Session 20 Breast Conditions-final
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20/1
Breast conditions After completing this session participants will be able to recognize and manage these common breast conditions: flat and inverted nipples engorgement blocked duct and mastitis sore nipples and nipple fissure
Both the diagnosis and management of breast condition are important in order to relieve mothers and enable her to continue breastfeeding
This is for teaching purposes only. This cannot be published
20/2
Different Breast Shapes
There are different sizes of breast. This is mostly due to the amount of fat and not to the amount of tissues that produce milk The nipples and areolas also have different sizes and shapes. Sometimes shapes make it difficult for a baby to get well attached to the breast. Babies can breastfeed quite well from breast of any size, with almost any kind of nipple
Nipple looks flat
Testing protractility of the nipple
20/3
Points to Remember
The baby does not suck from the nipple. He takes the nipple and the breast tissue underlying the areola into his mouth to form a “teat”. Breast protractility is more important than the shape of the nipple “stretch the nipple to form a teat". This improves during pregnancy and in the first week or so after the baby is born.
20/4
Inverted nipple
20/4
Management of flat and inverted nipples
Antenatal treatment is not helpful Build the mother’s confidence Help the mother to position her baby If a baby cannot suckle effectively in the first week or two help his mother to feed with expressed milk
Page 117 of your participants manual
20/5
Syringe Method for the treatment of Inverted Nipple 1. 2.
Put the plunger to the cut end of the barrel Insert plunger from cut end
Put the smooth end of the syringe over her nipple Gently pull the plunger to maintain a steady but gentle pressure
Do this for 30 sec to one min several times a day Push the plunger back to decrease the suction ,if she feels pain and when removing it from the breast
20/6
Summary of Difference Between full and Engorged Breast Full breast
Engorged breast
Hot
Painful
Heavy
Edematous
Hard
Tight, shiny, looks red Milk flowing
Milk flowing No fever
May be fever for 24 hours
Reasons of Engorgement
Delay in starting breastfeeding Poor attachment to the breast so breast milk is not removed effectively Infrequent removal of milk –not on demand Restricting the length of breast feeds
Treatment of Breast Engorgement
Do not “rest” the breast If baby is able to suckle he should feed frequently If baby can not suckle help his mother to express her milk Before feeding or expressing stimulate the mothers oxytocin reflex (warm compress, massage, relax) After a feed put a cold compress Build the mother’s confidence
20/7
20/7
Red and swollen
fissure
20/8
Symptoms of blocked duct and mastitis blocked duct
milk stasis
• Lump • Tender • Localised redness • No fever • Feels well
non-infective mastitis
Progresses to
infective mastitis
• Hard area • Feels pain • Red area • Fever • Feels ill
Causes of blocked duct and mastitis Poor drainage of whole breast:
infrequent feeds short feeds
Poor drainage of part of breast: ineffective suckling pressure from clothes pressure from fingers during feeds
20/9
Treatment of blocked duct and mastitis
Most important – improve drainage of milk Look for cause and correct Suggest:
frequent feeds gentle massage towards nipple warm compresses Start feed on unaffected side; vary position
Antibiotics in severe symptoms, analgesics, rest
20/10
Treatment of blocked duct and mastitis
Start the feed on the unaffected breast Blocked duct or mastitis improves within a day when drainage to the part of the breast improves When severe symptoms or with fissure mother needs antibiotic treatment Management with HIV mothers are different. Mother must stop breastfeeding and do expression
Antibiotic Treatment for Infective Mastitis
The commonest bacterium found in breast abscess is Staphyloccous aureus
Drugs
Dose
Instructions
Flucloxacin
250 mgs orally 6hourly for 7-10 days
Take dose at least 30 min before food
Erythromycin
250-500mgs orally 6hourly for 7-10 days
Take dose two hors after food
20/11
20/11
GOOD OR BAD POSITIONING /ATTACHMENT?
FISSURE
Management of sore nipples The most common cause of sore nipples is poor attachment.
