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An evidence-based nipple care pathway for new breastfeeding mothers: a Delphi study

02 July 2024
Volume 32 · Issue 7



Only 1% of UK mothers maintain exclusive breastfeeding for the first 6 months, as per global recommendations. Early breastfeeding cessation often involves complex issues, with nipple-related injuries being a common cause. This study aimed to develop an evidence-based tool for early identification and management of breastfeeding-related nipple injuries through expert consensus.


A mixed method approach was used, including a 5-stage scoping review and a modified Delphi consensus technique with 26 UK-based maternal health experts and experienced breastfeeding mothers.


Consensus (80% agreement) was reached on recommendations, including the provision of realistic information, early peer support engagement and Lanolin use. Some commonly recommended practices, such as letting the nipple air dry, did not reach consensus, highlighting a misalignment between expert consensus and published guidance.


This study generated evidence-based, expert-validated self-management guidance, emphasising the need for improved stakeholder engagement in policy development.

Evidence has shown that breast milk alone is sufficient for infant nutrition in the first 6 months of life (Butte et al, 2002). The World Health Organization (WHO, 2024) recommends that babies should be put to the breast within the first hour after birth and be exclusively breastfed for the first 6 months. It is recommended to continue breastfeeding up to 2 years of age or beyond, and implement complementary foods only after 6 months (Butte et al, 2002).

Despite the well-established evidence supporting these recommendations, exclusive breastfeeding rates remain low (WHO, 2024). According to the WHO (2023) fact sheet, only 44% of infants are exclusively breastfed globally. In the UK, only 1% of mothers maintain exclusive breastfeeding to 6 months (Department of Health, Social Services and Public Safety, 2013; UNICEF, 2017). Across the UK, rates of exclusive breastfeeding to 6 weeks vary, with 24% reported in England, 17% in Wales, 32% in Scotland and 13% in Northern Ireland (D'Cruz, 2018; UNICEF, 2024). A study by the Scottish government in 2017, showed an increase in the proportion of infants receiving breastmilk at 6 months to 43%, from 32% in 2010 (D'Cruz, 2018). Approximately 80% of breastfeeding mothers in the UK do not meet their breastfeeding desires as a result of breastfeeding-related pain and other maternal, infant or social challenges (UNICEF, 2017; Wray and Garside, 2018).

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