Breastfeeding Pain

Background/Objectives: Despite the intent of most mothers to breastfeed their children, breast or nipple pain can be the reason for early cessation of breastfeeding. Current understanding about lactation-related pain revolves around mechanical or pathological causes, discounting the role of psychosocial factors which can influence management of pain. The Breastfeeding Pain Reasoning Model is a clinical reasoning tool developed to support those evaluating women’s lactation-related pain. We aimed to explore perspectives of breastfeeding women on lactation-associated pain and determine how they align with the Breastfeeding Pain Reasoning Model (BPRM). Methods: We conducted a qualitative descriptive study using phenomenological approach in Singapore. Eighteen women with recent breast and/or nipple pain during lactation underwent individual semi-structured interviews in 2022. Thematic analysis was performed. Results: Deductive analysis showed that lactation-associated pain was aligned with BPRM’s domains (i.e., local stimulation, external influences, and central modulation). Psychosocial factors likely influencing central processing of pain were not recognised by most of the participants. Participants described severe breastfeeding pain often accompanied by feelings of vulnerability, injustice, and uncertainty. Inductive analysis identified two additional themes of motivation and expectations. Conclusions: Greater awareness of the interplay between the broad influences on pain is needed. Using an interoceptive lens could help to illustrate how signals from the breast inform the brain, and how social, emotional, and cognitive factors influence the individuals’ perception of painful experiences. Educating breastfeeding women and healthcare personnel about the biopsychosocial nature of pain may empower women to better navigate the challenges of breastfeeding and improve breastfeeding outcomes.

Introduction: Painful breastfeeding (BF) has a very negative impact on the establishment of BF and is one of the main causes of BF cessation, and is therefore considered an important public health problem. Unfortunately, this problem is underestimated by the health care community and few studies have been devoted to its prevalence, characteristics and the attitude of the mothers who experience it. Sample and methods: The study was conducted in the framework of the Breastfeeding and Child Development Study (LAyDI) and focused on BF pain in the first 4 months after birth in a cohort of 203 lactating women managed in primary care centres of the Community of Madrid (Spain). Results: We found a high incidence of pain in women with BF (68.5%), most frequently with onset in the first days after birth, although in 13% of cases it developed after several weeks. In 44% of cases, the pain resolved within 15 days, but in 46% it lasted longer (in 17%, longer than 2 months). We found that 30.9% of mothers contemplated BF cessation at some point due to severe or sustained pain. However, despite having access to professional support, mostly provided by midwives, nearly half of the women who considered weaning did not seek help. Conclusions: Current efforts in different fields of study need to converge urgently to explore the aetiology and pathogenesis of pain and safe and effective approaches to its management in a nonjudgmental and unbiased environment.

Introduction Although there are many known benefits of providing human milk to infants, breastfeeding-related pain is a significant reason for breastfeeding cessation. Breastfeeding-related pain is a unique experience due to breastfeeding’s goal-directed purpose, repetitive nature, and socio-emotional reflections of successful parenting. Understanding how lactating parents cope with breastfeeding-related pain will inform clinical practice to encourage individuals to meet their lactation goals. The aim of this study was to evaluate how lactating parents view coping with breastfeeding-related pain to be different from coping with other types of pain. Methods We conducted a secondary analysis of a pilot randomized control study of a breastfeeding pain self-management intervention. Data from 57 participants who breastfed and completed self-report surveys at 1-, 2-, and 6-weeks postpartum were included. We employed Boyatzis’ thematic analysis method to evaluate affirmative responses to “Is coping with breastfeeding pain different than coping with other pain?”. We evaluated correlations between responses to coping with breastfeeding pain and pain severity scores. Results We identified three main themes: (1) Uncharted Waters, (2) Light at the End of the Tunnel, and (3) Parental Role and Responsibility. No significant differences were detected between the pain scores of individuals who viewed coping with breastfeeding to be different and those who did not. Discussion Lactating parents reported an array of psychological coping strategies in response to breastfeeding-related pain. Coping processes were influenced by personal goals, parental role evaluations, and a desire to meet their infant’s needs. Interventions during prenatal and postpartum care that incorporate individualized coping strategies could support breastfeeding goal attainment.

Simple Summary Breastfeeding is encouraged worldwide due to its nutritional and bonding benefits, but more attention needs to be given to the potential psychological challenges it poses to new mothers. This study investigated whether breastfeeding pain relates to mothers’ and infants’ bonding behavior. Seventy-one mothers with varying levels of breastfeeding pain were videotaped with their infants during face-to-face interactions. We found that mothers with severe breastfeeding pain express less affect and less infant-directed gaze during interactive moments of engagement and play than mothers with no or moderate pain. Infants of mothers experiencing pain also express less affect and more mother-directed gaze than those of mothers not experiencing pain. These findings suggest that maternal pain can interfere with the behaviors of both mothers and infants, potentially impacting development and bonding. Since the mother–infant dyad is a codependent allostatic unit, the allostatic challenges of one partner can influence both partners. Therefore, nutritional advances should be considered along with additional allostatic consequences of breastfeeding to ensure the well-being of both mothers and infants. Abstract Breast milk is considered the ideal infant nutrition, and medical organizations encourage breastfeeding worldwide. Moreover, breastfeeding is often perceived as a natural and spontaneous socio-biological process and one of the fundamental roles of new mothers. While breastfeeding is beneficial, little scientific consideration has been given to its potential psychological challenges. Here, we investigate the phenomenon of breastfeeding pain in mothers and its association with maternal and infant behavioral regulation. During the postpartum weeks, the mother–infant dyad can be considered one allostatic unit directed at infant regulation and development. We hypothesize that pain comprises an allostatic challenge for mothers and will thus impair the capacity for dyadic regulation. To test this, we recruited 71 mothers with varying levels of breastfeeding pain and videotaped them with their infants (2–35 weeks old) during spontaneous face-to-face interactions. We quantified the individual differences in dyadic regulation by behaviorally coding the second-by-second affective expressions for each mother and infant throughout their interactions. We tested the extent to which breastfeeding pain alters affect regulation during mother–infant interactions. We discovered that mothers with severe breastfeeding pain express less affective expressions and less infant-directed gaze during interactive moments of engagement and play than mothers with no or moderate pain. Moreover, infants of mothers experiencing pain during breastfeeding express less affective expressions and more mother-directed gaze while interacting with their mothers than infants of mothers who are not in pain. This demonstrates that the allostatic challenge of maternal pain interferes with the behavioral regulation of both mothers and infants. Since the mother–infant dyad is a codependent allostatic unit, the allostatic challenges of one partner can impact the dyad and thus potentially impact child development, bonding, and mother and infant well-being. The challenges of breastfeeding should be considered in addition to the nutritional advances.

Background Nipple pain or injury is one of the main reasons many mothers stop breastfeeding. We integrated existing literature and conducted a quantitative evaluation of efficacy, with the aim of identifying effective clinical interventions for alleviating breastfeeding-related nipple pain and injury, and providing evidence-based recommendations for future research and clinical practice. In our study, non-specific interventions are defined as measures that do not specifically provide breastfeeding support and are designed to exclude natural factors or induce placebo effects. Conversely, interventions that target the study outcomes and have standardized operational procedures are referred to as specialized interventions. Methods We conducted a systematic literature search across 9 databases, including MEDLINE (via Ovid), PubMed, Web of Science, CINAHL (via EBSCO), EMBASE, the Cochrane Library, CNKI, SinoMed, and Wanfang. Two independent reviewers screened the publications and extracted the data. We evaluated the quality of literature on randomized controlled trials (RCTs) and quasi-experimental clinical trials using the Cochrane Systematic Evaluation Risk of Bias Assessment Tool and the JBI Critical Appraisal Tool. After completing the quality assessment of the literature, we performed a meta-analysis using Stata 17.0. Results A total of 18 studies were identified in the meta-analysis. The results of the meta-analysis showed that specialized interventions were significantly better than non-specific interventions in preventing and treating nipple pain and injury associated with breastfeeding. The specialized interventions were effective in reducing the incidence of nipple pain [OR = 0.366, 95% CI (0.155, 0.862), Z = −2.301, p = 0.021 < 0.05], nipple pain scores [SMD = −0.451, 95% CI (−0.748, −0.154), Z = −2.978, p = 0.003 < 0.05], incidence of nipple injury [OR = 0.316, 95% CI (0.231, 0.433), Z = −7.177, p < 0.001], and intensity of nipple injury [SMD = −0.964, 95% CI (−1.404, −0.525), Z = −4.303, p < 0.001]. Conclusion This study shows that specialized interventions for breastfeeding-related nipple injury and pain are significantly more effective than non-specific interventions. It also demonstrates that preventive measures initiated before nipple pain onset are more effective than post-pain interventions. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251045411, PROSPERO CRD420251045411.

BACKGROUND Breastfeeding is an international public health priority and is considered optimal for both infants and parents. However, initiating and sustaining breast/chestfeeding can be difficult. Evidence suggests that parents commonly encounter physical barriers to feeding, with most experiencing at least some pain during initiation of breast/chestfeeding. Enduring feeding pain takes a physical and emotional toll, yet little is known about lived experiences of this pain. OBJECTIVE In this study, we explore parents' open-ended descriptions of their breastfeeding pain experiences, elicited through a mixed-methods online survey. METHODS Drawing on an affective discursive practice approach, we analyse 668 open-text answers to a question on experiences of feeding pain. RESULTS Our findings are organised into two parts that explore (1) the visceral and emotional experiences of feeding pain, including two themes of 'toe curling pain' and 'I would dread the latch'; and (2) contextual factors that made feeding pain hard(er) to deal with, including 'pain is normal, toughen up' and 'the latch looks good'. CONCLUSION Material, affective, and discursive forces converge to constrain the articulation of feeding pain and limit access to support. We call for greater acknowledgement of these realities and for critical examination of the cultural assumptions that intensify this often-silenced experience.

Background Over 90% of women experience pain during breastfeeding initiation and lack strategies to self-manage breast and nipple pain. Guided by the Individual and Family Self-Management Theory, a breastfeeding self-management (BSM) intervention targeted women's knowledge, beliefs, and social facilitation to manage their breast and nipple pain and achieve their breastfeeding goals. Objectives The purpose of this longitudinal pilot randomized control trial (RCT) was to test the preliminary efficacy of the BSM intervention on general and specific pain related to breastfeeding. Methods Sixty women intending to breastfeed were approached within 48 hours of delivery to participate in this pilot RCT (30 randomized to the BSM intervention and 30 randomized to the control group). All participants provided baseline data before discharge and pain and breastfeeding measures at 1, 2, and 6 weeks. Participants in the BSM intervention group received educational modules addressing breast and nipple pain and biweekly, text-based nurse coaching and completed a daily breastfeeding journal. Results Women in the BSM intervention group reported significantly less breast and nipple pain at 1 and 2 weeks using a visual analog scale (p < .014 and p < .006) and at 2 weeks using the Brief Pain Inventory intensity scale (p < .029), but no difference in breastfeeding duration. Discussion The BSM intervention pilot demonstrates a positive effect on breastfeeding specific and overall generalized pain. Future investigation is needed to identify at-risk women of ongoing breastfeeding pain and develop precision interventions to sustain this beneficial health behavior for mothers and infants.

Sometimes during breastfeeding women adopt positions that may cause problems with musculoskeletal system, resulting in back pain. The aim of this study was to determine the prevalence of lower back, upper back and neck pain in breastfeeding women and how this may be related to the act of breastfeeding. An online survey within Poland was conducted among 395 breastfeeding women who were 1 to 48 months postpartum and were divided into two groups; “no back pain” and “back pain present”. The measurement tools used included an original questionnaire, the International Physical Activity Questionnaire (IPAQ), a Numerical Pain Rating Scale (0–10), and the Roland-Morris Disability Questionnaire. Pearson’s chi-squared tests, Mann-Whitney U tests, Student’s t-tests, and Kruskal-Wallis ANOVA tests were used to compare the groups. It was found that 84% of breastfeeding mothers suffered from back pain at least once a month. Pain was experienced at least once a week in the cervical, thoracic and lumbosacral regions in 48%, 36%, and 66% of the women, respectively. A dysfunctional state was present in 27.6% of breastfeeding mothers who suffered from back pain. Mothers experiencing back pain spent significantly more time on single breastfeeding episodes (p < 0.05) and had an increased total time breastfeeding per day (p < 0.01) compared to mothers with no back pain. Neck pain was significantly less intense in mothers preferring to breastfeed in a lying position as compared to mothers preferring a sitting position in a chair or an armchair (p < 0.05). This survey of Polish breastfeeding mothers revealed a very high prevalence of lower back, upper back and neck pain. The amount of time spent on breastfeeding and the choice of body position for breastfeeding were important factors differentiating the prevalence and intensity of the pain. It is recommended that breastfeeding mothers do not extend the single-feeding time in the adopted position beyond the required time. It is of utmost importance to choose a breastfeeding position in which all parts of the mother’s body are supported. To prevent neck pain, lying and semi-lying positions with head support are recommended.

Background: Auricular acupressure influences pain reduction in patients with diseases. However, study results on its influence on breast pain, common among breastfeeding mothers, are insufficient. Research Aim: This study aimed to explore the effectiveness of auricular acupressure on breast pain among breastfeeding mothers who also received a standard gentle hand technique. Methods: This was a placebo-controlled study wherein auricular acupressure was provided for 4 weeks to 52 breastfeeding mothers consulting a local breastfeeding clinic. In the intervention group, auricular acupressure was applied to specific acupoints, including Shenmen, central rim, breast, and endocrine, which are related to breast pain and postpartum lactation. For the placebo control group, auricular acupressure was applied to acupoints not related to breast pain. The degree of breast pain was assessed using a numeric rating scale and a pressure algometer. Results: After 4 weeks of auricular acupressure, numeric rating scale pain scores did not show a significant change. However, the pressure pain threshold for the upper left (Z = −2.202, p = .028) and upper right (t = 2.613, p = .012) areas of the right breast increased significantly in the intervention group. Conclusion: This study employed subjective and objective measurements to evaluate the efficacy of auricular acupressure in alleviating breast pain. The intervention shows potential as a nursing measure. Further research is required to determine the optimal intervention duration and frequency, particularly for breastfeeding parents with severe pain, and to evaluate long-term outcomes.

Objective: To evaluate the efficacy and safety of nonpharmacological topical interventions for treating breastfeeding nipple pain. Methods: Randomized clinical trials (RCTs) assessing lactating women suffering from breastfeeding painful nipples were included. Primary outcomes were pain, healing process, and adverse events. A comprehensive search was conducted on June 02, 2023, without date or language restrictions. Methodological quality was assessed using the Cochrane risk of bias tool and the certainty of the evidence, the GRADE approach. Results: Nineteen RCTs with unclear to high risk of bias were included. There was uncertain evidence regarding the effects of photobiomodulation versus placebo on pain reduction (mean difference [MD] −0.15; 95% confidence interval [95% CI] −1 0.49 to 1.19; 139 participants, 2 RCTs). There are uncertainties concerning the effects of lanolin versus breast milk on pain (MD −1.80; 95% CI −2.43 to −1.17; 1 RCT; 180 participants), wound healing (MD 0.10; 95% CI −0.26 to −0.46; 1 RCT; 180 participants), and any adverse events (zero events in both groups). Similar effects were observed by the other interventions assessed. Conclusion: The evidence of nonpharmacological topical interventions for painful nipples is imprecise, and future RCTs with higher methodological quality are needed to support recommendations. Considering the accessibility and low cost of these alternative treatments, the findings of this evidence synthesis could support clinical decision-making and guide future research. PROSPERO CRD42020170320.

