12 Nipple
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Sesi 12 Breast and nipple conditions
1. SESSION 12 BREAST AND NIPPLE CONDITIONS BREASTFEEDING PROMOTION AND SUPPORT A TRAINING COURSE FOR HEALTH PROFESSIONALS ADAPTED FROM THE BABY FRIENDLY HOSPITAL INITIATIVE: REVISED, UPDATED AND EXPANDED FOR INTEGRATED CARE (SECTION 3) WHO/UNICEF 2009
2. 1. Examination of mother’s breasts and nipples
3. Examination of mother’s breasts & nipples • Reassure mothers that most breast produce breast milk well regardless of size and shape. • No need to physically examine women’s breasts and nipples except if she has pain or difficulty. • In most cases , observation is all you need to do
4. Examination of breasts and nipples Explain what you want to do Ensure privacy Ask permission If touching the breasts is necessary, do gently 5
5. Examination of mother’s breasts and nipples • Look for: — engorgement/lumps/swelling/redness — evidence of past surgery Highlight positive sign Do not sound critical about her breasts. Build her confidence in her ability to BF 6
6. Nipple size and shape
7. Flat Nipples and Protractility Nipples become protractile /stretchy during pregnancy No need to diagnose or treat flat/inverted nipple during pregnancy wearing shells / exercise may cause pain Makes woman feel that her breasts are not right for BF No longer recommended Protractility improves during pregnancy and after delivery May look flat but baby is able to suckle Build her confidence and provide support. Attachment and avoiding artificial teats and pacifiers assist BF to establish.
8. Inverted Nipples Not always a problem as babies attach to breast and not to nipple. Build mothers’ confidence and provide support. Supportive practices include : Skin to skin contact, encourage baby to find own way to breast , correct positioning. Help mothers to attach properly Can breastfeed successfully with help Really difficult nipples are rare. 9
9. 2. Management of Nipple Problems
10. Management of Flat and Inverted Nipples • Antenatal treatment — Probably not helpful • Soon after delivery — Build mother’s confidence — Explain baby sucks from BREAST not nipple — Let baby explore breast, skin-to-skin — Help mother to position her baby — Try different positions — Help her to make nipple stand out more - Use syringe, pump, massage • For first week or two if baby not suckle effectively — Express breastmilk — feed with cup — Express into baby’s mouth
11. Syringe method for inverted nipples
12. Long or Big Nipples May cause difficulties baby does not take breast far enough back into mouth likely to suck only nipple and not taking breast with the lactiferous sinuses into mouth. Be ready to help mother with BF technique help mother to position and attach correctly
13. Long Nipples
14. Helping Mother With Long and Big Nipples • Re-assure mother: Baby’s mouth will grow and lengthen. Her nipples will not grow !! • Express breastmilk and feed with cup. • Express breastmilk into baby’s mouth.
15. Management of Nipple Fissure (Cracked Nipple) Commonly caused by incorrect positioning and poor attachment. Baby pulls on nipple as he sucks and causing pain Repeated suckling >> damage nipple skin >>> fissure. Help mother for correct positioning.
16. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Sore Nipple ©UNICEFC107-31
17. Sore Nipples Breastfeeding shouldn’t hurt Some find nipples slightly tender at beginning of feed for few days but usu. disappears in a few days • Most causes of nipple soreness are simple and avoidable • Ensure all maternity staff know how to help mothers get babies attached to breasts If babies are well attached Most mothers do not get sore nipples 18
18. Observation and history taking for sore nipples Causes of sore nipple: • Poor attachment • Baby is pulled off breast to end feed • Breast pump ( cause stretching of nipple) • Candida (from baby’s mouth) infection of nipple • Infant’s tongue tie causing friction on nipple.
19. Observation and history taking for sore nipples • Ask mother to describe what she feels: —Pain at start of a feed that fades when baby lets go, is most likely related to attachment. —Pain that gets worse during feed and continues after feed has finished, often describe as burning/stabbing is more likely caused by Candida Albicans.
