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Lochner JE et al. – The best intervention is education on proper positioning and attachment of the infant (strength of recommendation [SOR]: A, a systematic review of randomized controlled trials [RCTs]). No single topical preparation has been consistently demonstrated to be superior to others for relieving nipple pain (SOR: B, inconsistent RCTs). Topical agents that show some evidence of benefit include expressed breast milk, lanolin, warm water compresses, tea bag compresses, hydrogel dressings, a chlorhexidinealcohol spray, and a polyethylene film dressing (SOR: B, inconsistent RCTs). Several studies found these interventions to be equivalent to basic breast care, including keeping the nipple clean and dry (SOR: B, RCTs). One type of glycerin–based hydrogel dressing was associated with an increased incidence of breast infections (SOR: B, inconsistent RCTs).

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