Introduction: Episiotomy-related perineal pain may significantly impact breastfeeding self-efficacy, influencing new mothers' ability to successfully initiate and maintain breastfeeding. The aim of this study was to determine the relationship between MPQ-SF and postpartum BSES-SF scores. Methods: This descriptive study was conducted at a maternity hospital in Istanbul and involved 208 volunteer mothers who had undergone an episiotomy during childbirth. Data were collected using a “Participant Information Form,” the “McGill Pain Questionnaire-Short Form,” the “Postpartum Breastfeeding Self-Efficacy Scale-Short Form,” and the “Visual Analogue Scale.” The data were analyzed using a statistical program, with significance set at P-value < 0.05. Results: The average age of the mothers was 27.29 ± 5.88 years, with 44.7% experiencing their first childbirth. Severe perineal pain was reported by 9.1% of the mothers, and 35.6% indicated that this pain affected their ability to breastfeed. A significant relationship was found between perineal pain and both the McGill Pain Questionnaire score and breastfeeding self-efficacy score (P-value < 0.05). Additionally, there was a negative correlation between postpartum McGill Pain Questionnaire scores and postpartum breastfeeding self-efficacy scores (P-value < 0.05). Conclusion: Postpartum perineal pain affected mothers' breastfeeding self-efficacy. It is recommended to take measures to reduce perineal pain that negatively affects mothers' breastfeeding. Keywords: breastfeeding; episiotomy; perineal pain; postpartum; self-sufficiency

Aim: To compare the effect of different analgesic regimens on the time to initiate breastfeeding (BF) and ambulation after cesarean section (CS). Methods: This prospective, double-blinded, placebo-controlled randomized study included 300 women (20–40 years of age) of the American Society of Anesthesiologists status 1 or 2 with singleton term pregnancies scheduled for CS under spinal anesthesia. Women were allocated to three groups of 100 each by computer-generated randomization. As an adjunct to 1,000 mg intravenous acetaminophen, Group 1 received 100 mg rectal diclofenac, Group 2 received 100 mg rectal tramadol, and Group 3 received rectal glycerin suppository. The time to initiate BF and ambulation was compared between different analgesic regimens and corelated with pain score. Results: BF (both with and without support) was initiated significantly earlier in Groups 1 and 2 as compared with control Group 3 (p < 0.001). A significantly shorter time was taken to initiate BF without support in Group 1 as compared with Group 2 (p = 0.028). The time to start ambulation (both with and without assistance) was significantly lower in Groups 1 and 2 as compared with Group 3 and in Group 1 versus Group 2 (p < 0.001). A significant positive correlation was found between the time to initiate BF with support and ambulation without assistance and postoperative pain score at 0, 1, and 6 hours. Conclusion: Effective post-CS analgesia affects early initiation of BF and ambulation in the immediate postnatal period. The inclusion of rectal diclofenac suppository in post-CS analgesic regimens is a promising approach to postoperative delivery care.

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OBJECTIVE Beeswax is a natural ingredient used effectively for wound healing. This study aimed to determine the effectiveness of beeswax and breast milk in preventing nipple pain and cracks in the early postpartum period. MATERIALS AND METHODS This non-blinded, randomized controlled trial was carried out between November 15, 2019, and April 1, 2020, in the postpartum clinic of a state university hospital and at mothers' homes. Ninety primiparous mothers meeting the inclusion criteria were randomly divided into beeswax (n=30), breast milk (n=30), and control (n=30) groups using simple randomization. Mothers in the beeswax, breast milk, and control groups were assessed for nipple pain and cracks on postpartum days 1st, 3rd, 5th, 7th, and 10th. RESULTS On postpartum day 10, nipple pain and cracks occurred highest in the control group (%53.3), whereas nipple pain and cracks were encountered least in the beeswax group (%20,0) on postpartum observation days. The differences between the groups in terms of nipple cracks and pain severity were statistically significant (p < 0.05, p=0.004, and p=0.000, respectively). CONCLUSION Beeswax is more effective than breast milk in preventing nipple pain and crack formation. A beeswax barrier can be used to prevent nipple pain and cracks.

Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple–areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple–areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.

• The most frequent cause of nipple pain in breastfeeding women is poor latch or attachment to the breast • An itchy, erythematous rash on the nipple, areola area, or breast is likely to be eczema, and should not automatically be diagnosed as nipple thrush • Persistent nipple and breast pain during lactation is usually multifactorial. Elicit factors from maternal, infant, medical, mental, and psychosocial health, as well as from mechanical trauma or infection

Background: Nipple trauma and pain pose a challenge, leading to premature discontinuation of breastfeeding. Moisturizing therapies, including lanolin and hydrogel dressings, have been proposed for nipple trauma and pain management. Despite the availability of multiple approaches, evidence for moisturizing therapy is lacking. Research Aim: This review aimed to determine the efficacy of moisturizing therapy in treating nipple trauma and nipple pain in lactating women. Methods: A systematic review based on the PRISMA-P guidelines was conducted. Seven databases were systematically searched and screened, and 24 studies were analyzed. The interventions were categorized as high, moderate, or low, based on their moisturization levels. Sample characteristics, interventions, and outcomes were examined. Results: A total of 21 interventions were identified: high moisturization (two types), moderate moisturization (12 types), and low moisturization (seven types). Hydrogel dressings, lanolin, and breast milk are commonly used interventions. Although intervention and effectiveness evaluation methods differed between studies and could not be compared, results in 10 (41%) of the studies demonstrated that one intervention with more moistening was more effective. Of the three studies categorized as including high moistening interventions, two (66%) supported their effectiveness compared to low moistening interventions; however, two of the three studies were judged to be at high risk of bias, and some reported adverse events. Conclusions: Moisturization interventions show promise for treating nipple trauma and pain more than drying nipples or using breast milk, but high moisturization needs cautious use due to few rigorous trials and the presence of reported risks. Methodological challenges and the lack of robust trials hinder evidence synthesis and robust conclusions. Abstract in Japanese 背景： 乳頭損傷や乳頭痛は産褥早期に授乳を断念する要因である。その対処法として、ラノリンやハイドロジェルドレッシングによる保湿療法が提案されている。しかし、乳頭損傷や乳頭痛に対する保湿療法の効果に関する検討は不足している。 目的： 本システマティックレビューは、授乳中の乳頭損傷と乳頭痛の治療における保湿の有効性を検討することを目的とした。 方法： PRISMA-Pガイドラインに基づく系統的レビューを実施した。7つのデータベースを用いて、体系的に検索とスクリーニングを行い、最終的に24件の文献を対象とした。介入方法を保湿レベルに基づいて高保湿、中保湿、低保湿に分類し、サンプル特性や、介入、および結果について検討した。 結果： 高保湿（2種類）、中保湿（12種類）、低保湿（7種類）の合計21種類の介入が特定された。ハイドロジェルドレッシング、ラノリン、母乳の塗布が一般的な介入として使用されていた。介入および効果の測定方法は研究間で異なり、結果の統合は困難であったが、10件（41％）でより高い保湿の介入が効果的であるとされていた。高保湿に分類された3件のうち2件（66％）が低保湿の介入と比較して効果的であるとされたが、2件（66％）はバイアスリスクが高いと判定された文献であり、有害事象の報告もあった。 結論： 保湿療法は乾燥や母乳の塗布と比較して乳頭損傷や乳頭痛の対処法として有望であるが、高保湿の対処法には厳密な無作為化比較試験の不足と有害事象の報告があり、慎重な検討が必要である。堅牢な実験研究の不足と方法論的な課題が、結果の統合とエビデンスの確立の妨げとなっている。 Back translated by Katsumi Mizuno, PhD, MD, IBCLC

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Estimates suggest that only 24.9% of infants born in 2019 were exclusively breastfed before six months of age, despite the known health benefits of exclusive breastfeeding. Breast and nipple pain is one of the primary determinants of exclusive breastfeeding. Environmental contributions to breastfeeding success have been reported extensively in the literature, but the contribution(s) of maternal genetics has yet to be discovered. The purpose of the study was to identify an association between pain and lactation related gene variants with exclusive breastfeeding determinants. We selected four genes having single nucleotide polymorphisms (SNPs) with potential functional significance in breastfeeding and pain: prolactin receptor (PRLR), oxytocin receptor (OXTR), catechol-O-methyltransferase (COMT), and milk fat globule-EGF factor 8 (MFGE8). We performed a cross-sectional secondary analysis of a longitudinal randomized controlled trial study, PROMPT (NCT05262920). Breast and nipple pain, perceived insufficient milk, and breastfeeding self-efficacy were examined using total scale scores for the Brief Pain Inventory (BPI), Visual Analog Scale (VAS), H&H Lactation Scale, and the Breastfeeding Self- efficacy Scale short form (BSES-SF) respectively. Of the candidate genes examined, SNPs within COMT were significantly associated with breastfeeding-related outcomes. Specifically, COMT rs4633 and rs4680 minor allele carriers (T, A) reported higher breast and nipple pain intensity than women homozygous for the major allele (C, G). COMT is the most widely researched "pain gene" and has been linked to cold, postoperative, and postpartum pain. This study is the first to identify a contribution of COMT variants to breast and nipple pain and, as a result, to breastfeeding exclusivity. TRIAL REGISTRATION: PROMPT was registered in ClinicalTrials.gov (protocol #NCT05262920)1. PERSPECTIVE: Two single nucleotide polymorphisms in the pain gene COMT are associated with breast and nipple pain. Clinically, a minor allele in COMT rs4633 and rs4680 may increase a woman's rating of moderate breast and nipple pain.

The analgesic role of PBMT for breastfeeding women with nipple pain is inconclusive. This study aimed to determine the efficacy of PBMT at 660 nm in postnatal women with nipple pain planning to exclusively breastfeed. A randomised, placebo-controlled clinical study was initiated at a tertiary hospital in Brisbane, Australia on the inpatient maternity wards from May 2020 to September 2020. Eligible participants were randomised into two groups, an intervention group receiving usual care and PBMT (Group A) and a control group receiving usual care and sham PBMT (Group B). Usual care involved consultation with a midwife and/or lactation consultant to assist with infant latching and breastfeeding positioning. PBMT (660 nm; 250 Hz; 17 mW; 0.5 cm2 spot size) was administered three times within 24 hours. Nipple pain was the primary outcome measure analysed using a Visual Analogue Scale (VAS). Quality of life (QoL) and the participants’ perceived efficacy of treatment were secondary outcome measures evaluated using the PROMIS Global Short Form and a combined 5-point Likert scale and thematic analysis, respectively. Due to the impact of COVID-19, only 10 participants were recruited. Compared to sham, three applications of PBMT at 660 nm provided no significant difference to participants’ nipple pain, QoL or perceived efficacy of treatment. Three key themes of PBMT treatment were simplicity, safety and support. This study was unable to demonstrate the impact of PBMT at 660 nm on relieving nipple pain due to low participant numbers. An adequately powered RCT with COVID-19 modifications, is recommended.

BACKGROUND Nipple pain and cracks are common in breastfeeding, and while traditional and non-pharmacological methods are used, evidence on their effectiveness is inconsistent. The findings of this study contribute to further health professionals' provision of culturally sensitive, evidence-based care. RESEARCH AIM This study explored the experiences and perceptions of first-time breastfeeding mothers regarding traditional approaches used to prevent and manage nipple pain and cracks, as well as their evaluations of the effectiveness of these practices. METHODS A qualitative descriptive phenomenological design was employed. A total of 24 first-time breastfeeding mothers were recruited through snowball sampling, with data collection continuing until saturation. Face-to-face, semi-structured interviews lasting 20-25 minutes were conducted and audio-recorded with consent. Interviews were transcribed verbatim, anonymized (M1-M24), and analyzed using MAXQDA (Version 24), following Braun and Clarke's thematic analysis approach. The study adhered to the Consolidated Criteria for Reporting Qualitative Research, with themes refined through expert input. RESULTS Analysis identified four main themes and eight subthemes. Nipple pain and cracks were mainly linked to physiological issues during early lactation and mechanical trauma from incorrect latch. Mothers reported physical discomfort and impacts on self-confidence and maternal identity. Traditional remedies like human milk and herbal oils offered temporary relief, while professional counseling and proper technique were essential for effective management. CONCLUSION Traditional approaches may provide supportive relief for nipple pain and cracks in first-time breastfeeding mothers, but are insufficient as standalone interventions. Integrating culturally sensitive counseling with evidence-based breastfeeding support is essential to promote effective and sustainable breastfeeding practices.

BACKGROUND During the immediate postpartum period, breastfeeding could be challenge for many women due nipple pain and trauma. Non-pharmacological therapeutic strategies that reduce pain and accelerate healing are essential to prevent early weaning and support successful lactation. OBJECTIVE This study aimed to evaluate the effectiveness of low-level laser therapy (LLLT) in reducing pain and promoting healing of nipple trauma in postpartum women, as well as to assess participants satisfaction with the intervention. METHODS This multicentric, controlled, randomized, double-blind clinical trial included 60 women equally divided into an experimental group (2 J of red light at the nipple's central point and 4 J of infrared light in a cross pattern over the areolar region) and a sham group. Pain intensity was measured using the Numeric Rating Scale before, during, and up to 7 days after the intervention, and healing was assessed using a validated instrument. Intention-to-treat analysis was conducted. RESULTS We found a significant reduction in pain in the experimental group, with relief observed 30 min (p = 0.0439) after the LLLT application. Pain diary analyses indicated that, compared to the sham group, the experimental group reported lower pain intensity at 1h (p = 0.0485), 6h (p = 0.0194), 12h (p = 0.0033), and 7 days after the intervention (p = 0.0085). There was no significant difference in the level of satisfaction between groups (p = 0.652), and no adverse effects were identified. CONCLUSION LLLT proved to be a safe, effective, and feasible approach for managing pain associated with nipple trauma in the early postpartum, providing maternal comfort and supporting the continuation of exclusive breastfeeding.

Nipple pain and discomfort during or after breastfeeding remains one of the most common reasons for premature cessation of lactation among the affected women. The belief that yeasts, and especially Candida spp., are responsible for such symptoms is highly supported by many physicians, midwives, or lactation specialists, but is also viewed with scepticism by other health care providers. The aim of this paper is to provide an updated report of the evidence against, as well as in favour of, the “Candida hypothesis”. Several studies have documented that lactating women with symptoms such as nipple soreness, with or without radiating breast pain, are more likely to test positive for Candida spp. than non-symptomatic women. However, its role as an undisputable aetiopathogenic factor for infection in these cases cannot always be established. Physicians should evaluate thoroughly such patients, because early and correct recognition of the underlying problem can prevent phenomena of early weaning.

Back ground : Pain on breastfeeding is an important cause of weaning and, therefore, its prevention is essential. Application of olive oil on nipple decreases this pain as it contains nutrients that fight inflammation. Aim of study : Was to examine application of olive oil on nipple in late pregnancy period to prevent nipple trauma during lactation. Design: Aquasi-experimental design (pre-post design) was utilized to fulfill the aim of this study. Setting: This study was conducted at Obstetrics and Gynecology Outpatient Clinic in Benha University Hospital. Sample: A purposive sample of 120 primigravida who attended the above mentioned setting during six months was recruited for the study. Tools of data collection : Four tools were used to collect the necessary data. I: A structured interviewing questionnaire. II: Nipple trauma score. III: Nipple Soreness Rating Scale and IV: Follow up sheet. Results : There was a highly statistical significant differences between both study and control group in favor of study group regarding nipple trauma score and nipple soreness score. Also, there was a highly statistically significant relation between nipple trauma score as well as nipple soreness score and frequency of application of olive oil per day. Finally, there was a highly statistically significant relation between nipple trauma score as well as nipple soreness score and period of using olive oil on nipples. Conclusion : Application of olive oil on nipple in late pregnancy period had appositive effect to prevent nipple trauma during lactation. Recommendations : There is a need to provide counseling program during the third trimester for pregnant mothers & direct postpartum period about protection and treatment of the traumatic nipple.

