Positioning and attachment interventions for nipple pain: a systematic review

Sharon Guille, Marlene Sinclair (Contributor), B Bunting, Bernie Reid, P. A. McCarron

Research output: Contribution to journalArticlepeer-review

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Background: Nipple pain is a common difficulty experienced by breastfeeding mothers, with negative impacts on breastfeeding duration and experience. Previous systematic reviews, focusing mainly on various topical treatments, dressings and protective devices for nipple pain, concluded there was insufficient evidence to recommend any of these interventions, advocating correct positioning and attachment for the prevention of pain and trauma. Achieving optimal positioning and attachment forms the basis of management advice for nipple pain.
Aim: The aim of this review was to collate and synthesise current evidence for the
effectiveness of positioning and attachment interventions for the prevention and/
or management of nipple pain in breastfeeding mothers. Other outcomes included identifying factors associated with effective intervention design and also examining the effectiveness of positioning and attachment interventions for nipple pain on breastfeeding duration.
Methods: The scope of the review was defined using the PICOS tool. Literature searches were conducted on the following databases: MEDLINE, Embase, PsycInfo, CINAHL, Proquest Academic Complete, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL). A search of the grey literature was also undertaken. A risk of bias analysis was completed for included studies.
Results: Following the search and having removed duplicates, 163 records were screened by title and abstract. 152 studies were excluded for reasons including: non-experimental study design, the testing of interventions outside the scope of this review or interventions targeted at dyads who may find breastfeeding more challenging. Of the 11 full text articles assessed for eligibility, three studies involving 489 participants met the full inclusion criteria. Owing to the low number of studies, variations in design and conflicting results, there is insufficient evidence to determine the effectiveness of positioning and attachment interventions for nipple pain. Subsequently, there is not enough information to recommend any specific intervention study design or to determine the impact on
breastfeeding duration.
Conclusion: This review highlights the need to invest in further research focused on positioning and attachment interventions for nipple pain. Further studies will help identify factors associated with effective intervention delivery and consider if these interventions improve breastfeeding technique. Studies should also examine pain severity through the use of measurement tools and include a  thorough pain assessment, prior to intervention delivery, to determine intervention effectiveness.
Original languageEnglish
Pages (from-to)293-306
Number of pages14
JournalEvidence Based Midwifery
Issue number3
Publication statusPublished (in print/issue) - 30 Sep 2020


  • breastfeeding
  • positioning and attachment
  • intervention
  • nipple pain
  • duration
  • systematic literature review
  • evidence based midwifery


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