SESSION 12

Breast and Nipple

Conditions
SESSION OBJECTIVES

1. List the points to look for when examining a

mothers breasts and nipples;

2. Describe causes, prevention and

management of engorgement and mastitis;

3. Describe causes, prevention and

management of sore nipples;

4. Demonstrate through role-play assisting a

mother with breast or nipple conditions.
EXAMINATION OF MOTHERS BREAST AND NIPPLE

Ante-natal reassure that most breast

produce milk regardless of shape and
size.
After delivery examine only if mother
has pain/ difficulty.
Observe privacy / make her comfortable
Ask permission to expose breast / No
touch.
Highlight positive signs / Build confidence.
SIZE AND SHAPE 12/1

There are
many different
shapes and sizes
of breast and
nipple.
Babies can
breastfeed from
almost all of
them.
Breastfeeding Counselling: a training course,
WHO/CHD/93.4, UNICEF/NUT/93.2
NIPPLE SIZE AND SHAPE

Nipples change shape

increases Protractility
*Inverted Nipples
*Long or big nipple

Babies attach to breast, not to

nipple.
 12/7

SYRINGE METHOD
FOR INVERTED
NIPPLES

Breastfeeding Counselling: a training course,

WHO/ CHD/ 93.4, UNICEF/ NUT/ 93.2
 UNICEF C-107-19
Full Breast

What do you see ? Normal breast changes ?

Slide 12/3
ENGORGEMENT

Causes :
Feedback Inhibitor of
lactation activated
-Delayed initiation

-Poor attachment
reduce
-Infrequent feeding
milk production
PRACTICES TO AVOID ENGORGEMENT

Step 4 - Skin to skin, initiate BF within

1 hr
Step 5 Offer help early show how to
express milk
Step 7 - Keep together 24 hrs a day
Step 8 - Breastfeed on demand
Step 9 - No pacifiers, teats
WHY HELP RELIEVE ENGORGEMENT ?

Relievediscomfort
Prevent further complications

Ensure continuous milk

production
Enable baby to receive
breastmilk
HOW TO RELIEVE ENGORGEMENT

Check attachment
Express between feeds

Encourage frequent feeds

Apply warm compress

Massage

Help mother to be comfortable

Provide supportive atmosphere

Cold compress
BLOCKED DUCT & MASTITIS

Milk remains in a Causes :

part of the breast
Infrequent feedings
Non-infective mastitis Inadequate removal

Infective mastitis Local pressure

 12/4

UNICEF C107-39
TREATMENT OF MASTITIS

Frequent emptying of breast

Check attachment
Offer affected breast first
Help milk to flow
Gentle massage
Warm compress
check clothing
Rest with baby
DRUG TREATMENT FOR MASTITIS

Anti-inflamatory
Ibuprofen(Mild analgesic)
Antibiotic
if indicated, 10-14 days
Generally oral antibiotic (erythromycin,
flucloxacillin, dicloxacillin, amoxacillin,
cephalexin.)
 MASTITIS IN THE WOMAN WHO IS
HIV-POSITIVE
o Increase the risk of transmission
-Give antibiotics
o Discontinue breastfeeding on the affected
breast
o Express milk from affected breast
effectively
o Breastfeed from unaffected side
-AFASS
SORE 12/6

NIPPLE
12/5

UNICEF C107-31
 CANDIDA ON THE NIPPLE
12/8

UNICEF C107- 33
UNICEF C107-34
 TONGUE-TIE
12/10

UNICEF C107-35
OBSERVE A FEED

-Check how baby goes to breast

-How BF ends
-What nipple looks like after a feed
-Check mouth
-Check breast pump (if used)
-Decide the cause of sore nipple
MANAGEMENT OF SORE NIPPLE

Reassurance

Treat cause/s :
- Improve attachment & positioning

-Treat source of irritation Candida?

Short Frenulum ?
Comfort measure
WHAT DOES NOT HELP SORE NIPPLE?

DO NOT stop breastfeeding

DO NOT limit breastfeeding
DO NOT apply any substance
DO NOT use nipple shield