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Aim: In the first months of lactation, nipple pain and chaps emerge among most of the mothers due to inadequate breastfeeding, and it gets difficult for the baby to feed on breast milk. Ineffective breastfeeding and baby feeding in wrong position cause damage, chap of nipple and pain while breastfeeding and mothers may give up breastfeeding for this reason. Therefore, using scales which measure efficacy of breastfeeding is important in order to predetermine nipple pain and trauma risk and prevent formation of nipple chaps. When the risk is determined, there would be a chance of removing the problem before it occurs through suitable midwifery care and breastfeeding. In this study, it was aimed to determine the relation between self-efficacy of breastfeeding of mother and nipple pain/trauma. Methods: In data collection of this study which is a sectional and analytical research, a question form was used about descriptive characteristics of puerperant, ‘LATCH Breastfeeding Charting Scale’ and ‘Breastfeeding Self-Efficacy Scale’ were used in order to evaluate breastfeeding efficacy; ‘Nipple Pain and Trauma’ was used in order to determine nipple pain and trauma of puerperant mothers. Setting and study participants: The study was carried out at Gerbay Family Health Center in İzmir-Bayraklı. Puerperants (74) within 8th and 40th days of puerperium period were included in the study since nipple pain and chap are observed in the first weeks of postnatal period. Findings: According to Breastfeeding Self-efficacy Scale, although all of the puerperants regard themselves as ‘efficacious’ abut breastfeeding; when their breastfeeding efficacy are evaluated with LATCH scale it was determined that 83.8% of them are ‘inefficacious’ about breastfeeding and do not breastfeed according to technique. Moreover, it was determined that 77% of puerperants who do not use suitable breastfeeding technique have nipple chap. Results and Suggestions: Study results are important since they show that although mothers regard themselves efficacious about breastfeeding they are in fact inefficacious when evaluated with an objective scale and in this sense they have nipple chap. Therefore, in puerperium period especially midwives and nurses should observe and examine breastfeeding techniques and positions; if there is a problem on nipple it should be determined and solved at an early period *Correspondence to: Esin Ceber, Associate Professor, Izmir Atatürk School of Health, Ege University, Izmir, Turkey, Tel: +902323882851; E‐mail: esin.ceber@ ege.edu.tr

Objective To investigate Candida species and Staphylococcus aureus and the development of ‘nipple and breast thrush’ among breastfeeding women. Design Prospective longitudinal cohort study. Setting Two hospitals in Melbourne, Australia (one public, one private) with follow-up in the community. Participants 360 nulliparous women recruited at ≥36 weeks’ gestation from November 2009 to June 2011. Participants were followed up six times: in hospital, at home weekly until 4 weeks postpartum and by telephone at 8 weeks. Main outcome measures Case definition ‘nipple and breast thrush’: burning nipple pain and breast pain (not related to mastitis); detection of Candida spp (using culture and PCR) in the mother's vagina, nipple or breast milk or in the baby's mouth; detection of S aureus in the mother's nipple or breast milk. Results Women with the case definition of nipple/breast thrush were more likely to have Candida spp in nipple/breast milk/baby oral samples (54%) compared to other women (36%, p=0.014). S aureus was common in nipple/breast milk/baby samples of women with these symptoms as well as women without these symptoms (82% vs 79%) (p=0.597). Time-to-event analysis examined predictors of nipple/breast thrush up to and including the time of data collection. Candida in nipple/breast milk/baby predicted incidence of the case definition (rate ratio (RR) 1.87 (95% CI 1.10 to 3.16, p=0.018). We do not have evidence that S aureus colonisation was a predictor of these symptoms (RR 1.53, 95% CI 0.88 to 2.64, p=0.13). Nipple damage was also a predictor of these symptoms, RR 2.30 (95% CI 1.19 to 4.43, p=0.012). In the multivariate model, with all three predictors, the RRs were very similar to the univariate RRs. This indicates that Candida and nipple damage are independent predictors of our case definition.

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Background: Breastfeeding is crucial for infant health, but nipple trauma remains a common challenge. In particular, nipple trauma can lead to the onset of mastitis and psychological distress for mothers. Silver nipple protectors have been suggested to alleviate this issue, but detailed research is needed. Research Aim: This study aims to clarify the effectiveness of silver nipple protectors in treating nipple trauma in Japanese women. Methods: A non-randomized comparative trial compared 47 participants (94 nipples) using silver nipple protectors with a control group of 50 participants (100 nipples) from historical data. The assessment included chronological changes in nipple condition, level of nipple pain, and safety, among other factors. Data collection spanned from 2023 to 2024. Results: The group using silver protectors experienced fewer instances of severe nipple trauma and showed a higher frequency of healing patterns. Many of these patterns involved a transition from mild erythema or swelling toward a healing state. Specifically, the level of nipple pain on the 4th postpartum day was significantly lower. No safety issues from the use of silver protectors were noted. Conclusion: This study suggests that silver nipple protectors may prevent the occurrence of severe nipple trauma and are safe and beneficial for Japanese women. Future research should focus on the mechanism of silver protectors, their long-term effects, regional differences, practical challenges for implementation, and comparisons with other common treatments.

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BackgroundDeep breast pain during lactation, with or without accompanying nipple pain and soreness continues to be anecdotally linked to infection by Candia albicans despite lack of robust evidence in the literature that Candida albicans is the cause of women’s breast symptoms.MethodsA case-control study of breastfeeding women in Sweden with (n 35) and without (n 35) symptoms that may be attributable to Candida albicans was carried out. The symptoms were radiating, burning and penetrating or non-penetrating breast pain with or without associated nipple pain during or after breastfeeding. The primary aim of the study was to test the hypothesis that breastfeeding women with symptoms commonly associated with Candida albicans infection will have a growth of Candida albicans in their breast milk significantly more often than women without these symptoms. A secondary aim was comparison of breastfeeding self-efficacy, measured by the BSES-SF (Breastfeeding Self Efficacy Scale –Short Form), between cases and controls.ResultsNone of the women in the control group and eight of the women in the case group showed a growth of Candida albicans in their breast milk (p <  0.01), which confirms the hypothesis. There were no statistically significant differences in severity or type of symptoms between those in the case group with and without growth of Candida albicans in their breast milk. Results of the BSES-SF measurement showed no statistically significant differences between cases and controls. However, when analyses were stratified for parity, multiparous controls showed statistically significant higher scores for breastfeeding self-efficacy than multiparous cases.ConclusionsNeither clinical symptoms nor microbial cultivation appear to be reliable means for making a diagnosis of Candida albicans infection of the breast. Skilled breastfeeding consultants should offer support and help with positioning, attachment and identification of physical impediments to successful breastfeeding. Professionals should be aware that it is possible that uncertainty in the breastfeeding situation may to some extent account for mothers’ breast symptoms. The ISRCTN (International Standard Randomised Controlled Trial Number) identity for this case-control study is ISRCTN88839993. The study was retrospectively registered on 30 November 2016.

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The breastfeeding period is a crucial period in supporting infant growth and development, where proper breastfeeding techniques are essential to prevent various physical problems in mothers such as mastitis, sore nipples, and breast milk engorgement. This study aims to analyze the relationship between breastfeeding techniques and the incidence of physical problems in breastfeeding mothers. The study design used a cross-sectional analytical approach involving 30 breastfeeding mothers aged 0–6 months at the Kobe Community Health Center. Data were collected through questionnaires regarding breastfeeding techniques and physical complaints, then analyzed using the Chi-Square test. The results showed that sore nipples were the most common complaint (33.3 %), followed by breast milk engorgement (23.3%) and mastitis (16.7%). Bivariate tests showed a significant relationship between breastfeeding techniques and mastitis (p=0.05) , sore nipples (p=0.02), and breast milk engorgement (p=0.04), where mothers who used inappropriate breastfeeding techniques were at higher risk of experiencing physical complaints. This study concludes that breastfeeding techniques play an important role in preventing physical problems in breastfeeding mothers, so breastfeeding education and support from health workers are very necessary to increase the success of exclusive breastfeeding.

Nipple blisters often occur in breastfeeding mothers due to incorrect breastfeeding techniques. So far, sore nipples dominate the complication in the lactation process, which is caused by a lack of information regarding the breastfeeding process. Data showed that mothers who experience sore nipples worldwidewere 56.4%, while in Indonesia by 79.3%. Data in Sitti Fatimah hospital depicts that 14.8% mothers experienced sore nipples in 2021. This study aimed to recognize the effects of breastfeeding techniques on sore nipples in postpartum mothers.This was quasi experimental study with a treatment group without a control group. The number of samples was 16 respondents of population by 85 mothers selected by purposive sampling. Data collection applied questionnaires and observation sheets. The results revealed that there was a significant change in the value of degree of sore nipples before and after the correct breastfeeding technique intervention was applied. Paired Sample Test obtained p-value = 0.000 (<0.05). It concluded that breastfeeding techniques influenced the sore nipples in postpartum mothers at Siti Fatimah Hospital. It is encouraged to postpartum mothers, especially primiparous ones to increase knowledge and insight on breastfeeding and the correct techniques, and for further researchers it is suggested to develop research related to health services that are carried out to increase knowledge of postpartum mothers, especially in primiparous.

Background: Blistered nipples are a common problem faced by breastfeeding mothers, characterized by cracked, red, and sometimes bleeding nipples. This study aims to analyze the influence of education with animated videos on knowledge about the prevention of nipple abrasions in postpartum mothers. Method: This study used quasi-experimental pre-test and post-test design with control group. The subjects of the study of 60 postpartum mothers were divided into two groups each consisting of 30 mothers in the intervention group and 30 mothers in the control group selected by consecutive sampling. The tool used is a questionnaire. The duration of the animation video is seven days, with three sessions. The results of the analysis of the data normality test using Shapiro-Wilk with a value of ≥0.05 showed that the data was distributed normally. Data analysis using the T test is not paired with SPSS 25 for Windows. Result: Before starting the help for the intervention group showed they had an average score of 70.3. Meanwhile, the control group had an average score of 68.2. The average outcome of knowledge after intervention was given in the intervention group was 96.8 and in the control group 69.7. The results of statistical tests using unpaired T tests showed Asymp. Sig (2-tailed) ≤0.000, which indicates a significant effect of this therapy, there was a noticeable difference in how much the two groups knew about preventing sick nipples. Conclusion: Animated videos can be an alternative to increase postpartum mothers' knowledge about the prevention of putting blisters.  

Nipples need no special treatment unless they are causing pain or discomfort. But as a midwife, the way you teach positioning and attachment can make all the difference because nipple pain often leads to early cessation of breastfeeding.

According to the results of the Indonesian Toddler Nutritional Status Study (2020), as many as 27.67% of toddlers in Indonesia experience stunting. One intervention that is considered capable of overcoming the problem of stunting is optimal exclusive breastfeeding. Indonesia's exclusive breastfeeding coverage in 2022 was recorded at only 67.96%, down from 69.7% in 2021. The causes of failure to provide exclusive breastfeeding are three factors, namely psychosocial factors, socio-demographic factors and health service factors. Providing knowledge about early breastfeeding will increase positive attitudes and the success of exclusive breastfeeding. The aim of this research is to identify the relationship between breastfeeding techniques and the incidence of sore nipples in postpartum mothers at TPMB Ari Kristiyani, Tambun Selatan District, Bekasi Regency in 2023. The research method used is a cross sectional survey method. sampling using a total sampling technique of 30 respondents. Univariate analysis uses a frequency distribution and for bivariate tests uses the Chi Square test. This research uses primary data from filling out questionnaires by respondents. The results showed that of The P value has a value of 0.000 < 0.05, which means that Ha is accepted and Ho is rejected or means that there is a relationship between breastfeeding technique and the incidence of sore nipples at TPMB Ari Kristiyani. It is hoped that this research will become a reference for educational materials in independent practice settings, especially breast-feeding techniques so that the breastfeeding process is comfortable and pain-free. It is also hoped that this research will become a basis and reference for further research related to increasing knowledge and become material for further study

Problems during breastfeeding are caused by breastfeeding mothers' low knowledge about the breastfeeding process. The aim of the study to provide midwifery care to postpartum mothers on the 14th day by providing the correct breastfeeding position at PMB NH Bandar Lampung City. The design of educational needs about research used is descriptive with a case study approach. This case study research was conducted from April 4 2023 to April 5 2023. The subject of this research was Mrs. T Postpartum day 14.  Implementation of continuing midwifery care for Mrs. T is carried out in accordance with midwifery service standards. The midwifery care provided by the researchers was the correct breastfeeding technique or the correct breastfeeding position to prevent chafed nipples. From the study it was found that postpartum mothers experience sore nipple discomfort, the authors have made a diagnosis and made a plan, Mrs. T was given management according to the mother's complaints, namely by treating chafed nipples and breastfeeding techniques properly and correctly. This is in accordance with the needs of the mother and midwifery care standards. Care is evaluated and documented in accordance with midwifery care for postpartum mothers using the SOAP method according to Varney's mindset. It is recommended for PMB to be able to prepare health education media such as leaflets, posters related to the discomfort of chafed nipples in postpartum mothers, so that patients 

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Breast feeding is very important for the health and well-being of infants and mothers. It has been traditional way of feeding newborn in our country and is one of the most natural and bene icial acts a mother can do for her child. Areola irritation is regular in breastfeeding ladies during the initial not many days after conveyance. Most of the sore and broke areolas are the aftereffect of wrong situating and connection of the infant at the breast. The present study aims to assess the effectiveness of breast milk application on sore nipples among postnatal mothers in a Saveetha Medical College and Hospital, Chennai. A quantitative pre-experimental one group pretest and post-test research con iguration was embraced and the examination was directed with 30 postnatal moms who were chosen by utilizing non-likelihood purposive inspecting method. The organized meeting was utilized to gather segment information and Nipple Trauma Checklist was utilized to survey the sensitive areola. Pretest was directed prior to overseeing the bosom milk by surveying the areola utilizing Nipple Trauma Checklist. Investigator expressed the mother’s breastmilk into a sterile gauze piece and gently rubbed over the nipples, allowing it to air dry for 10-15minutes. Interventionwas given for thrice a day for two days and posttest was done on the third day. The study inding shows that critical improvement was seen which unmistakably derives that use of expressed breast milk over areola was discovered to be compelling in the administration of areola irritation among postnatal moms.

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Background/Objectives: Breastfeeding multiple birth infants (MBIs) poses unique challenges that require tailored support; however, research on these mothers’ experiences is limited. This study explored the breastfeeding journeys of Australian mothers of MBIs, highlighting barriers, facilitators, and support needs. Methods: Data were collected via an online survey (May–August 2024) and included quantitative data on breastfeeding initiation, duration, and challenges, as well as qualitative insights into mothers’ experiences. Thematic analysis was used to identify key themes, and statistical analyses were used to compare breastfeeding outcomes by parity. Results: While most mothers (87%) had an antenatal intention to breastfeed, they faced barriers such as latching difficulties (56%), inadequate milk supply (49%), and sore nipples (47%). Preterm births (58%) and neonatal unit admissions delayed the breastfeeding initiation. Most mothers (99%) used electric breast pumps to boost milk supply (68%) and enable expressed breast milk feeding by other caregivers (65% of mothers). While 72% were satisfied with hospital breastfeeding support and some mothers received excellent hands-on support, others felt neglected due to busy staff or conflicting advice. Mothers frequently reported that breastfeeding guidance was geared toward singletons, leaving them unprepared for the challenges of feeding multiples. Mothers’ suggestions for improving care included specialised guidance, better access to lactation support, and in-home practical support to alleviate the burden of feeding and expressing. Additionally, mothers reported that healthcare professionals should be trained to offer practical, non-judgemental support to help mothers navigate the elaborate challenges of breastfeeding MBIs. Conclusions: This study underscores the need for early postpartum support and tailored guidelines to enhance MBI breastfeeding outcomes and maternal-infant well-being.