Mother should wash breast only once a day Medicated lotions and ointments are not advisable After breastfeeding, rub a little expressed milk over the nipple and areola
20/12
Candida infection of the breast Signs and symptoms: Skin is sore and itchy. Red ,shiny and flaky Burning or stingy sensation (needle prick) during feeds baby have oral thrush
Treatment of Candida of the Breast
Treatment of both mother and infant with Nystatin Nystatin cream 100,000 IU/g .Apply to nipple 4x daily for 7days after feeds Nystatin suspension 100,000 IU/ml. One ml 4x daily for 7 days after feeds or as long mothers are treated Stop using pacifiers, teats and nipple shields
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Breast conditions After completing this session participants will be able to recognize and manage these common breast conditions: flat and inverted nipples engorgement blocked duct and mastitis sore nipples and nipple fissure
Both the diagnosis and management of breast condition are important in order to relieve mothers and enable her to continue breastfeeding
This is for teaching purposes only. This cannot be published
20/2
Different Breast Shapes
There are different sizes of breast. This is mostly due to the amount of fat and not to the amount of tissues that produce milk The nipples and areolas also have different sizes and shapes. Sometimes shapes make it difficult for a baby to get well attached to the breast. Babies can breastfeed quite well from breast of any size, with almost any kind of nipple
Nipple looks flat
Testing protractility of the nipple
20/3
Points to Remember
The baby does not suck from the nipple. He takes the nipple and the breast tissue underlying the areola into his mouth to form a “teat”. Breast protractility is more important than the shape of the nipple “stretch the nipple to form a teat". This improves during pregnancy and in the first week or so after the baby is born.
20/4
Inverted nipple
20/4
Management of flat and inverted nipples
Antenatal treatment is not helpful Build the mother’s confidence Help the mother to position her baby If a baby cannot suckle effectively in the first week or two help his mother to feed with expressed milk
Page 117 of your participants manual
20/5
Syringe Method for the treatment of Inverted Nipple 1. 2.
Put the plunger to the cut end of the barrel Insert plunger from cut end
Put the smooth end of the syringe over her nipple Gently pull the plunger to maintain a steady but gentle pressure
Do this for 30 sec to one min several times a day Push the plunger back to decrease the suction ,if she feels pain and when removing it from the breast
20/6
Summary of Difference Between full and Engorged Breast Full breast
Engorged breast
Hot
Painful
Heavy
Edematous
Hard
Tight, shiny, looks red Milk flowing
Milk flowing No fever
May be fever for 24 hours
Reasons of Engorgement
Delay in starting breastfeeding Poor attachment to the breast so breast milk is not removed effectively Infrequent removal of milk –not on demand Restricting the length of breast feeds
Treatment of Breast Engorgement
Do not “rest” the breast If baby is able to suckle he should feed frequently If baby can not suckle help his mother to express her milk Before feeding or expressing stimulate the mothers oxytocin reflex (warm compress, massage, relax) After a feed put a cold compress Build the mother’s confidence
20/7
20/7
Red and swollen
fissure
20/8
Symptoms of blocked duct and mastitis blocked duct
milk stasis
• Lump • Tender • Localised redness • No fever • Feels well
non-infective mastitis
Progresses to
infective mastitis
• Hard area • Feels pain • Red area • Fever • Feels ill
Causes of blocked duct and mastitis Poor drainage of whole breast:
infrequent feeds short feeds
Poor drainage of part of breast: ineffective suckling pressure from clothes pressure from fingers during feeds
20/9
Treatment of blocked duct and mastitis
Most important – improve drainage of milk Look for cause and correct Suggest:
frequent feeds gentle massage towards nipple warm compresses Start feed on unaffected side; vary position
Antibiotics in severe symptoms, analgesics, rest
20/10
Treatment of blocked duct and mastitis
Start the feed on the unaffected breast Blocked duct or mastitis improves within a day when drainage to the part of the breast improves When severe symptoms or with fissure mother needs antibiotic treatment Management with HIV mothers are different. Mother must stop breastfeeding and do expression
Antibiotic Treatment for Infective Mastitis
The commonest bacterium found in breast abscess is Staphyloccous aureus
Drugs
Dose
Instructions
Flucloxacin
250 mgs orally 6hourly for 7-10 days
Take dose at least 30 min before food
Erythromycin
250-500mgs orally 6hourly for 7-10 days
Take dose two hors after food
20/11
20/11
GOOD OR BAD POSITIONING /ATTACHMENT?
FISSURE
Management of sore nipples The most common cause of sore nipples is poor attachment.
Mother should wash breast only once a day Medicated lotions and ointments are not advisable After breastfeeding, rub a little expressed milk over the nipple and areola
20/12
Candida infection of the breast Signs and symptoms: Skin is sore and itchy. Red ,shiny and flaky Burning or stingy sensation (needle prick) during feeds baby have oral thrush
Treatment of Candida of the Breast
Treatment of both mother and infant with Nystatin Nystatin cream 100,000 IU/g .Apply to nipple 4x daily for 7days after feeds Nystatin suspension 100,000 IU/ml. One ml 4x daily for 7 days after feeds or as long mothers are treated Stop using pacifiers, teats and nipple shields
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