All about APNO

Do you need an all-purpose nipple ointment to heal your sore nipples? Here's everything you need to know if you're considering APNO cream.

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Before breastfeeding, you probably didn’t give your nipples much thought, right? Their default was happy and healthy—and, boy, did you ever take that for granted! That all changes in the early days of breastfeeding, when you and your baby learn how to latch and nurse and the state of your nipples becomes top priority. Some soreness is normal in the first week or so (after all, you’re not used to having a tiny human at your breast for hours every day and night), but an incorrect latch or a thrush infection can lead to painful, cracked and infected nipples. While the most important thing is to get a proper latch sorted out, the next step is to help you heal. Natural remedies and over-the-counter ointments work just fine for some new moms, but others may need more potent treatments. Often, your healthcare provider will prescribe an all-purpose nipple ointment (APNO). Here’s what you need to know.

What is APNO?

Jack Newman, a Toronto paediatrician and breastfeeding expert, created a prescription for APNO, and it remains the most commonly prescribed treatment. (Non-prescription treatments for damaged nipples include applying breastmilk, coconut oil, lanolin and over-the-counter balms.) APNO contains an antibiotic ointment called mupirocin, a corticosteroid ointment called betamethasone, and an antifungal powder called miconazole.

What does APNO treat?

It’s a multipurpose medication. “The antibiotic is broad spectrum, so it fights a lot of different bacteria, including staphylococcus, which lives on the skin,” says Simone Rosenberg, a Toronto midwife. “The corticosteroid helps with any nipple pain related to inflammation and accelerates the healing of abrasions and cracks. The antifungal treats candida, or yeast, which baby can pass on to mom when they nurse.”

Where do I get APNO?

Your doctor or midwife can write a prescription. It needs to be filled at a compounding pharmacy, where a pharmacist will mix up the ingredients to form the ointment. You can find a list of compounding pharmacies at Professional Compounding Centers of America (which includes Canadian locations).

How do I use APNO?

Newman’s tip is to apply just enough APNO to make the nipples and areolas shiny. “The prescription says ‘apply sparingly,’ and I recommend a pea-sized amount on each nipple,” says Rosenberg. “A little bit goes a long way. You apply it right after you nurse, and you don’t need to wipe it off before baby nurses the next time.” On the other hand, some doctors suggest wiping or washing APNO off your nipples before nursing because the antifungal medication tastes bad, says Jarron Yee, a compounding pharmacist in Regina. “The thinking is that the taste and consistency of the ointment will make the baby not want to latch,” says Yee. However, Newman doesn’t recommend wiping off the ointment before nursing because unnecessary washing can cause the nipples to dry out and cause more damage. (Yes, these are mixed messages, so consider seeing how your baby reacts and discuss it with your own healthcare provider.)

Is APNO safe for my baby? How about me?

The medicines in APNO are in such low doses that it’s not a concern for your baby to ingest them, says Yee. Rosenberg adds that most of the ointment is absorbed by your skin between feedings. In theory, there is a slight risk of a localized skin reaction for the mother if she happens to be allergic to any of the ingredients, but it’s not at all common, says Yee. “Long-term use of corticosteroids can thin the skin, so we usually suggest taking them for no longer than two weeks and then taking a couple of days off and starting again if you still need them.” (Newman notes that his practice hasn’t seen any thinning of the skin, even when breastfeeding parents have used APNO for several weeks.)

How long do I use APNO?

As long as your baby is latching well, using APNO for a couple of weeks will be enough to get your nipples healthy again. “We recommend using it from seven to 10 days to heal completely and then applying it one or two days after that,” says Yee. Rosenberg goes by the skin’s appearance and mom’s experience. “I consider it to be healed when there are no visible cracks or abrasions on the nipples,” she says. “When your baby is latching, there shouldn’t be any discomfort after the first 10 seconds at the breast.” If your nipple pain flares up again later on, it’s fine to use your existing APNO rather than get a new prescription, says Yee. And, of course, talk to a medical professional, like a lactation consultant, to figure out where the pain is coming from.

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