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Objectives To evaluate the association between ankyloglossia and breastfeeding outcomes, particularly exclusive breastfeeding (EBF) and maternal nipple pain during the immediate postpartum period and to estimate the prevalence of ankyloglossia in a population of Portuguese newborns. Study design This cross-sectional study assessed 501 newborns within the first 5 days of life at Centro Hospitalar Universitário de São João, Oporto, Portugal, before hospital discharge. Ankyloglossia was diagnosed by a single examiner using the Assessment Tool for Lingual Frenulum Function protocol. Data on breastfeeding practices and maternal nipple pain were collected. Poisson regression analysis was used to evaluate associations. Results The prevalence of ankyloglossia among newborns was 13.8%. During hospitalization, 71.0% of newborns were exclusively breastfed, and 28.4% of mothers reported nipple pain during breastfeeding. There was no statistically significant association between ankyloglossia and EBF rates during hospitalization. However, mothers of newborns diagnosed with ankyloglossia had a significantly higher probability of experiencing nipple pain during breastfeeding (prevalence ratio, 1.51; 95% CI, 1.11-2.06). Conclusions Although ankyloglossia was not associated with lower EBF rates during the hospital stay, it was significantly linked with increased maternal nipple pain during breastfeeding. These findings suggest that, although ankyloglossia may not hinder EBF in the immediate postpartum period, it can contribute to maternal discomfort and potentially adversely affect the breastfeeding experience.

Background : Musculoskeletal pain (MSP) is common among lactating mothers. The aims of this study were to assess the prevalence of MSP and its association with the positioning of lactating mothers in Riyadh, Saudi Arabia. Methods : This was a descriptive cross-sectional survey study using an online self-administered questionnaire. Results : 336 women aged 20–50 years participated in this study (58.3% reported vaginal delivery, 74.1% had one to four children, 61.3% had a bachelor’s degree or higher, and 45.5% worked). Only 25% of the mothers were given health education regarding MSP. 97.3% of mothers reported pain on at least one part of their body. There were differences in pain intensity ratings across different locations (with a median and interquartile range in parentheses): lower backs at 0 (0, 6) and upper backs at 2 (0, 5), necks at 3 (0, 6), shoulders at 3 (0, 5) and arms at 2 (0, 4), and hands at 1 (0, 4). MSP prevalence ranges from 58.6% for arm and hand to 72.3% and 67.6% for lower back and neck, respectively. MSP prevalence is significantly associated with breastfeeding positions ( p < 0.001). A cradle position was the most commonly used (54.8%), and it was associated with MSP across different locations ( p < 0.001). Conclusions : The prevalence of lower back and neck pain is higher among breastfeeding mothers in Riyadh, Saudi Arabia. MSP and breastfeeding position were significantly associated. Mothers received limited health education about MSP.

Abstract Background Breastfeeding (BF) is a physically demanding task and is predominantly performed in a head-down position as the mother attempts to maintain eye contact with the infant. There are possibilities of BF-related neck pain (BFRNP) that have not been widely studied. This study investigated the prevalence and correlates of BFRNP in Nigerian lactating mothers. Methods A cross-sectional descriptive survey was conducted among 310 lactating mothers selected from post-natal clinics in Enugu, Nigeria. Information on their BF profile was sought as well as the prevalence and characteristics of BFRNP using a self-structured questionnaire. Results It was found that cradle hold was the commonly adopted BF position (94.0%) and the majority breastfed ≥10 times daily (55.2%) for <30 min per session (49.1%). BFRNP was seen in 51.7% of women, of which 55.0% reported moderate pain intensity and 60.0% experienced this pain during BF. None of the maternal characteristics and breastfeeding profiles were significantly associated with the prevalence of BFRNP (p>0.05). Conclusions There is a high prevalence of BFRNP among nursing mothers. Although maternal characteristics and BF positions were not associated with reported BFRNP, the results suggest that changing BF positions reduces neck pain during nursing sessions. Therefore this study recommends that nursing mothers should regularly change their BF positions to increase relaxation and comfort.

Background: Breastfeeding is essential for infant nutrition and maternal health; however, repetitive infant handling and prolonged breastfeeding posture may predispose mothers to wrist-specific musculoskeletal injuries, leading to pain and functional limitations.Objective: To determine the prevalence of wrist-specific injuries among breastfeeding females and examine the association between selected demographic and breastfeeding-related factors with wrist-specific injuries.Methods: A cross-sectional observational study was conducted among 100 breastfeeding females. Wrist pain was assessed using the Numerical Rating Scale (NRS), functional disability using the Patient-Rated Wrist Evaluation (PRWE), and clinical diagnosis through Finkelstein’s test, Phalen’s test, and Tinel’s sign. Data were analyzed using descriptive statistics, Welch’s independent t-test, Chi-square test, and one-way ANOVA.Results: Wrist-specific injuries were identified in 77% of participants. Wrist Overuse Pain (33%) and De Quervain’s Tenosynovitis (32%) were the most prevalent conditions. Feeding duration and infant weight showed statistically significant associations with wrist-specific injuries (p<0.001), whereas age, BMI, postpartum duration, feeding frequency, and carrying habits were not significantly associated.Conclusion: Wrist-specific injuries are highly prevalent among breastfeeding females. Early screening, ergonomic education, and physiotherapy interventions may reduce pain, improve function, and promote successful breastfeeding.        

The postpartum period is associated with significant musculoskeletal stress, particularly among breastfeeding mothers who frequently maintain prolonged forward-flexed neck postures. This repetitive strain predisposes them to acute trapezitis, characterized by trapezius muscle tenderness, pain, and functional limitation. Despite increasing reports, limited research has examined the specific prevalence of acute trapezitis in breastfeeding postpartum females.

Abstract Thoracic spine pain (TSP) is a disturbing condition associated with a decreased quality of life among postpartum women. We conducted a cross-sectional survey assessing the prevalence of TSP and associated factors among 400 conveniently recruited postpartum women from four public hospitals in Enugu, Nigeria. We collected data on thoracic spine pain, posture, and mobility using the Oswestry thoracic disability index, an inclinometer, and the tape rule(cm), respectively. We found a 22.5% prevalence of TSP, with over 65% of cases occurring during and after pregnancy. More than half (64.4%) of the participants recorded flexion hypomobility, while 37.3% had extension hypomobility. We found a significant association between TSP and age (χ2 = 2.493, p = .013), employment status (χ2 = 11.650, p = .003), and jobs needing repetitive spinal movements like neck bending (χ2 = 9.491, p = .023). TSP is fairly common in postpartum women with associated factors of younger age and being in jobs that require repetitive spinal movements.

Objective To investigate the prevalence of musculoskeletal disorders, and to explore the association between maternal positioning and musculoskeletal pain among lactating women. METHODS The cross-sectional survey-based study was conducted from January to May 2022 at buraidah, Saudi Arabia, and comprised Arabic-speaking women aged 18-49 years who were breastfeeding. Sociodemographic and clinical data related to musculoskeletal disorders was collected using a redesigned questionnaire through Twitter and WhatsApp platforms. Data was analysed using SPSS 28. RESULTS Of the 474 women who responded, 192(40.7%) were excluded because they did not meet the eligibility criteria. The sample comprised 281(59.3%) women. The median age was 33 years with an interquartile range of 10 years 71(25.3%). Overall, 163(58%) subjects reported musculoskeletal pain caused by breastfeeding, 78(27.8%) experienced musculoskeletal pain with breastfeeding, 43(15.3%) considered discontinuing breastfeeding, and 59(21%) reported that musculoskeletal pain prevented them from performing their activities of daily living. The most painful segments reported were the back 6.24±3.21, nipple 5.51±3.43, shoulders 4.88±3.40, and neck 4.10±3.13. Sitting on a mat was the commonly adopted maternal positioning 2.38±1.41. Cradle hold was the most convenient baby-holding positioning during breastfeeding reported by 170(60.5%). Conclusion The prevalence of musculoskeletal disorders was found to be high among breastfeeding women in Saudi Arabia, and an association was found between musculoskeletal disorders and maternal breastfeeding positioning.

ABSTRACT Nipple pain during breastfeeding significantly impacts the emotional well-being, daily activities, and sleep patterns of mothers, increasing the risk of early breastfeeding cessation and postpartum depression. Previous studies have reported high prevalence rates of nipple pain among breastfeeding mothers in various countries. This study aims to identify the factors contributing to nipple pain, utilizing a cross-sectional design and Shomers's statistical test. Nipple pain severity was assessed using visual analog scores, with nipple lesions, latch-on techniques, nipple shape, and maternal parity as independent variables. The results demonstrate strong positive associations between nipple pain and nipple lesions (P value 0.000, r = 0.866), latch-on techniques (P value 0.000, r = 0.629), and nipple shape (P value 0.001, r = 0.341). However, there is no significant correlation (P value 0.132) between nipple pain and maternal parity (r = -0.182). To promote successful breastfeeding, healthcare facilities should prioritize the provision of education on proper breastfeeding techniques, pain prevention and management strategies, and solutions to address the unique challenges faced by breastfeeding mothers. Key word: Nipple pain Nipple trauma Lacth-on Parity Nipple Shape

ABSTRACT Purpose This study aimed to determine the prevalence of musculoskeletal pain related to breastfeeding positions in the first six months postpartum and to identify associated factors. Design A descriptive, cross-sectional study. Methods Data were collected from 216 breastfeeding women attending a pediatric outpatient clinic in a tertiary hospital between June 2023 and January 2024. Face-to-face interviews were conducted using the Individual Information Form, the Women’s Postpartum Musculoskeletal Pain Questionnaire, and the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire. Descriptive statistics, Chi-square tests, independent t-tests, and multivariable linear regression analyses were used to examine factors associated with upper extremity functional disability (p < 0.05). Findings Musculoskeletal pain was highly prevalent: 90.7% reported lower back pain, 63.9% neck pain, 62.5% back pain, and 34.3% shoulder pain. Pain severity often increased during breastfeeding, with onset typically within four weeks postpartum. Ergonomic practices such as using a nursing pillow or chair were rarely adopted. The football hold position was associated with lower back pain, while the cross-cradle hold increased shoulder pain (p < 0.05). Mothers who received social support and used physical support equipment had lower DASH scores, indicating reduced disability. In multivariable linear regression analysis, rocking the baby to sleep in the arms and breastfeeding-related shoulder and neck pain were independently associated with higher DASH scores, whereas receiving support for daily activities was associated with lower functional disability (p < 0.05). Conclusions and Clinical Relevance Postpartum musculoskeletal pain is common and associated with non-ergonomic breastfeeding practices and insufficient support. Education on correct breastfeeding positions, ergonomic aids, and social support may reduce pain and improve maternal well-being. Community health nurses and midwives play an important role in early identification and prevention.

Breastfeeding (BF) is a global practice essential for infant nutrition and maternal-child bonding. However, breastfeeding-related musculoskeletal pain (BFMP) is a common yet under-researched condition that may impair functional ability and contribute to early weaning. Although BFMP has been investigated in several populations, limited evidence exists regarding its prevalence, associations, and functional impact among lactating mothers in Arabic-speaking countries. A cross-sectional study utilized an online questionnaire developed in Microsoft Forms and distributed via different social media platforms through convenience and snowball sampling. Eligible participants included Arabic-speaking non-pregnant mothers aged 18 years or older who had been breastfeeding for at least one month. The questionnaire, adapted from validated tools, underwent expert review and pilot testing for the BF characteristics and infant/toddler characteristics. Additionally, pain severity (using the Numeric Rating Scale), and functional limitations (Neck Disability Index, Oswestry Disability Index, and DASH) were assessed. SPSS program, version 27 was used to analyze data using binary logistic regression, Spearman rho, and chi-square tests to identify associations between BFMP and related variables. Out of 471 participants (mean age = 31.3 ± 5.6 years), 81.7% reported BFMP, with the back (40.4%) and upper extremities (36.8%) being the most affected areas chosen. Higher maternal age, longer feeding duration and frequent sessions were linked to increased pain (p < 0.05). Moreover, Use of ergonomic support during BF was associated with lower pain scores (p = 0.01). Functional limitations were significantly associated with pain severity (p < 0.001). Furthermore, Psychological distress and a tendency toward early weaning were significantly higher among those with severe pain (p < 0.01). Breastfeeding- related musculoskeletal pain (BFMP) is highly prevalent among lactating mothers in Arabic-speaking countries and significantly affects functional capacity and breastfeeding (BF) sustainability. These findings underscore the need for targeted ergonomic education and early multidisciplinary intervention including physical therapy (PT) and occupational therapy (OT) to support maternal health and prolong successful BF.

Background: Breastfeeding is globally recognized for its health benefits to infants and mothers. However, its impact on maternal musculoskeletal health is often overlooked. Trapezitis, an inflammatory condition of the trapezius muscle, is increasingly seen among breastfeeding women, likely due to sustained poor posture during nursing. Objectives: To determine the prevalence of trapezitis among breastfeeding women and assess associated postural risk factors. Methods: A cross-sectional, observational survey was conducted over three months in Karad, involving 60 breastfeeding women aged 20–40 years. Participants were selected using simple random sampling. Data were collected via a structured Google Form questionnaire covering demographic details, breastfeeding posture, duration, and symptoms suggestive of trapezitis. Women with non-breastfeeding-related musculoskeletal pain or neurological disorders were excluded. Responses were statistically analysed to assess prevalence and contributing factors. Results: The study revealed that 75% of participants exhibited signs or symptoms linked to trapezitis. Of these, 38% were identified with active trapezitis, while 37% were at risk due to reported postural deviations and discomfort during or after breastfeeding. Cradle hold was the most common breastfeeding position. Lack of ergonomic support (e.g., backrest or nursing pillows) was frequently reported. Most symptomatic participants breastfed more than four times daily in unsupported postures. Conclusion: There is a significant prevalence of trapezitis among breastfeeding women. Improper posture, extended feeding durations, and lack of ergonomic awareness were major contributors. The findings highlight the importance of incorporating postural education and physiotherapy into postpartum care to improve maternal musculoskeletal health.

Background Breastfeeding is an unrivaled way of providing ideal food for healthy growth and development of infants. However, as important as breastfeeding is for the child’s health, it can affect the mother’s physical health, by causing musculoskeletal disorders like breastfeeding related neck pain (BFRNP). BFRNP has not yet been addressed in Cameroonian literature. Thus, this study aimed to evaluate the prevalence and the associated factors of breastfeeding related neck pain among lactating mothers in two hospitals of Bafoussam, Cameroon. Methods A cross-sectional survey was conducted from 1st to 29th February 2024 among breastfeeding women in two hospitals in the city of Bafoussam. Were excluded from the study, all women having a specific neck pain. With an exhaustive technique, this study included 110 breastfeeding mothers. Data on the general characteristics of the population, the occurrence of BFRNP and its characteristics were collected face to face with breast-feeding mothers, using a structured questionnaire. Data collected were analyzed using Statistical Package for Social Sciences, version 23. Binary logistic regression was used to determine the association between BFRNP and general characteristics. The level of significance was set at P ˂ 0.05 and the confidence interval at 95%. Results The prevalence of breastfeeding related neck pain was 35.45%. For most women in the study, pain was mild (56.4%) and usually happened during breastfeeding (56.4%). Also, pain lasted less than 10 min in most women (56.4%) and occurred about once a week (48.7%). After logistic regression, the “football hold " position (AOR = 8.70; 95% CI: [1.18–63.8]; p = .033); the “inverted cradle” position (AOR = 3.35; 95% CI: [1.03–10.9]; p = .044) and child’s weight between 5.1 and 8 kg (AOR = 5.14; 95% CI: [1.61–16.3]; p = .006) were found to be significant risk factors. Conclusion These findings underscore the importance of targeted education for lactating mothers on ergonomic breastfeeding Supplementary Information The online version contains supplementary material available at 10.1186/s12884-026-08959-9.

