# Situation: A 22-year-old primipara gave birth vaginally to a healthy term newborn at a lying-in clinic, and her episiotomy was repaired. She plans to breastfeed exclusively, and the nurse follows her through the first days after birth. On day 2, the nurse observes a breastfeed. Which observation BEST shows that the baby is attached well to the breast?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629484  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 22-year-old primipara gave birth vaginally to a healthy term newborn at a lying-in clinic, and her episiotomy was repaired. She plans to breastfeed exclusively, and the nurse follows her through the first days after birth.

On day 2, the nurse observes a breastfeed. Which observation BEST shows that the baby is attached well to the breast?

## 보기

1. More areola shows above the mouth than below it **✔ 정답**
2. The cheeks draw inward with each suck
3. The lips are pushed forward around the nipple base
4. Quick, shallow sucks continue steadily through the feed

**정답: 1**

## 해설

In good attachment the baby takes a large mouthful of breast from below the nipple, so more areola is visible above the upper lip than below the lower lip, with the mouth wide open, the lower lip turned out, and the chin touching the breast. Hollowed cheeks, pursed lips, and continuous rapid shallow sucking suggest that the baby is sucking on the nipple only.

## 심화 해설

Understanding good attachment

On day 2 after a vaginal birth, the nurse watches how the newborn takes the breast. The question is not about milk volume or maternal pain, but about the mechanics of latch. In a well-attached baby, the mouth opens wide and the infant grasps a large portion of the breast from below the nipple, not just the nipple tip. This is why more areola is visible above the upper lip than below the lower lip—the lower jaw is positioned further back on the areola, and the chin rests against the breast .

Key point! The visual asymmetry of areola above versus below the mouth is a direct marker of how deep the breast tissue is drawn into the infant’s mouth. A shallow latch, by contrast, leaves the lips near the nipple base and produces equal or reversed areola visibility.

Why the other options indicate poor attachment

Cheeks drawing inward with each suck means the infant is using negative pressure around the nipple rather than compressing the lactiferous sinuses with the tongue and lower jaw. This hollowing is a classic sign of nipple-only sucking . Similarly, lips pushed forward around the nipple base describe pursed or rolled-in lips, not the everted lower lip seen in a deep latch . Quick, shallow sucks that continue steadily suggest the infant is not getting effective milk transfer; in good attachment, sucking starts rapid to stimulate letdown, then shifts to slower, deeper, rhythmic sucks with audible swallowing .

| Observation | What it indicates | Attachment quality |
| --- | --- | --- |
| More areola above mouth than below | Deep grasp of breast from below; lower jaw on areola; chin touches breast | Good |
| Cheeks draw inward | Nipple-only sucking; negative pressure around nipple | Poor |
| Lips pushed forward around nipple base | Pursed lips; lower lip not everted | Poor |
| Quick, shallow sucks throughout feed | No transition to deep rhythmic sucking; ineffective milk transfer | Poor |

Clinical reasoning for the licensure exam

The nurse’s role includes assessing latch quality as part of breastfeeding support, especially in the first days when nipple trauma and poor milk removal can derail exclusive breastfeeding . Anatomic variations such as a tight upper lip frenulum or ankyloglossia can alter latch mechanics, but the observation described in the correct answer reflects the functional outcome—the infant’s ability to take breast tissue deeply and asymmetrically—rather than a specific anatomic diagnosis . When the nurse sees more areola above the mouth, the lower lip is typically everted and the mouth is wide open, which supports effective milk extraction and reduces maternal nipple pain .

Watch out! Do not confuse “lips pushed forward” with a normal wide-open mouth. In a correct latch, the lips are flanged outward, especially the lower lip, and the angle of the mouth is wide—not pursed or protruding around the nipple.

## 임상 시나리오

Assessing Breastfeeding LatchDay 2 Postpartum Observation Guide
In good attachment, the infant grasps breast tissue from below the nipple, so more areola is visible above the upper lip than below the lower lip.

Confirm the chin touches the breast, the mouth is wide open, and the lower lip is everted. Sucking should shift from rapid to slow, deep, rhythmic with audible swallowing.

CautionHollowed cheeks, pursed lips, or continuous rapid shallow sucks indicate nipple-only sucking and require latch correction before feeding continues.

## 핵심 개념

- **Good attachment** — Infant takes a large mouthful of breast from below the nipple, with wide-open mouth, lower lip everted, and chin touching the breast.
- **Areola asymmetry** — More areola visible above the upper lip than below the lower lip indicates deep latch and correct positioning of the lower jaw.
- **Nipple-only sucking** — Shallow latch where the infant sucks on the nipple tip, causing hollowed cheeks, pursed lips, and poor milk transfer.
- **Lactiferous sinuses** — Dilated milk reservoirs beneath the areola that are compressed by the infant's tongue and lower jaw during effective feeding.
- **Letdown reflex** — Milk ejection triggered by initial rapid sucking; feeding then transitions to slower, deeper sucks with audible swallowing.

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