Jayendra R Gohil, Prof. MD.
Retracted or inverted nipple is widely believed to cause breast feeding inadequacy. This type of nipple is caused by short ducts and fibrous bands pulling and binding or tethering the areola to subcutaneous tissue. A retracted nipple can be pulled back but inverted cannot be. An article in Indian Pediatrics mentioned retracted nipples, as an anomaly hindering breast feeding, and a novel treatment- sucking by husband is mentioned. A ‘syringing’ suction treatment has also been devised [J Human Lactation]. These treatments are offered before and after delivery.
Retracted or inverted nipple is widely believed to cause breast feeding inadequacy. This type of nipple is caused by short ducts and fibrous bands pulling and binding or tethering the areola to subcutaneous tissue. A retracted nipple can be pulled back but inverted cannot be. An article in Indian Pediatrics mentioned retracted nipples, as an anomaly hindering breast feeding, and a novel treatment- sucking by husband is mentioned. A ‘syringing’ suction treatment has also been devised [J Human Lactation]. These treatments are offered before and after delivery.
Breast feeding is made possible by holding the baby
to a proper ‘position’; resulting in good
latching & attachment, followed by coordinated
reflex actions by baby.
As per definition and as a fact a baby latches onto areola and not nipple. So a
small nipple or nipple retraction does not come in the way of a baby’s ability to latch onto areola to
breast-feed. However, if baby has small mouth (preterm)
or small mandible (micrognathia), and nipple is large(r) it may choke the baby.
This has been corroborated in IMNCI, WHO manual where no mention
is made to treat, care or even recognize flat, retracted or inverted nipples;
rather they have placed emphasis on Breast
engorgement and 'improper positioning’ as cause of breast-milk ‘not
coming’ or ‘baby not sucking’.
The ‘Navajat Shishu Suraksha Karyakram’ (NSSK- Hindi) from health department of India Government, Delhi and similar Basic Newborn Care and Resuscitation Program of Indian Academy of Pediatrics, Bombay mentions that flat or short nipple does not cause breastfeeding problems; however inverted nipple should be recognized and mother assisted antenatally.
The ‘Navajat Shishu Suraksha Karyakram’ (NSSK- Hindi) from health department of India Government, Delhi and similar Basic Newborn Care and Resuscitation Program of Indian Academy of Pediatrics, Bombay mentions that flat or short nipple does not cause breastfeeding problems; however inverted nipple should be recognized and mother assisted antenatally.
Proper counseling to mother after delivery
should be- ‘Do not worry about (small) size of nipples, baby anyway is going to take areola in mouth and
draw milk out from ducts behind nipples, with the help of proper positioning. Only nipple
sucking may cause sore nipples and breast feeding problem. Before delivery, treatment counselling may be advised with the reassurance that
her retracted nipples, even if
uncorrected by the time of delivery, shall not lead to any breast feeding
problems.
By telling mother (her nipple is defective), leads to anxiety; less
hormone (oxytocin) secretion and BF failure. So if a baby is not breastfeeding due to insufficient milk or due to some problem, then certainly the problem is not the retracted nipple, but it lies in most of the cases in 'incorrect position' or 'faulty beliefs or assumptions'.
A well conducted RCT in BMJ even recommends to abandon the practice of diagnosis of flat/retracted nipples, to avoid such anxiety.!!
A well conducted RCT in BMJ even recommends to abandon the practice of diagnosis of flat/retracted nipples, to avoid such anxiety.!!