Background of the study: Mothers’ knowledge and attitude towards breastfeeding positions may influence the level of musculoskeletal pain. Ergonomic advice was given to improve the breastfeeding position. Early postnatal mothers choosing good breastfeeding positions helps to prevent musculoskeletal pain. To determine the knowledge and attitude about breastfeeding positions and ergonomics among early postnatal mothers. To determine the prevalence of musculoskeletal pain by Orebro musculoskeletal pain questionnaire.  Design: Cross-sectional survey.  Methodology: 75 consenting lactating mothers who had been breastfeeding their baby for 2 months volunteered for this crosssectional survey. A self-developed questionnaire and the Örebro Musculoskeletal Pain Screening Questionnaire (short version), which sought information on maternal socio-demographic variables,knowledge, attitudes, and breastfeeding techniques of mothers, were employed.

This cross-sectional observational study investigated the preferred breastfeeding positions among exclusive breastfeeding mothers and evaluated their association with low back pain (LBP). A self-structured questionnaire was administered to 100 mothers aged 20 to 40 years who were 12 to 15 weeks postpartum and recruited from tertiary hospitals and community settings. Descriptive analysis revealed that the cradle hold was the most frequently adopted position (58%), followed by the cross-cradle hold (24%). Notably, a high prevalence of low back pain was reported, with 76% of mothers experiencing discomfort. While 83% of the participants had received professional advice regarding proper feeding postures, a significant knowledge gap was identified concerning nutritional guidelines, as only 21% were aware of the clinical definition of exclusive breastfeeding. A Chi-square test was applied to determine the relationship between maternal positioning and musculoskeletal discomfort. The statistical analysis revealed no significant association between specific breastfeeding positions and the occurrence of low back pain (p = 0.6727). Consequently, the null hypothesis was accepted. The high incidence of LBP among the sample population, despite the lack of direct correlation to a singular feeding posture, suggests that maternal discomfort is likely multi-factorial. Contributing elements may include general postpartum physical weakness, prolonged sitting, and the broader ergonomic strains associated with daily infant care chores. These findings highlight the necessity for comprehensive postpartum ergonomic education that extends beyond breastfeeding positions to encompass general maternal physical well-being.

Background: Postpartum women commonly experience musculoskeletal discomfort due to hormonal changes, altered posture, faulty breastfeeding positions, repetitive infant-care activities, and muscle imbalance. Upper back and periscapular pain are frequently reported complaints during the postpartum period, yet these conditions often remain under-recognized despite their impact on daily activities and quality of life. With more than 45,000 live births occurring annually in Amritsar, postpartum musculoskeletal health has become an important area requiring greater clinical attention and preventive physiotherapy strategies. Objective: To determine the prevalence of upper back and periscapular pain among postpartum women in Amritsar and to analyze associated factors, including mode of delivery and functional impairment. Methods: A cross-sectional observational study was conducted among postpartum women aged 20-40 years attending various hospitals in Amritsar. Women between 6 weeks and 12 months postpartum were screened during the study period. Data regarding demographic characteristics, mode of delivery, postpartum duration, and pain characteristics were collected. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), and functional impairment was evaluated using the Shoulder Pain and Disability Index (SPADI). Statistical analysis was performed using IBM SPSS software. Results: The study demonstrated a high prevalence of upper back and periscapular pain among postpartum women. Among the 150 postpartum women screened, reported upper back and periscapular pain, indicating a high prevalence of musculoskeletal complaints during the postpartum period. Women with vaginal deliveries demonstrated comparatively higher pain intensity and SPADI scores than women with cesarean deliveries. Conclusion: Upper back and periscapular pain are common musculoskeletal complaints among postpartum women and may be associated with altered posture, childcare activities, and delivery-related factors. Early physiotherapy screening, ergonomic education, and postural correction strategies may help reduce pain and improve functional outcomes in postpartum women. Keywords: Postpartum women, Upper back pain, Periscapular pain, Numeric Pain Rating Scale, Shoulder Pain and Disability Index, Physiotherapy.

Background The effect of joint health on the quality of life of middle-aged and older women is becoming more widely recognized with the aging of the world’s population. However, the association of long-term breastfeeding with joint pain and knee osteoarthritis has not been fully examined. The aim of this study was to determine the association of prior breastfeeding duration with current joint pain and knee osteoarthritis in middle-aged Korean women. Methods This cross-sectional study was conducted among 3454 women aged ≥50 years who underwent knee radiography and answered a questionnaire on breastfeeding and joint pain for the 5th Korea National Health and Nutrition Examination Survey (2010–2011). After adjusting for confounding sociodemographic, medical history, and obstetric and gynecologic variables, logistic regression analysis was conducted to analyze the prevalence of joint pain and knee osteoarthritis according to breastfeeding and its duration. Results Among the 3454 participants, 298 had not breastfed and 1042, 815, and 1299 had breastfed for 1–24, 25–48, and ≥ 49 months, respectively. Of all participants, 1731 had joint pain and 739 were diagnosed with knee osteoarthritis after radiography. Using the non-breastfeeding group as a reference, the odds ratio (OR) for joint pain among women who breastfed ≥1 month was 1.49 (95% confidence interval [CI] 1.01–2.21). As the breastfeeding duration increased, the OR of joint pain prevalence also increased (p for trend; p  = 0.002). For knee osteoarthritis, the OR was 2.30 in the 25–48 months group (95% CI 1.09–4.86). The OR of knee osteoarthritis in the ≥49 months group was 2.17 (95% CI 1.01–4.64). Sensitivity analysis after selecting only participants aged ≥60 years showed that the prevalence of joint pain and knee osteoarthritis was more positively correlated with extended breastfeeding duration (joint pain, p for trend; p  = 0.005) (knee osteoarthritis, p for trend; p  = 0.012). Conclusions Long-term feeding for more than 25 months was associated with an increased prevalence of joint pain and degenerative arthritis in Korean women aged ≥50 years.

This study aimed to investigate maternal knowledge, attitude, and practice towards breastfeeding and mastitis. This cross-sectional study was conducted between March and August 2023 in author’s Hospital, using a self-administered questionnaire. A total of 682 (an average age of 28.83 ± 4.86 years) valid questionnaires were enrolled, including 372 (54.55%) married. The mean knowledge, attitude and practice scores were 8.96 ± 4.66 (possible range: 0–22), 51.65 ± 11.55 (possible range: 15–75), and 63.83 ± 17.05 (possible range: 18–90), respectively. Multivariate logistic regression analysis showed that urban area (OR = 2.031, 95% CI: 1.194–3.454, P = 0.009), high school or vocational school (OR = 0.355, 95% CI: 0.153–0.825, P = 0.016), non-working (OR = 0.484, 95% CI: 0.31–0.756, P = 0.001), history of breast surgery (OR = 0.572, 95% CI: 0.361–0.906, P = 0.017) were independently associated with knowledge. Junior college or bachelor’s degree (OR = 2.288, 95% CI: 1.365–3.836, P = 0.002), monthly household income more than 10,000 CNY (OR = 1.538, 95% CI: 1.013–2.336, P = 0.044), history of breast surgery (OR = 0.595, 95% CI: 0.428–0.829, P = 0.002) were independently associated with attitude. Attitude (OR = 1.016, 95% CI: 1.001–1.03, P = 0.032), and maternity insurance (OR = 1.435, 95% CI: 1.02–2.019, P = 0.038) were independently associated with practice. Mothers had inadequate knowledge, suboptimal attitude and proactive practice towards breastfeeding and mastitis. It’s recommended to target interventions for breastfeeding knowledge in urban areas, enhance attitudes among higher-educated individuals and those with a history of breast surgery, and prioritize support for maternity insurance to promote better breastfeeding practices and mastitis prevention in clinical practice.

INTRODUCTION Japanese midwives support lactating women to continue breastfeeding. However, midwives often learn breast care methods through practical experience. This study investigated how midwives acquire knowledge about mastitis and breast cancer. METHODS This cross-sectional study was conducted in Japan over two months. The study participants were midwives with breast care experience. The questionnaire was sent to 800 midwifery facilities for recruitment. The questions covered learning and diagnostic methods for general breast care, bacterial mastitis, severe mastitis, and breast cancer during lactation. The analysis method involved descriptive statistics. An Ethical Review Committee approved this study. RESULTS The survey return rate was 27.50% (n=200). The valid response rate was 87.27% (n=192). Although the learning method that helped midwives most regarding mastitis, in general, was breast care experience (38.0%), knowledge about bacterial mastitis and severe mastitis came from advice from doctors or senior midwives (33.3%, 42.4%). However, knowledge about breast cancer during lactation was mostly learned during formal education (29.5%); many had never learned about it (10.5%). The most common method used by midwives to make breast care decisions was subjective judgment. CONCLUSIONS Most midwives learned a great deal by observing and palpating actual breasts in clinical settings. Some midwives had learned very little about breast cancer. Most midwives did not use medical equipment for breast evaluations. This suggests that Japanese midwives have high breast care skills. However, there is room for improving midwives' skills in using medical equipment.

Lactational mastitis is a common condition during breastfeeding, which, in rare cases, can progress to life-threatening necrotising mastitis, particularly in cases where Streptococcus pyogenes is involved. The development of streptococcal toxic shock syndrome (STSS) is associated with a fatality rate of approximately 50%. In this Grand Round, we present the case of a healthy mother, aged 35 years, breastfeeding a child diagnosed with scarlet fever. The mother subsequently developed lactational mastitis, with a high load of S pyogenes, culminating in skin necrosis and STSS. This case, along with six more case reports identified in a thorough literature search, underscores the severity of lactational S pyogenes mastitis. In all cases, the only identifiable risk factor for invasive S pyogenes disease was close contact to individuals exhibiting symptoms of scarlet fever. During breastfeeding, the direct contact of the nipple to the child's pharynx, containing S pyogenes in the case of scarlet fever, presents a probable route of transmission, especially when considering the pathogenicity of the bacterium. Although breastfeeding is generally encouraged, the current literature lacks sufficient guidance regarding breastfeeding practices in children with scarlet fever. This Grand Round proposes a simple strategy to minimise maternal risks, offering valuable insights into clinical management and prevention.

Mastitis is a common reason new mothers visit their general practitioner (GP). In Australia, the Therapeutic Guidelines: Antibiotic provides practical advice to GPs managing a range of infections, including mastitis. It is not known if Australian GPs prescribe antibiotics and order investigations as recommended for the management of mastitis. A convergent mixed methods design integrated quantitative analysis of a general practice dataset with analysis of interviews with GPs. Using the large-scale primary care dataset, MedicineInsight, (2021–2022), antibiotics prescribed and investigations ordered for mastitis encounters were extracted. Mastitis encounters were identified by searching ‘Encounter reason’, ‘Test reason’ and ‘Prescription reason’ free text field for the term ‘mastitis’; ‘granulomatous mastitis’ was excluded. Clinical encounters for mastitis occurring within 14 days of a previous mastitis encounter were defined as belonging to the same treatment episode. Semi-structured interviews were conducted with 14 Australian GPs using Zoom or telephone in 2021–2022, and analysed thematically. The Pillar Integration Process was used to develop a joint display table; qualitative codes and themes were matched with the quantitative items to illustrate similarities/contrasts in findings. During an encounter for mastitis, 3122 (91.7%) women received a prescription for an oral antibiotic; most commonly di/flucloxacillin ([59.4%]) or cefalexin (937 [27.5%]). Investigations recorded ultrasound in 303 (8.9%), blood tests (full blood examination [FBE]: 170 [5.0%]; C-reactive protein [CRP]: 71 [2.1%]; erythrocyte sedimentation rate [ESR]: 34 [1.0%]) and breast milk or nipple swab cultures in approximately 1% of encounters. Analysis using pillar integration showed consistency between quantitative and qualitative data regarding mastitis management. The following themes were identified: - GPs support continued breastfeeding. - Antibiotics are central to GPs' management. - Antibiotics are mostly prescribed according to Therapeutic Guidelines. - Analgesia is a gap in the Therapeutic Guidelines. - Low use of breast milk culture. Prescribing antibiotics for mastitis remains central to Australian GPs’ management of mastitis. Interview data clarified that GPs were aware that antibiotics might not be needed in all cases of mastitis and that delayed prescribing was not uncommon. Overall, GPs followed principles of antibiotic stewardship, however there is a need to train GPs about when to consider ordering investigations.

Background In 2022 the Academy of Breastfeeding Medicine (ABM) published Clinical Protocol #36: The Mastitis Spectrum, which aims to update clinical approaches to management of benign lactation-related breast inflammation. The protocol has been timely because of the exponential increase in knowledge about the human milk microbiome over the past decade. This Commentary aims to continue respectful debate amongst clinicians and researchers within the Academy of Breastfeeding Medicine and more broadly, confident that we share a fundamental commitment to promote breastfeeding and support the well-being of lactating women, their infants and their families. Analysis Although Clinical Protocol #36 offers advances, it does not fulfil the principles of best practice implementation science for translation of evidence into clinical guidelines. Clinical Protocol #36 inaccurately represents studies; misrepresents theoretical models as proven aetiologies; does not consistently attribute sources; does not reliably apply the SORT taxonomy; and relies upon single case reports. As a result, various recommendations in Clinical Protocol #36 lack an evidence-base or credible underlying theoretical model. This includes recommendations to use ‘lymphatic drainage’ massage, therapeutic ultrasound, and oral lecithin. Similarly, based on a contestable theoretical model which is presented as fact, Clinical Protocol #36 makes the recommendation to either reduce frequency of milk removal or to maintain current frequency of milk removal during an episode of breast inflammation. Although Clinical Protocol #36 limits this advice to cases of ‘hyperlactation’, the diagnosis ‘hyperlactation’ itself is undefinable. As a result, this recommendation may put breastfeeding women who present with breast inflammation at risk of worsened inflammation and decreased breast milk production. Conclusion Clinical Protocol #36 offers some advances in the management of breast inflammation. However, Clinical Protocol #36 also exposes clinicians to two international trends in healthcare which undermine health system sustainability: overdiagnosis, including by over-definition, which increases risk of overtreatment; and antibiotic over-use, which worsens the crisis of global antimicrobial resistance. Clinical Protocol #36 also recommends unnecessary or ineffective interventions which may be accessed by affluent patients within advanced economies but are difficult to access for the global majority. The Academy of Breastfeeding Medicine may benefit from a review of processes for development of Clinical Protocols.