20. Observation and history taking for sore nipples • Look at nipples and breast — Broken skin is usually caused by poor attachment. — Skin is red, shiny, itchy, flaky with loss pigmentation often seen with Candida. — Candida and trauma from poor attachment can exists together. — nipple can have eczema, dermatitis and other skin condition.
21. Observation and history taking for sore nipples • Observe a complete breastfeeding • Check how the baby : —goes to breast —Attachment —Suckling —Notice how mother ends feed —Observe what nipples look like at end of feed 22
22. Management of Sore Nipples Reassurance sore nipples can be healed and prevented in future Treat cause of sore nipples Suggest comfort measures while nipple healing Treat Cause: • Help mother to improve attachment and positioning • Show mother how to feed in different feeding position • Treat Candida both on mother and baby • If baby had tongue tie – refer for treatment 23
23. • . 24
24. Suggest comfort measures While nipples are healing:- • Apply expressed breast milk to nipples after feed. • Begin each breastfeed on least sore nipple • Gently remove baby if baby begin to fall asleep at breast. • Wash nipples only once a day. • Avoid using soap on nipples, as it removes natural oils. 25
25. What do not help DO NOT stop breastfeeding to rest nipple. DO NOT limit frequency or length of breastfeeds. DO NOT apply any substances to nipple. DO NOT use nipple shield. 26
26. 3. Causes, Prevention and Management of Common Breast Problems Engorged breast
27. Common Breast Problems 1. Breast engorgement 2. Block duct and mastitis 3. Breast abscess 4. Candidiasis
28. UNICEFC-107-19 Breast Engorgement 12/3
29. Full breasts Engorged breasts • NORMAL 48/72 hours after birth. • PATHOLOGICAL • can occur any time during breastfeeding. • Warm, full and heavy. • Painful, Oedematous. • Hot and hard. • Tight and flat especially nipple area. • Shiny and may look red. •Milk flowing. • Milk NOT flowing. • Fever uncommon. • Fever may occur. • For the next 10 to 14 days breast fullness often occurs BEFORE a feed. •**FIL (Feedback Inhibitor of Lactation) may cause decrease in milk supply if engorgement continues.
30. Causes and Prevention of Breast Engorgement CAUSES PREVENTION •Plenty of milk. •Delay starting to breastfeed. •Start breastfeeding soon after delivery. •Poor attachment to breast. • Ensure good attachment. • Infrequent removal of milk. • Restriction on the length of feeds. • Encourage unrestricted BF (feeding day and night with long duration of feeds). •Express in between feeds 31
31. Management of Breast Engorgement • If the baby able to suckle •Feed frequently, help with positioning • If the baby not able to suckle • Express milk • Before feed (to stimulate oxytocin reflex) • Warm compress or warm shower. • Massage neck and back. • Light massage of breast • Help mother to relax • Provide supportive atmosphere. • After feed (to reduce oedema) • Cold compress on breasts. 32
32. Relief of engorgement • Removing milk from breast will relieve engorgement. • This will: • Relieve mother’s discomfort. • Prevent mastitis and abscess formation. • Help to ensure continued production of milk. • Enable baby to receive breastmilk.
