired, preferably after the nipple tissue has been pat dry. A small amount goes a long way, so you'll need very little. Warming the ointment by rolling it between fingers can make application easier. There are two popular brands of 100% lanolin on the market: Purelan made by Medela and Lansinoh.

Occasionally cracked nipple tissue may become infected. This can manifest with redness, oozing, heat in the area, fever, and pain. There may also be no other symptoms of infection other than the cracking itself. If a cracked area is not healing quickly, there is nothing wrong with applying an antibiotic ointment for a few days to see if this might speed healing. Try Neosporin, Triple Antibacterial Ointment, or Bacitracin. All of these are readily available over-the-counter. Apply the ointment after feedings once you have rinsed the area with clear water and patted it dry. You do not have to wash it off before nursing again. Simply wipe away any excess that might still be on the surface of the skin with a dry cloth. If relief is not seen within 3-4 days of using an antibacterial ointment, further assistance should be sought from a lactation consultant.

Yeast can infect nipple tissue. Cracked nipples often allow for yeast to enter. However, yeast can proliferate despite healthy nipple tissue, especially if there are risk factors for yeast in the history. If a yeast infection of the nipples is suspected, certain over-the-counter yeast creams can be applied to the nipple. These include Lotrimin AF, Micatin, and Monistat. They are applied to the nipple area after feedings and after rinsing the area of the baby's saliva and patting it dry. Just as with antibacterial ointments these preparations do not have to be washed off prior to nursing again. Any excess can simply be wiped away with a dry cloth. If there is no improvement with the nipple trauma within 3-4 days of using an antifungal cream or ointment, further help should be sought from a lactation consultant.

Occasionally something stronger with more active ingredients may be warranted. Dr. Jack Newman has suggested an "All Purpose Nipple Ointment " (APNO) for treating any type of nipple trauma that is slow to heal. A combination of two antifungal ingredients, one antibacterial ointment, and one steroid almost ensure that any cause of nipple pain and trauma will be addressed. The steroid is added for quick relief of inflammation and pain. This ointment can be called in by a physician and compounded by a compounding pharmacist. It is applied after feedings and can be used as long as needed. It does not need to be washed away prior to feeding. For a complete listing of the ingredients, including amounts, of APNO, click here.

If your physician will not call in the APNO for you or your insurance will not cover compounded medications, you can still take several over-the-counter ingredients and come up with a similar ointment. Simply take equal parts of an antibacterial ointment, an antifungal cream, and some cortisone (Cortaid brand is fine) and mix them together to make one ointment.

Nystatin is an antifungal cream that is also used to treat yeast on the nipples. Your doctor will need to call this in as a prescription. It should be applied after every feeding once the nipples have been rinsed with clear water and patted dry. It does not need to be washed off prior to nursing again. Because yeast has become highly resistant to Nystatin, many experts are recommending that it be skipped completely when treating nipple yeast.

Because of breastmilk's antibacterial and healing properties it makes a wonderful nipple salve. It also has Vitamin E in it in amounts that are obviously safe for the baby. After a feeding, simply express a little more milk and rub it into your nipples. This practice should be avoided if you think you may have a yeast infection as yeast thrive in milk.

Written by: Becky Flora, BSed, IBCLC

Last Revision: January 22, 2002