Mastitis is a common phenomenon experienced by a lot of breastfeeding women. Lactational mastitis, commonly occurs because of prolonged milk duct engorgement, which allows bacteria to enter through breaks in the skin, resulting in an infection. Mastitis can occur at various stages of lactation, although it is most observed within the second and third weeks following childbirth. For isolation and identification of bacteria associated with mastitis, Blood agar medium, MacConkey agar, and mannitol salt agar were used, whereas Sabouraud Dextrose Agar (SDA) was used for fungal isolation. Different biochemical test has been performed for bacterial isolates including gram stain, catalase, coagulase, and Vitec 2 compact. For fungal isolates, KOH treatment and lactophenol cotton blue test were performed. Fungal DNA was extracted then PCR was used for the detection ITS Gene of candida spp.  Using gel electrophoresis of PCR product on 2% agarose. The study revealed Staphylococcus aureus, Klebsiella pneumoniae, and Candida spp. as significant bacteria that are commonly related to mastitis in women. The prevalence of Staphylococcus aureus was seen to be high, with a notable manifestation of lesions. Additionally, both Staphylococcus aureus and Klebsiella pneumoniae were shown to be associated with the presence of redness. Candida albicans had a notable prominence, displaying a heightened prevalence in the regions of the nipple. Furthermore, it demonstrated a correlation with the presence of lesions and redness. The presence of redness was observed as a notable sign in cases linked with Candida tropicalis. This study provides insights into the microbial diversity linked to mastitis mainly in breastfeeding women, highlighting the prevalence of Staphylococcus aureus, Klebsiella pneumoniae, and Candida spp.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.

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Subclinical mastitis (SCM) is an important risk factor of postnatal HIV-1 transmission that is still poorly understood. A longitudinal sub-study of the ANRS12174 trial including 270 breastfeeding mothers in Lusaka, Zambia measured sodium (Na+) and potassium (K+) in archived paired breast milk samples collected at week 14, 26 and 38 postpartum to determine cumulative incidence of SCM and the effects of recurrent severe SCM on HIV-1 shedding in breast milk. A nested retrospective cohort study including 112 mothers was also done to determine longitudinal effects of SCM on four pro-inflammatory cytokines; IL6, IL8, IP10 and RANTES. The cumulative incidence for any SCM (Na+/K+ ratio > 0.6) and severe SCM (Na+/K+ ratio > 1) were 58.6% (95%CI: 52.7 – 64.5) and 27.8% (95%CI: 22.5 – 33.1), respectively. In majority of affected mothers (51.4%) severe SCM was recurrent. Both breasts were involved in 11.1%, 33.3% and 70% of the mothers with a single episode, 2 and 3 episodes respectively. In affected breasts, an episode of severe SCM resulted in steep upregulation of the four cytokines considered (IL8, IP10, RANTES and IL6) compared to: before and after the episode; contralateral unaffected breasts; and SCM negative control mothers. Recurrent severe SCM significantly increased the odds of shedding cell-free HIV-1 in breast milk (OR: 5.2; 95%CI: 1.7 – 15.6) whereas single episode of severe SCM did not (OR: 1.8; 95%CI: 0.8 – 4.2). A Na+/K+ ratio > 1 indicative of severe SCM is an excellent indicator of breast inflammation characterized by a steep, localized and temporal upregulation of several pro-inflammatory cytokines that favor HIV-1 shedding in mature breast milk and may facilitate postnatal HIV-1 transmission through breastfeeding.

Mastitis is a debilitating condition that can impact around 20% of mothers and is characterized by fever, flu-like symptoms and tender, swollen areas of the breasts. Despite the emerging evidence that breast milk dysbiosis is an underlying cause of mastitis, breast pumps have been implicated as a predisposing risk factor in the pathophysiology of mastitis in breastfeeding mothers. Previous studies have suggested that the use of a breast pump increases a mother's risk for developing mastitis, however, incidence rates of mastitis over the stages of lactation do not match breast pump usage rates. Furthermore, breast pumps, even when used at low vacuum, still promote some breast drainage, thus avoiding milk stasis, which is considered a key factor in the development of mastitis. As a consequence, these data suggest that the literature association of breast pumps with mastitis is more a case of reverse causation and not direct association. Moreover, it is important to note that breast pumps are actually a part of the conservative management of mastitis. In combination, these data show that the breast pump should not be considered a driver in the pathophysiology of mastitis in women.

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No abstract available

Idiopathic granulomatous mastitis (IGM) is a rare benign breast condition with a course that is often rapidly progressive and slow to resolve. There is no consensus on management, especially during pregnancy and lactation. A 30-year-old at 33 weeks presented with mastalgia, induration and galactorrhoea in the left breast. There was no improvement with antibiotics. Initial workup was negative, and a core needle biopsy showed findings consistent with the diagnosis of IGM. She was treated with steroids antepartum. She was co-managed by rheumatology and her obstetrician/breastfeeding medicine specialist postpartum. She was treated with azathioprine, breastfed exclusively for 6 months and continued breastfeeding through the first year. A multidisciplinary team approach is crucial in diagnosing, treating, and facilitating successful breastfeeding in patients with IGM.

Objective The purpose of this study was to explore the relationship between acute mastitis and the constitution of traditional Chinese medicine (TCM) and the potential risk factors of acute mastitis in Chinese breastfeeding mothers. Method A retrospective study on infant feeding practices was conducted in the Breast Surgery Department of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between February 2017 and March 2018. A total of 184 women with acute mastitis and 201 women without mastitis of childbearing age were included in this study. All participants filled a baseline questionnaire on demographic characteristics, previous deliveries, and mastitis history and other possible risk factors; data were collected by face-to-face interview. Logistic regression analysis was conducted to ascertain pertinent risk factors affecting the incidence of acute mastitis. The biased constitution of TCM of participants was identified through questionnaires surveyed with the TCM constitution table (ZYYXH/T157-2009). The relationship between acute mastitis and the constitution of TCM was assessed. Results The protective factors included regular nipple cleansing and cesarean section. The risk factors were nipple infection, Primipara, improper diet, emotional stimuli, postpartum colostrum overdue for more than 72 h, breastfeeding more than 7 times each day, and late primiparity age. Forty-five percent of acute mastitis occurred within 8 weeks after postpartum, and the most common biased constitution of TCM at this period was Qi-Deficiency Constitution (QDC) and Qi-Stagnation Constitution (QSC). Another peak was 25–48 weeks after delivery, accounting for 18%, and the most common biased constitution of TCM was QSC and QDC. More participants were or were prone to be classified as Balanced Constitution (BC) in the control group than the case group (88.5% vs 29.6%), while QDC was the most common constitution of TCM in the case group. The logistic regression analysis further proved that BC was the protective factor of acute mastitis while QDC was a risk factor. Conclusions The protective factors of acute mastitis were regular nipple cleansing and cesarean section. The risk factor was nipple infection. Among all the constitutions of TCM, BC was a protective factor, while QDC was a risk factor. For all breastfeeding mothers with various constitutions of TCM, regular nipple cleansing and breast vacuuming, a healthy lifestyle, and a positive mental state can keep mastitis away.

PURPOSE This study aimed to describe clinical response to 5-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct. METHODS This retrospective study included 922 breastfeeding women, 714 with plugged ducts and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree and range of breast induration were recorded pre-FSST and post-FSST. RESULTS After a single FSST, pain score and swelling degree were significantly improved (both, p <.001) in all cases. After FSST, the mean breast pain relief score was 1.69±.70, while the mean swelling fade-away degree was 1.61±.62. In subgroup analysis, pain score and swelling degree were significantly improved (both, p <.001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63±.68 vs. 1.91±.70, t=5.30, p <.001), while improvement of swelling fade-away was greater in the plugged ducts group than the mastitis group (1.65±.64 vs. 1.48±.56, t=3.49, p =0.001). The composition ratio of changes in induration range between the two groups was statistically different (Pearsonχ2=137.87, p <.001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ2=25.65, p <.001). CONCLUSION FSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.

Mastitis is an inflammation in the breast, which may involve a bacterial infection. Breast infection during breastfeeding is a common phenomenon that requires immediate and appropriate treatment. Without proper treatment, inflammation may lead to the cessation of breastfeeding. Another potential complication is the development of an abscess. Based on the nutritional and immunological value of breast milk, the recommendations of the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) is exclusive breastfeeding up to 6 months of age, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infanRecent meta-analyses indicate breastfeeding protects against childhood infections, allows for a possible increase in intelligence, and for a reduction in overweight and diabetes. Breastfeeding is beneficial for nursing women as well. It is therefore important to help the mother overcome difficulties such as mastitis and to continue breastfeeding. The choice of a proper treatment and the provision of therapeutic instructions to the patient are crucial for a cure, for a successful duration of breastfeeding, and for preventing complications for mother and baby. In this article, we provide the latest clinical guidelines regarding drug treatment and supportive therapy in mastitis. We also discuss the latest guidelines of candida treatment, as candida infection may develop as a result of antibiotic therapy. Overall, improperly treated mastitis may cause the premature cessation of breastfeeding, and will cause suffering to both mother and baby; giving proper treatment and instructions to the mother are hence of the utmost importance.

ABSTRACT Objective: To analyze functional aspects of breastfeeding, self-efficacy, and pain reported by mothers during breastfeeding, in newborns with severe and mild ankyloglossia. Methods: This is an observational study, carried out with 81 babies with ankyloglossia, assessed by the Bristol Tongue Assessment Tool (severe: scores 0–3; mild: scores 4–6) nested in a cohort carried out at the University Hospital of the Federal University of Maranhão, São Luis, Brazil. The functional aspects of breastfeeding were analyzed using the Breastfeeding Observation Form of the United Nations Children's Fund (BOF-UNICEF) and the LATCH Scoring System. Breastfeeding self-efficacy was measured using the Breastfeeding Self-Efficacy Scale — Short-Form. Pain indicators were evaluated by the Short-Form McGill Pain Questionnaire. The significance level adopted was 5%. Results: Maternal age was 26.7±0.8 years, and 64.2% reported high school education. Most babies were male (67.9%), and the birth weight was 3232±60g. A significant association was detected in the sucking aspect evaluated by the BOF-UNICEF [β=0.22 (95%CI 0.07; 0.73), p-value=0.013]. However, the groups did not differ in the assessment of breastfeeding performed by the LATCH scale. The groups had no differences in the assessment of breastfeeding self-efficacy reported by mothers, and in pain scores. Conclusions: Despite the observation of sucking difficulty in infants with severe ankyloglossia., the quality of breastfeeding in general, maternal pain, and self-efficacy reported by mothers do not differ when compared with infants with mild ankyloglossia. Therefore, the severity of ankyloglossia seems not to affect the breastfeeding indicators.

BACKGROUND The management of ankyloglossia and its impact on breastfeeding remains a controversial issue with limited scientific evidence, particularly regarding the utility of frenotomies. PURPOSE The study purpose was to determine the effects of lingual frenotomy on improving breastfeeding effectiveness and pain in newborns with ankyloglossia. STUDY DESIGN, SETTING, AND SAMPLE We conducted a double-blind randomized controlled trial at Tampa General Hospital from April 2015 to October 2017. Eligible mother-newborn couplets with breastfeeding difficulties and ankyloglossia were randomized to frenotomy or sham procedure. Exclusion criteria included prematurity, older than 2 weeks, craniofacial anomalies, neurological compromise, or maternal conditions affecting milk supply. PREDICTOR VARIABLE The predictor variable was lingual frenum management, and newborns were randomly assigned in a 1:1 allocation to frenotomy or sham procedure. OUTCOME VARIABLES The outcome variables were the changes in LATCH scores (a breastfeeding assessment tool) and maternal pain scores (using the Wong-Baker Pain Scale), assessed by a blinded lactation consultant before and immediately after the intervention. COVARIATES The covariates were newborn age, gestational age, sex, race, severity of ankyloglossia, as well as maternal comorbidities. ANALYSES Descriptive and multivariate linear regression analyses were conducted, with significance set at P < .05. RESULTS A total of 112 couplets were enrolled (55 [49%] frenotomy, 57 [1%] sham). No significant differences were observed in LATCH or pain scores between groups (LATCH: 0.02; 95% CI, 0.64 to 0.69; P = .9; and pain: 0.32; 95% CI, 0.56 to 1.19; P = .5). Similarly, the results of the multivariate linear regression analyses showed no significant differences between the 2 groups for improvements in both LATCH and pain scores (-0.11; 95% CI, -0.89 to 0.68; P = .8 and .38; 95% CI, -1.20 to 1.96; P = .6, respectively). CONCLUSIONS The study findings did not demonstrate significant differences between lingual frenotomy and sham procedures on immediate improvements in pain or LATCH scores. Therefore, this study does not support the recommendation of a lingual frenotomy to improve breastfeeding difficulties in the immediate newborn setting.

INTRODUCTION Ankyloglossia in breastfeeding infants has been proposed to cause maternal nipple pain. Lingual frenotomy has been cited to reduce maternal nipple pain. The aim of this systematic review was to investigate if frenotomy in infants with ankyloglossia and breastfeeding problems reduces maternal nipple pain. METHODS We conducted a systematic literature search for RCTs comparing frenotomy to a sham procedure or usual care in mother-infant dyads with ankyloglossia and maternal nipple pain. Maternal nipple pain was registered as the main outcome. We conducted a meta-analysis and assessed the risk of bias using Rob 2.0 and the quality of evidence, adopting the GRADE approach. RESULTS Five RCTs were included in the review. Three RCTs were used for the meta-analysis. The meta-analysis showed a significant pre-post intervention reduction in maternal nipple pain in the frenotomy group compared with the comparison group: mean difference = -1.23; 95% confidence interval: -1.88 to -0.57. The overall bias was assessed to range from "some concerns" to "high". The quality of evidence for the assessed outcome, maternal nipple pain, was classified as "low" to "very low". CONCLUSIONS We found that frenotomy reduced maternal nipple pain in the short term. Despite being statistically significant, the clinical relevance of a 1.2-point reduction on a ten-point VAS must be questioned. Due to a considerable risk of bias along with a low study quality, the definitive benefit of frenotomy on maternal nipple pain remains unproven. Hence, quality large-scale RCTs are warranted.

Between 1997 and 2012, the diagnoses of ankyloglossia and the indication for frenotomy increased by ˃800%. About 38% of diagnosed cases are surgically treated. Breastfeeding promotion includes evaluating maternal hereditary and personal history of breastfeeding, breast structure, endocrinological physiology, emotional well-being of the mother, breastfeeding technique, quality and quantity of milk, and the newborn's ability to latch on and suckle. Frenotomy would be indicated when restriction of tongue function causes difficulties that have not resolved after thorough evaluation and counseling to correct other causes. Frenotomy can have complications: feeding and respiratory difficulties, pain, weight loss, vascular or nerve damage, and delayed diagnosis of other underlying pathologies. It does not always solve breastfeeding difficulties. Interdisciplinary teamwork reduces the frequency of unnecessary frenotomies.

Background Tongue-tie is associated with nipple pain and early breastfeeding cessation. To date, research has been limited by small sample sizes and a dearth of evidence on the effects of tongue-tie on infant feeding symptoms and physiologic breastfeeding mechanics. Objectives In this article, we describe the protocol for our study exploring infant feeding, negative breastfeeding symptoms, maternal anatomy, and physiologic sucking data between infants with and without tongue-tie. Methods A prospective cohort study design is being employed. Over 8 weeks, three visits will be conducted with a sample of mothers and their infants without tongue-tie and a sample of mothers and their infants diagnosed with tongue-tie undergoing treatment via frenotomy. The aims of the study were to compare breastfeeding symptoms, breast anatomy, infant feeding symptoms, feeding efficiency, and nutritive sucking parameters between infants with and without tongue-tie, further comparing these metrics pretreatment and posttreatment via frenotomy with the non-tongue-tied age-matched counterparts. Results This study is currently ongoing. Discussion Tongue-tie is an everyday problem; clear guidelines are needed to decide whether to treat it. This novel, innovative, and multidisciplinary research study aims to fill critical gaps in understanding the physiological and functional effects of tongue-tie on breastfeeding, offering evidence to inform better clinical decisions and support effective interventions.

