Résumé
A sore nipple is a commonly encountered problem during breastfeeding. Though it is an easily preventable condition, once it happens it can lead to a lot of serial complications. Many mothers experience such painful sore nipples that they stop breastfeeding before they intended. The present work aims at exploring the problem of sore nipples regarding its association with poor lactation management, time of presentation after delivery, bottle and pacifier use and the infection hazards to both members of the mother/infant dyad. This is a case control study where forty nine nursing dyads with mothers complaining of nipple cracks or sores, were compared with fifty one dyads whose mothers had no nipple complaint. Study tools included: physical examination of infants and local breast examination of mothers. Pre-structured questionnaire was asked, demonstrating infant's medical history and including patterns of feeding. Also bacteriologic examination [swabs and cultures] for nipple of the mother, oral cavity of the infants and bottles and/or pacifiers were done. Forty nine [49] cases were included in the group having sore nipples and 51 were included in the control group with no sore nipples. Pattern of feeding significantly affected the event of sore nipples. None of the infants in the sore nipple group was exclusively breast fed, while all of the exclusively breastfed infants [100%] were located in the control group [P= 0.000]. Most of the sore nipple cases [95.9%] showed nipple and oral mucosa colonization to be compared with only 70.6% of the control group [P=0.001]. Nipple culture of pathogenic strains were almost four folds in the case group than in the control group [P=0.004]. Ninety two percent [92%] and 78.6% of the case and control groups' teats showed bacteriologic growth [P=0.596]. 98.5% of each of the nipple cultures and the oral mucosa cultures of those using bottle feeding with the breast showed colonization. 93.3% of each of the nipple cultures and the oral mucosa cultures of those using spoon feeding with the breast showed colonization, while only 11.8% [2 cases] of the exclusively breastfed infants showed colonization in each of their nipple cultures and oral mucosa cultures and these 2 cases were commensals [P=0.000]. There was no statistical difference as regards infants gender, the mode of delivery or maturity at birth [P=0.164, 0.229 and 0.332 respectively] between both groups. Sore nipples are a manifestation of poor lactation management, and are closely associated with the use of bottles and/ or pacifiers and early introduction of supplements even without bottle use. Bottles, pacifiers and other feeding utensils also carry the potential risk of infection to both members of the nursing dyad. The earlier the lactation management to achieve the goal of exclusive breastfeeding appears to be the only safeguard against such problems