Inverted nipples, sore nipples, and breast engorgement
THE CONTEXT
Breastfeeding difficulties may arise from nipple anatomy, incorrect attachment, or inadequate milk removal. The passage distinguishes these problems and describes relevant care.
Inverted nipples
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Flat or small nipples that become prominent when pulled out do not cause breastfeeding difficulty. Genuinely inverted or retracted nipples can impair latching.
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Incomplete attachment causes the neonate to suck on the nipple and may produce soreness.
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Treatment includes pulling the nipple out and rolling it between the finger and thumb several times daily. A cut plastic syringe is an alternative.
Sore nipples
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Incorrect attachment makes the neonate suck on the nipple rather than the nipple and areola. Difficulty obtaining milk can lead to vigorous sucking and biting, worsening soreness.
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Frequent washing with soap and pulling the baby off the breast while still sucking can also cause soreness.
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Correct positioning and latching are the primary treatment. In most cases, breastfeeding can continue with correct attachment.
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Hindmilk may be applied after feeding, and the nipple should be kept dry between feeds. Routine cleaning during bathing is sufficient; frequent washing, creams, and ointments are discouraged.
Engorgement versus fullness
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Milk production accelerates from the second to the third day after delivery. Delayed or infrequent feeding and ineffective feeding from poor positioning or attachment can cause engorgement.
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Engorged breasts are hard, warm, and tender with shiny skin.
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Full breasts are heavy but are not warm, hard, or tender. They require no specific treatment.