BACKGROUND While breastfeeding support and feeding therapy are first-line interventions for ankyloglossia, specific oral-motor protocols, often categorized as passive Myofunctional Therapy (MFT), have mainly been studied as an adjunct to surgery. Evidence on their effectiveness as a primary conservative approach in infants remains limited, highlighting the need for randomized controlled trials. RESEARCH AIM To compare the effectiveness of an infant-appropriate oral-motor MFT protocol on lingual frenulum function, breastfeeding establishment, and nipple pain, compared with breastfeeding education (BE) in infants with ankyloglossia. METHODS This two-arm, single-blind randomized trial (July-November 2023) assigned 200 infants to passive MFT (oral-motor stretches and massages; n = 100) or BE (n = 100) for 1 month. The primary outcomes were lingual frenulum function (Assessment Tool for Lingual Frenulum Function, ATLFF), and breastfeeding establishment (LATCH scale). Maternal nipple pain (Visual Analogue Scale, VAS) was the secondary outcome. RESULTS No significant differences were found in ATLFF-Appearance scores pre- and post-intervention (p = 0.28, p = 0.42). Post-intervention, the MFT group showed higher ATLFF-Function scores (r = 0.33; p < 0.001), lower maternal nipple pain (r = -0.38; p < 0.001), and higher LATCH scores (r = 0.26; p < 0.001). Infants receiving MFT were more likely to avoid surgery (OR = 4.63; p = 0.005), particularly with higher LATCH (OR = 2.74; p < 0.001) and ATLFF-Function scores (OR= 1.83; p < 0.001). CONCLUSION An infant-appropriate MFT protocol based on passive oral-motor techniques significantly improved tongue function, breastfeeding establishment, and reduced nipple pain, with a higher likelihood of avoiding surgery compared to BE.

Tongue tie is a common problem affecting breastfeeding due to poor infant latch and/or maternal pain. Evidence of whether treatment improves breastfeeding outcomes is conflicting. We conducted a systematic review and meta‐analysis to examine the effectiveness of tongue‐tie treatment on breastfeeding difficulties.

Background: Ankyloglossia is characterized by abnormal tongue movements that can possibly interfere with breastfeeding due to incorrect latching, pain, nipple fissure, and ineffective suction. Objective: To determine the prevalence of ankyloglossia in newborns and its association with exclusive breastfeeding and early breastfeeding difficulties. Materials and Methods: This is an analytical cross-sectional study conducted in seven public maternity hospitals in the city of Recife, PE, Brazil. The study sample consisted of 822 mothers/newborns of both genders. The diagnosis of ankyloglossia was confirmed by comparing two previously standardized and validated lingual frenulum assessment tools. Information on the mother's socioeconomic profile and breastfeeding difficulties were also collected. The data were analyzed using bivariate and multivariate logistic regression models. Results: The prevalence of ankyloglossia was 2.6% when using the Bristol Tool and 11.7% with the Assessment Tool for Lingual Frenulum Function (Neonatal Tongue Screening Test—NTST). The agreement between the two assessment tools was 2.2%, with a significant difference between them (p < 0.001). There was an association between the occurrence of ankyloglossia and breastfeeding difficulties (odds ratio = 1.99), but no association with exclusive breastfeeding practice was found. Conclusions: The diagnostic tools used herein revealed different prevalence rates of ankyloglossia in newborns. This condition was associated with breastfeeding difficulties, and the NTST was more effective in determining such an association.

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Background: Ankyloglossia, including lip tie, is becoming a common and perhaps overused diagnosis when breastfeeding difficulties arise in the mother-infant dyad. There is no strong published evidence to support performing frenotomy or of complications related to frenotomy, but some mothers report immediate decreased pain with breastfeeding after frenotomy. Concerns have been raised about the increase in diagnosis and possible complications after frenotomy. Purpose: 1. To survey pediatricians in the AAP Section of Breastfeeding (SOBr) regarding their experiences with ankyloglossia, frenotomy, and related complications using multiple choice and …

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Ankyloglossia can impair vital functions such as breastfeeding, swallowing, and maxillomandibular development, making effective treatment essential. This study aimed to compare the clinical effectiveness of diode laser (DL) and scalpel (SC) frenotomy in infants with severe ankyloglossia. This randomized, parallel, double-blind clinical trial evaluated the efficacy of diode laser surgery compared to conventional scalpel frenotomy in infants aged 0–6 months, all diagnosed with severe ankyloglossia (BTAT score 0–3) (n = 40/group). Patients were assessed at D0 (pre-, trans-, and/or 30 min postoperative), D7, and D14 using specific instruments according to each outcome: tongue repositioning and frenulum release (BTAT and Tongue Test), wound healing (Landry index), perioperative pain (CRIES scale), and breastfeeding performance (body mass variation, LATCH, and IBFAT scales). Both the diode laser (DL) and scalpel (SC) groups showed significant functional improvements and weight gain over time (p < 0.001), with no significant intergroup differences in most outcomes (p > 0.05). However, on D7, the SC group demonstrated superior breastfeeding performance (LATCH: p = 0.003; IBFAT: p = 0.024). Both groups exhibited reduced pain and progressive healing (p < 0.001). In the diode laser group, a negative correlation was found between total energy applied and healing quality at D14 (r = − 0.355; p = 0.027). Findings suggest both techniques are clinically effective, but laser parameters may influence healing. Further studies are warranted to optimize laser protocols in pediatric ankyloglossia surgery. RBR466cykz November 13th, 2024.

Introduction  Ankyloglossia is a congenital condition where a shortened sublingual frenulum restricts tongue movement, leading to breastfeeding challenges like nipple pain, poor latch, insufficient milk transfer, low infant weight gain and obstructive sleep apnea syndrome (OSAS) in children. Breastfeeding during the early months of a child's life is essential for healthy development.   Aim The aim of this study is to gather information based on scientific research regarding the effectiveness and justification of performing frenotomy in newborns who have experienced breastfeeding, speech, sleep difficulties due to ankyloglossia. We also focus on other reasons for performing frenotomy in children.   Material and method Multiple studies were conducted to assess the impact of frenotomy on issues related to ankyloglossia. Using PubMed, we searched for articles with the keywords "ankyloglossia" and "frenotomy" to identify publications that met our criteria.    Conclusions Based on a studies full lingual frenetomy is an effective intervention for improving speech, feeding, and sleep in children with restricted tongue mobility

Introduction: Ankyloglossia, or a short lingual frenulum, can interfere with breastfeeding, harming the infant's development, injuring the mother's nipples, and prompting early discontinuation of nursing. Objective: To analyze the existing literature on ankyloglossia, its epidemiology and related complications, as well as its correct diagnosis and treatment. Methodology: A search was carried out in the Pubmed, Google Scholar and Scopus databases using the keywords “ankyloglossia”, “breastfeeding”, “lingual frenulum”, and “pediatrics”. Results: The prevalence of ankyloglossia varies widely according to age and method of evaluation, being higher in newborns. Moderate or severe ankyloglossia limits tongue mobility and is associated with breastfeeding difficulties such as poor latch, nipple pain and sucking problems in the newborn. The lack of a clear definition of ankyloglossia complicates its diagnosis and treatment, although the Hazelbaker scale is one of the most widely accepted. Frenotomy, a common procedure to cut the lingual frenulum, is not recommended for all infants with ankyloglossia. Conclusion: Ankyloglossia is a condition whose prevalence varies according to age and method of assessment, being more common in newborns. Although frenotomy has been shown to be effective in improving breastfeeding-related symptoms such as poor latch, nipple pain and sucking difficulties, it is not suitable for all infants.

ABSTRACT Background Clinical diagnosis of ankyloglossia and its therapeutic management through lingual frenotomy (LF) have increased in several countries. However, systematic reviews (SRs) and experts opinions show conflicting results on this topic. Aim To synthesize the available knowledge with a critical evaluation of SRs on LF in infants up to 1 year of age on breastfeeding‐related outcomes. Design An umbrella review was carried out. Searches were conducted (seven electronic databases, gray literature). SRs of clinical trials involving infants up to 1 year of age undergoing LF to treat maternal self‐efficacy related to breastfeeding, nipple pain, and/or weight gain were included. The articles were critically analyzed (AMSTAR 2). Results We identified 272 studies; 15 SRs were included. Confidence was classified as critically low (n = 14; 93.3%) and moderate (n = 1; 6.7%). Fourteen SRs had more than two critical aspects, indicating that the studies were not conducted properly. Conclusion The evidence on the efficacy of LF in infants remains inconclusive in relation to breastfeeding outcomes, especially maternal self‐efficacy related to breastfeeding and weight gain. Evidence of benefit for the treatment of breast pain is weak. Overdiagnosis of ankyloglossia may lead to overtreatment of the condition, without high‐quality evidence to support the benefits of this procedure.

Background Nipple pain is a common issue experienced by breastfeeding mothers and if not resolved, can contribute to early cessation of breastfeeding. Aims To investigate mothers experiences of nip...

Background: Breastfeeding, a vital childhood intervention, faces challenges despite being a natural process. Factors such as maternal confidence, latching issues, breast pain, perceived milk insufficiency, and inadequate encouragement contribute to early discontinuation. Assessing breastfeeding in postpartum mothers prior to discharge is important for successful breastfeeding. The LATCH charting system designed by Jensen et al was used to assess the score. Objectives were to determine early breastfeeding problems using LATCH score and to study the impact of breastfeeding supportive measures on LATCH score. Methods: Hospital-based prospective observational study was conducted among 100 mothers who delivered in hospitals attached to Mahadevappa Rampure Medical College, Kalaburagi. The LATCH score was assessed twice, first within 24 hrs after birth and second 48 hrs after intervention. Results: Good LATCH score was found among the rural mothers, multiparous mothers and those who had a normal vaginal delivery. After providing breastfeeding support, a majority (81%) of the mothers transitioned from poor or moderate to a good LATCH score group. The overall mean LATCH score increased from 5.83±1.64 to 9.31±1.5 following intervention. Improvement was seen in all the individual components of LATCH. Conclusions: This LATCH assessment tool can identify mothers and infants who are at risk of early breastfeeding cessation and serve as a guide to initiate appropriate intervention.

Background: Tongue-tie and upper lip-tie have been linked to breastfeeding difficulties; however, traditional evaluation tools rely on subjective assessments. Ultrasound imaging enables objective assessment of infant sucking dynamics. Research Aim: This study aimed to assess the impact of tongue-tie and upper lip-tie on sucking function in newborns, using ultrasound imaging and other evaluation tools. Methods: This comparative observational study with short-term follow-up included 67 newborns (25 with tongue-tie, 21 with upper lip-tie, and 21 controls) and their mothers. Oral examinations were conducted during the hospital stay, prior to discharge. The maxillary labial frenulum was evaluated using the Kotlow classification, and the lingual frenulum was assessed with the Tongue Tie and Breastfed Infants (TABBY) tool. Sucking function was examined using ultrasound imaging between postnatal Days 5 and 15. Breastfeeding was evaluated via the LATCH tool, and maternal nipple pain was rated using a numeric scale. A 1-month follow-up call gathered data on feeding status, nipple pain, and surgical interventions. Results: No significant differences in LATCH or nipple pain scores were found across groups. Ultrasound measurements in the tongue-up position showed significantly lower anterior tongue height in the tongue-tie group. In the same position, intraoral space depth was reduced significantly in the upper lip-tie group. Anterior tongue height correlated negatively with maternal nipple pain in the tongue-tie group (r = -0.49, p = 0.014). Conclusion: Tongue-tie and upper lip-tie do not always lead to observable breastfeeding problems. Ultrasound imaging offers valuable insights into subtle sucking dysfunctions not captured by clinical assessment. Özet Arka plan: Dil bağı ve üst dudak bağı emzirme zorluklarıyla ilişkilendirilmiştir; ancak geleneksel değerlendirme araçları öznel değerlendirmelere dayanmaktadır. Ultrason görüntüleme, bebeklerin emme dinamiklerinin objektif olarak değerlendirilmesini mümkün kılar. Araştırmanın Amacı: Bu çalışma, yenidoğanlarda dil bağı ve üst dudak bağının emme fonksiyonu üzerindeki etkisini ultrason görüntüleme ve diğer değerlendirme araçlarını kullanarak incelemeyi amaçladı. Yöntemler: Bu kısa dönem takipli karşılaştırmalı gözlemsel çalışmaya 67 yenidoğan (25 dil bağı, 21 üst dudak bağı ve 21 kontrol) ve anneleri dahil edildi. Ağız muayeneleri, hastanede kalış sırasında taburculuk öncesinde gerçekleştirildi. Maksiller labial frenulum Kotlow sınıflandırmasına göre, lingual frenulum ise Tongue Tie and Breastfed Infants (TABBY) aracı ile değerlendirildi. Emme fonksiyonu postnatal 5. ve 15. günler arasında ultrason görüntüleme ile incelendi. Emzirme, LATCH aracı ile değerlendirildi ve annedeki meme ağrısı sayısal derecelendirme ölçeği ile puanlandı. Doğumdan bir ay sonra yapılan takip telefon görüşmesinde beslenme durumu, meme ağrısı ve cerrahi müdahalelerle ilgili veriler toplandı. Bulgular: Gruplar arasında LATCH veya meme ağrısı puanlarında anlamlı bir fark bulunmadı. Dil yukarı pozisyonunda yapılan ultrason ölçümlerine göre, dil bağı grubunda ön dil yüksekliği diğer gruplara göre anlamlı derecede düşüktü. Aynı pozisyonda, üst dudak bağı grubunda intraoral boşluk derinliği hem dil bağı grubuna hem de kontrol grubuna kıyasla azalmıştı. Dil bağı grubunda, dil yukarı pozisyonunda iken, ön dil yüksekliği ile meme ağrı skoru arasında anlamlı ve negatif bir ilişki gözlendi (r = -0,49; p = 0,014). Sonuç: Dil bağı ve üst dudak bağı her zaman gözlemlenebilir emzirme sorunlarına neden olmaz. Ultrason görüntüleme, klinik değerlendirmede belirlenmeyen emme fonksiyonu bozuklukları hakkında değerli bilgiler sağlar.

PURPOSE The purpose of the present study was to investigate the effects of surgical fear levels on perceived postpartum pain and breastfeeding success in women undergoing an elective cesarean section. DESIGN The study used a descriptive and cross-sectional research design. METHODS The study included 350 pregnant women who underwent elective cesarean section at the Gynecology and Obstetrics Department of Ankara Etlik City Hospital between January 15, 2024 and September 15, 2024. The data were collected through face-to-face interviews using the personal information form, the Surgical Fear Questionnaire, the Visual Analog Scale, and the LATCH Breastfeeding and Diagnostic Tool. The data were analyzed using numbers, percentages, mean, standard deviation, Pearson's and Spearman's correlation, and single regression analysis. FINDINGS The participants' mean age was 27.89 ± 4.27 years, and the mean duration of marriage was 5.94 ± 4.22 years. Of the participants, 66.9% had a medium income level, and 91.7% lived in a nuclear family. The participants scored an average of 36.47 ± 15.80 points on the Surgical Fear Questionnaire, 9.46 ± 0.84 points on the Visual Analog Scale at the second hour postpartum, and 6.69 ± 1.52 points on the LATCH Breastfeeding and Diagnostic Tool. While there was a low-level positive correlation between surgical fear and postpartum pain, there was a low-level negative correlation between surgical fear and breastfeeding (P < .001). CONCLUSIONS The fear that pregnant women experienced before elective cesarean section increased postpartum pain while reducing breastfeeding success.