33. Blocked milk ducts and Mastitis
34. Symptoms of blocked duct and mastitis blocked duct milk stasis non-infective mastitis infective mastitis • Lump • Tender • Localised redness • No fever • Feels well • Hard area • Feels pain • Red area • Fever • Feels ill Progresses to 35 Symptoms of Blocked Duct and Mastitis
35. Causes of Blocked Duct and Mastitis • Poor drainage of part or all of the breast • Stress, overwork • Trauma to breasts • Cracked nipples Which is due to: • Infrequent breastfeeds • Ineffective suckling • Pressure from clothes • Pressure from fingers during feeds • Large breasts draining poorly • Reduces frequency and length of feeds • Damages breast tissue • Allows bacteria to enter
36. Management of Blocked Ducts, Mastitis Assessment • important part of treatment is to improve drainage of milk from affected part of breast —Observe a breastfeed —Notice if her breasts are very heavy —Ask about frequency of feeds —Ask about pressure from tight clothes 37
37. Management of Blocked Ducts, Mastitis • Explain to mother that she MUST Remove milk frequently • Continue breastfeeding frequently • Check that baby is well attached • Gently massage blocked or tender area down towards nipple before and during feeds. • Apply warm cloth to area before feed. • Check that her bra does not have a tight fit. 38
38. Management of Blocked Ducts, Mastitis Treatment • Explain to mother that she MUST: —Rest with baby so that baby can feed often —Drink plenty of fluids —Express milk if baby unwilling to feed frequently • Infrequent removal >>engorgement >>abscess 39 REST THE MOTHER, NOT THE BREASTS
39. Drug treatment for Mastitis • Anti-inflammatory treatment - Ibuprofen - Or mild analgesia Antibiotic therapy is indicated if: fever for 24 hours or more evidence of possible infection eg infected cracked nipple symptoms do not subside within 24 hours of frequent and effective feeding/milk expression condition worsens Course of 10 to 14 days to avoid relapse 40
40. Breast Abscess A collection of pus forms in part of breast. May result fr untreated mastitis painful swelling Needs surgical incision ( I&D ) and antibiotic Continue breastfeeding if incision far from areola and does not interfere BF mother tolerate pain otherwise express milk from affected side Continue BF from unaffected breast Good management of mastitis should be preventive 41
41. Candida infection Can make skin sore, shiny, red and itchy Often follow antibiotic use to treat mastitis/other infections May be due to/cause baby’s oral thrush Describe burning/stinging pain which continues after feed 42
42. Candida 12/8 ©UNICEFC107-34 AreolaNipple
43. Oral Candidiasis
44. Signs and treatment for thrush Signs Treatment • Skin looks red, shiny and flaky . Nipples and areola may lose pigmentation/ look normal /red • Nystatin cream 100,000 IU/g •Apply to mother’s lesions 4x/day, after breastfeed and continue till 7 days after lesion healed • Nipples remain sore between feeds for prolonged time despite correct attachment. •Nystatin suspension 100,000 1U/ml: • Apply 1 ml by dropper to child’s mouth 4x/day after breastfeed.
45. SUMMARY : Session 12 BREAST AND NIPPLE CONDITIONS Examination of mother's breasts and nipples Prevention and management of : engorgement and mastitis sore nipple How to assist a mother with breast or nipple condition
46. THANK YOU
47. Question 1 To avoid sore nipples, these statements are true except : A.Ensure correct positioning and latch on B.Check baby’s mouth for oral thrush C.Do not wash breast before every feed D.Limit breast feeding for only 5 minutes from each breast 48
48. Question 2 During routine anc check up, if a mother is found to have inverted nipple, recommended mx include the following: I.Tell the mother that she is unable to breast feed her baby after birth II.Reassure her that she is able to breast feed her baby after birth III.Teach the mother how to manipulate her nipple and breast to ensure she can breast feed effectively IV.Educate mother to take good care of her health and breast hygiene A.I, III and IV B.II and IV C.I and IV D.III only 49
49. Question 3 Management of mastitis include : I.Assessment of mother’s practice of BF II.Apply warm cloth to the area before a BF III.Stop BF IV. Apply antibiotic cream to the affected area A.All of above B.I and II C.III and IV D.I, II and III 50
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Перевести · The nipple is a raised region of tissue on the surface of the breast from which, in females, milk leaves the breast through the lactiferous ducts to feed an infant. The milk can flow through the nipple passively or it can be ejected by smooth muscle contractions that occur along the ductal system. The nipple is surrounded by the areola, which is often a darker color than the surrounding skin. A nipple is often called a teat when referring to non-humans. Nipple …
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