Fig. 108.—Examples of imperfect nipples. (American Text Book.)
The child must not be left at the breast after he has nursed, but the nipple should be gently removed from the child’s mouth by passing one finger in beside the nipple. Fissures and abrasions usually occur within ten days if at all. Abrasions or erosions are due to the wearing away of the epithelial covering of the nipple in patches more or less extensive.
Thin-skinned blonde women suffer more than those with dark, dense oily skins.
A fissure is a distinct separation of tissue that goes deeply into the underlying substance.
A crack is a long abrasion which may deepen into a fissure.
Both fissure and crack may affect the top, the side of the apex, or the base of the nipple. They may be either longitudinal or circular. The entire nipple must be kept under observation and the instant a raw surface is detected, treatment must begin.
Fig. 109.—A standard nipple shield. (American Text Book.)
Compound tincture of benzoin, liberally applied, is a favorite and successful remedy. Our routine is to apply a paste made of equal parts of castor oil and subnitrate of bismuth. This is put on after the child nurses, and must be removed carefully before the next nursing. Sometimes the child’s stools become black and constipated and the trouble may be traced to imperfect removal of the bismuth preparation.
Whatever medication is used, the nipple must be protected from injurious friction by the clothing. This is best done by the hat-shaped lead nipple shield, which is placed over the nipple and held in place by a light binder. The shield should be boiled before use.