This study was conducted to determine the effect of the patient rotation and movement system (PRMS) on breastfeeding success, pain, and comfort in puerperants who gave birth by caesarean delivery. This is a randomised controlled trial. Data were collected in the caesarean unit of Kars Harakani State Hospital between 01.12.2020 and 30.06.2021. The study was completed with 146 puerperants (experimental group n = 74; control group n = 72). Data were collected using the LATCH Breastfeeding Diagnosis and Evaluation Scale, Visual Analogue Scale (VAS), Postpartum Comfort Scale (PCS), and Lactogenesis Symptoms Follow-up Form. The trial was retrospectively registered at ClinicalTrials.gov. LATCH scores were significantly higher in the experimental group at all breastfeeding assessments (p < 0.001). VAS pain scores were significantly lower in the experimental group during the first three breastfeeding sessions and the first breastfeeding before discharge (p < 0.05). Physical comfort and total PCS scores were significantly higher in the experimental group (p < 0.05). Most lactogenesis breast symptoms were more prevalent in the experimental group from postpartum day 2 onward. No adverse events related to PRMS use were observed during the study period. The PRMS improved breastfeeding success, reduced early postpartum pain, and enhanced physical comfort after caesarean delivery. No significant effect was observed on psychospiritual or sociocultural comfort. These findings suggest the PRMS may be a promising non-pharmacological supportive strategy in post-caesarean care. Future studies with formal safety endpoints and standardised protocols are warranted.

Background: The relationship between post-sectio caesarea pain levels and breastfeeding success within the first 24 hours postpartum is an important concern because postoperative pain may inhibit early breastfeeding. Mothers who undergo sectio caesarea often experience limited mobility, discomfort, and disruption of the milk ejection reflex due to pain. This study aimed to determine the relationship between post-sectio caesarea pain levels and breastfeeding success within the first 24 hours postpartum at Dharma Kerti Hospital, Tabanan, in 2026. Methods: This study used a quantitative analytic design with a cross-sectional approach. The sample consisted of 35 post-sectio caesarea mothers selected using a purposive sampling technique. Pain levels were measured using the Numeric Rating Scale (NRS), while breastfeeding success was assessed using the LATCH method. Data were analyzed using Fisher's Exact Test with a significance level of α < 0.05. Results: The results showed that most respondents experienced mild pain (48.6%), followed by moderate pain (37.1%) and severe pain (14.3%). A total of 85.7% of respondents successfully breastfed, while 14.3% were unsuccessful. Statistical analysis showed a significant relationship between post-sectio caesarea pain levels and breastfeeding success within the first 24 hours postpartum (p < 0.001). Conclusion: Higher pain levels were associated with an increased risk of breastfeeding failure.

Bu protokol çalışmasının amacı Kinezyo Bant (KB) uygulamasının emziren annelerde sırt ağrısına emzirme başarısına ve emzirme öz yeterliğe etkisini inceleyecek bir çalışma tasarımını sunmaktır. Araştırma tek merkezli, tek kör, paralel grup randomize kontrollü deneysel tasarımda planlanmış olup, araştırma SPIRIT'e uyumlu şekilde yürütülecektir. Çalışmanın örneklemini 0-6 aylık bebeği olan, aktif emzirmeyi sürdüren anneler oluşturacaktır. Çalışmanın örneklem büyüklüğü güç analizine göre belirlenmiş olup (n=60), anneler KB uygulanacak deney grubu (n=30) ve plasebo KB girişimi uygulanacak kontrol grubu (n=30) olmak üzere 2 gruba randomize şekilde atanacaktır. Deney grubundaki annelere gerilim ve açı verilen KB, kontrol grubunda yer alan annelere deney grubuyla aynı tür KB ile açısız ve gerilimsiz düz bantlama iki hafta boyunca haftada 2 kez uygulanacaktır. Bantlama yapılmadan önce, 7. ve 14. günlerde Visual Analog Ağrı Ölçeği, LATCH Emzirme Tanılama ve Değerlendirme Ölçeği ve Emzirme Öz Yeterlilik Ölçeği ile annelerden 3 ölçüm alınacaktır.

Background: Pain and delayed breastfeeding initiation is the most typical complications following a cesarean operation, which affect women’s comfort. Adverse effects of using medications to relieve pain and lack of access to them for some women have led to an increase in the application of non-drug methods such as massage. Aim: To assess the effect of deep tissue massage on women’s wound pain, comfort, and breastfeeding after cesarean section. Design: The study employed a single-blinded, randomized clinical trial. Setting: The study was conducted at the postpartum ward at Women's Health Hospital, Assuit University. Subjects: with a convenient sample size of 160 women (divided into two equal groups study and control). Tools: Structured interview, Visual Analogue Scale, Postpartum Comfort Questionnaire, and Breastfeeding Assessment Scale Latch LATCH were the four tools used. In the study group, DTM was implemented. Results: There is a highly statistically significant difference in wound pain, comfort, and breastfeeding following cesarean section between the study and control groups p<0.01. Conclusion: Applying DTM played a vital role in the management of post-cesarean section (CS) pain and improving mothers’ comfort, and breastfeeding. Recommendations: DTM should be recommended in hospital protocols for the management of post-cesarean pain that leads to improvement comfort, and encouraging breastfeeding.

STUDY OBJECTIVE The primary aim of the proposed study was to determine the association between postoperative pain and breastfeeding after cesarean delivery during hospital stay. DESIGN Retrospective cohort study. SETTING Postoperative recovery area and operating room. PATIENTS Data was obtained on singleton pregnancies undergoing scheduled cesarean deliveries under spinal anesthesia between 2013 and 2016. INTERVENTIONS Determine the association between postoperative pain and breastfeeding after cesarean delivery. MEASUREMENTS Postoperative pain score, breastfeeding, LATCH score post-partum depression and length of stay values collected. MAIN RESULTS The dataset consisted of electronic medical records from 5350 patients. We found that the pain score is negatively associated with the LATCH score; higher pain was associated with lower LATCH scores, -0.01 [-0.01,-0.00], p < .0402. Every one-point increase in average pain score was associated with a 21% reduction in the odds of in-hospital exclusive breast-feeding relative to exclusive formula-feeding, OR = 0.79 [0.70-0.90], p < .0002. We observed that the post-partum depression status was associated with the average postoperative pain score, F (1, 5347) = 41.51, p < .0001. We also found a significant positive association between the average pain score and the duration of hospital stay (p < .0001); every one-point increase in the average pain-score was associated with a 7.98 [6.28, 9.68] hour increase in length of stay. CONCLUSIONS Our results demonstrate significant association between the increase in post-cesarean pain scores and deterioration of breastfeeding initiation while also exposing slight reductions in the quality of breastfeeding. Additionally, we found that increases in post-cesarean pain scores also positively associate with postpartum depression and duration of stay, with each increase in pain score resulted in an almost one-day increase in the length of stay.

The aim of the study is to identify and compare the effect of pain, stress, and cortisol level during labor on breastfeeding success. The study was conducted with 51 pregnant women in the delivery room of Nenehatun Maternity Hospital between 15 August and 30 December 2016. The data were collected using the personal information form, visual analog scale (VAS), verbal category scale (VCS), perceived stress scale (PSS) and Breastfeeding Diagnostic and Assessment Scale (LATCH). It was determined that the total mean score of the mothers for the LATCH breastfeeding success scale was 6.56 ± 1.64, the perceived stress scale total mean score was 48.13 ± 4.09 in their active phase, and the perceived stress scale total mean score was 41.41 ± 5.78 in their postpartum period. A negative moderate significant correlation was observed between the LATCH breastfeeding success scale mean scores and the cortisol levels in the active phase and postpartum period. It was found that the LATCH had a significant correlation with the perceived stress and cortisol in the postpartum period. It was determined that the mothers had more stress in the active phase and this stress affected negatively the lactation and sucking behavior of the infant.

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PROBLEM Tongue tie is an added complication when breastfeeding, but little is known about the role tongue tie might play when breastfeeding twins. BACKGROUND Twins are much less likely to be breastfed than singleton babies due to added complications regarding pregnancy, birth and ongoing care. Tongue tie can cause breastfeeding barriers including poor latch, inefficient milk transfer and nipple pain. AIM The aim of this study was to conduct an in-depth exploration of the experiences of mothers who have breastfeed twins with suspected or diagnosed tongue tie. METHODS Interview and qualitative survey data exploring the experience of breastfeeding twins and multiples were analysed with a focus on the experiences of participants reporting on suspected or diagnosed tongue tie. Data were analysed using reflexive thematic analysis. FINDINGS Three themes were developed. These were: 1) feeling disempowered by tongue tie denial; which illustrated the experience of dismissal by healthcare professionals, 2) the avoidable impact of diagnostic delay; highlighting the practical, physical and psychological impact of tongue tie, and 3) improvements following intervention; illustrating the immediate improvements experienced following frenotomy. DISCUSSION Mothers who suspect tongue tie find themselves disempowered by denial of their experiences and needing to fight for intervention. Long delays lead to distress for both mother and child while intervention often leads to instant improvement. CONCLUSION Improved healthcare professional training and healthcare policy changes are needed to improve tongue tie support and intervention for parents of twins and reduce the threat to mother and child health and wellbeing. STATEMENT OF SIGNIFICANCE Problem or Issue: Breastfeeding rates for twins are much lower than for singleton babies. For some infants tongue tie may be an additional barrier to breastfeeding success. WHAT IS ALREADY KNOWN Research with parents of singleton babies has shown that tongue tie can cause distress, frustration and physical pain for mothers who report dismissal by healthcare professionals and a need to fight for support. WHAT THIS PAPER ADDS The voices of parents of infants with tongue tie who have successfully breastfed twins are presented. Like parents of singleton infants, they experienced diagnostic delays and psychological and physical impacts of tongue tie. Intervention was often sought privately when NHS support was lacking. Regardless of source, tongue tie intervention often led to immediate improvement highlighting how the added stresses and challenges created by tongue tie for twin parents could be prevented with appropriate support and intervention following birth.

Background: To investigate the efficacy of aloe gel in reducing pain and promoting wound healing in postpartum women with nipple trauma. Method: There were 80 postpartum women who took part in this study having developed nipple trauma during breastfeeding in the obstetrics department of a tertiary grade A hospital in Suzhou from January to December 2021. Postpartum women with nipple trauma whose hospital bed numbers ranged between 15 and 33 were included in the test group, whereas those whose hospital bed numbers ranged between 35 and 53 were included in the control group. Both groups received health education and breastfeeding guidance. The control group applied lanolin cream to their nipple trauma, whereas the test group used aloe gel. We used a nipple trauma severity assessment table to determine the severity of nipple trauma in lactating women and a Visual Analogue Scale (VAS) to determine the level of nipple pain and referred to the Traditional Chinese Medicine Standard for Diagnosis and Therapeutic Efficacy for Diseases and Syndromes to determine the healing time of their wounds. Results: The test group scored 3.70 ± 1.24 and 1.65 ± 0.74 points on the VAS on the first and third days following the intervention, whereas the control group scored 4.30 ± 0.94 and 2.23 ± 1.07 points, respectively. It took 3.75 ± 1.08 days and 4.45 ± 1.15 days for the nipple pain to completely disappear in the test group and the control group, respectively. The healing period for nipple trauma was 5.28 ± 1.26 days for the test group and 6.03 ± 1.61 days for the control group. All of the aforementioned distinctions were statistically significant (p < 0.05). Conclusions: Aloe gel can significantly alleviate the pain associated with nipple trauma in lactating women, accelerate wound healing, and reduce the duration of nipple trauma.

ABSTRACT  Trauma to the nipple such as excoriation (abrasions), hyperemia, and fissures is often one of the main reasons mothers stop breastfeeding. Therefore, proper treatment is needed to prevent this condition. Research related to non-pharmacological therapy as an effort to treat nipple trauma has been conducted, one of which is by utilizing plants containing flavonoids that function as anti-inflammatory agents. This study aims to examine the potential of guava leaves as an anti-inflammatory agent that can be used as an alternative treatment for nipple trauma. This article adopts the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) as a guideline. The database was taken from Science Direct, PubMed, and Google Scholar. The search was conducted using keywords such as "psidium guava" or "wound healing" or "psidium guava leaves antiinflamatory" or "Psidium guajava linn for wound". In this review, ten articles were analyzed to see the study design, objectives, results, and conclusions. The results of observations that have been made guava leaves have the potential as a medicine for nipple trauma because they contain flavonoids that act as anti-inflammatory. The results of observations that have been carried out show that guava leaves have the potential as a natural medicine to treat nipple trauma, thanks to their flavonoid content which has anti-inflammatory agen. Keywords: Nipple Trauma, Flavonoids, Anti-inflamatory, Guajava Leaves  ABSTRAK Trauma pada puting seperti ekskoriasi (lecet), hiperemia, dan fisura sering menjadi salah satu alasan utama ibu menghentikan pemberian ASI. Oleh karena itu, diperlukan penanganan yang tepat untuk mencegah kondisi tersebut. Penelitian terkait terapi non-farmakologi sebagai upaya pengobatan trauma puting telah dilakukan, salah satunya dengan memanfaatkan tanaman yang mengandung flavonoid berfungsi sebagai agen antiinflamasi. Penelitian ini bertujuan untuk mengkaji potensi daun jambu biji sebagai agen antiinflamasi yang dapat digunakan sebagai alternatif pengobatan trauma puting. Penelitian ini menggunakan metode Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA). Database diambil dari Science Direct, PubMed, dan Google Scholar. Pencarian dilakukan dengan menggunakan kata kunci seperti "psidium guava leaves" atau "wound healing" atau "psidium guajava leaves antiinflamasi" atau “daun jambu biji untuk luka”. Dalam tinjauan ini, sepuluh artikel dianalisis untuk melihat desain penelitian, tujuan, hasil, dan kesimpulan. Hasil tinjauan yang telah dilakukan menunjukkan bahwa daun jambu biji memiliki potensi sebagai obat alami untuk mengatasi trauma pada puting susu. Hal ini dikarenakan daun jambu biji mengandung flavonoid yang memiliki sifat antiinflamasi. Kata Kunci: Trauma Puting, Flavonoids, Anti-inflamasi, Daun Jambu Biji

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Electrotherapy in Lactation CareBreastfeeding offers significant health benefits but is often discontinued early due to inflammatory conditions of the lactating breast and nipple trauma. Common issues such as mastitis, engorgement, and nipple damage contribute to pain, infection, and reduced milk production, leading to early cessation. Effective management includes optimal positioning, strategies to maintain breastfeeding, and wound care. Emerging electrotherapies, such as Photobiomodulation Therapy and Therapeutic Ultrasound, may offer promising, non-invasive treatments to support lactation. Photobiomodulation therapy uses red and near-infrared light to stimulate cellular repair, reduce inflammation, and accelerate wound healing. It is safe, drug-free, and effective for nipple trauma. Therapeutic Ultrasound employs continuous ultrasound waves to relieve pain, reduce edema, and promote healing in inflammatory conditions of the lactating breast. Although the evidence base for these therapies is still developing, they may act as a complementary tool alongside conventional lactation care to provide enhanced support. In Ireland, where breastfeeding rates remain low, clinical innovation in two community care settings led to the introduction of electrotherapy by two Public Health Nurse Lactation Consultants who had trained in, and delivered, electrotherapy within their respective clinical sites. High levels of client satisfaction and symptom reduction were reported. This innovation has now spread to other Irish community and hospital settings where the development of a standardized practice protocol promotes consistency in practice, enhances patient safety and supports accountability. Electrotherapies can be successfully incorporated into lactation care, but priority should remain on optimal postpartum care to prevent breast inflammation, nipple pain, and damage.