module 15 common breastfeeding problems

Question 1

Inverted nipples

Answer 1

more difficult for the infant to latch on in the early days because it is harder to pull the nipple into the mouth.
- as feeding continues the nipple elongates and with time the problem becomes less severe.

Question 2

management of inverted nipples

Answer 2

• wear breast shells between feedings
• manually pull or roll the nipple before latch
• use a breast pump for 1-2 min before latch
• put a cold cloth or ice on the nipple before latch
• use a nipple shield to cover nipple to provide a rigid teat that may help the baby latch
• avoid pacifiers and bottles before baby is 4-6wks old
• if supplementation is needed use a syringe, dropper, or feeding tube

Question 3

Causes of sore nipples

Answer 3

• improper latch and positioning at the breast
• prolonged negative pressure
• inappropriate suction release
• use of or sensitivity to nipple creams and oils
• incorrect use of supplies: pumps, shells, shields.
• thrush
• leaking nipples that are not properly air-dried

Question 4

Management of sore nipples

Answer 4

Prevention:
- early assessment of feeding and latching
- supporting mother in various positions
- education about feeding supplies
Management:
- seek help early
- rub a few drops of colostrum or milk onto the nipple and areola
- expose the nipples to air several times a day
- use breast shells to prevent the bra or clothing from rubbing
- nurse from the least sore breast first
- short frequent feedings
- nipple shield during feeds to let breast heal
- pump the affected breast if pain is too severe

Question 5

Clinical findings of sore nipples

Answer 5

tender
bruised
raw
cracked
bleeding
blistered
discolored
swollen
traumatized

Question 6

Engorgement

Answer 6

bilateral intense fullness, soreness, and swelling of the breast, beyond the normal fullness
- r/t milk stasis in the breast from inadequate emptying

Question 7

engorgement clinical findings

Answer 7

• painful, hard, lumpy, swollen breasts
• breasts usually warm to the touch
• nipples flattened by the swelling

Question 8

Engorgement management

Answer 8

• take a hot shower/let warm water run over the breasts
• warm compresses 5-10 minutes before feeding
• gently massage the entire breast or use an electric pump with intermittent suction to empty excess milk
• manually express bilk before feeding to soften the areola and make latch easier

Question 9

Mastitis

Answer 9

infection of the breast that can occur at any time during lactation, including pregnancy
- most common cause: staphylococcus aureus
Pre-disposing factors:
- stress, fatigue
- cracked nipples, plugged ducts
- constricting bra
- inadequate emptying of breast
- sudden weaning or dec. number of feedings

Question 10

Mastitis clinical findings

Answer 10

malaise
breast tenderness or pain
reddened, warm lump in any quadrant
- sometimes with red streaking
flu-like s/s
- fever
- chills
- body aches

Question 11

Management of mastitis

Answer 11

empty the breast 
- milk not infected, freq. feedings should still happen 
inc. fluids
analgesics
antibiotics
rest
warm showers/compresses

Question 12

Breast milk jaundice

Answer 12

elevated serum indirect bili

• peak level after 1st week of life
• no other signs of liver abnormality

Question 13

breast milk jaundice clinical findings

Answer 13

healthy and thriving infant
adequate stooling and voiding
appropriate wt gain
inc. bili levels between day 7 and 10 
peaks approx. day 10-15 
persistence up to 3rd month of life

Question 14

Breast milk jaundice managment

Answer 14

continue breastfeeding unless clinical signs of pathologic jaundice occur

Question 15

oral candidiasis

Answer 15

when found on infant or mothers breast both mom and baby need to be treated

Question 16

Poor wt gain newborn period

Answer 16

initiation of breastfeeding may not proceed normally

- infant continues to lose weight or gain wt very slowly

Question 17

poor wt gain after newborn period

Answer 17

infants gain wt more slowly than expected

Question 18

Contributing factors of poor wt gain

Answer 18

Maternal: 
- infrequent or inadequate feedings 
- inadequate milk supply 
Genetic predisposition
Infection
Organic disease
Physical anomaly that prevents good suck/swallow

Question 19

Clinical findings with infant and poor wt gain

Answer 19

• continued wt loss after 5-7 days
• failure to regain birth weight by 2-3 weeks
• failure to maintain ongoing wt gain of 0.5-1oz/day
• wt below 3%
• lethargic, sleepy, inactive, unresponsive
• sleeping longer than 4 hours between feeds
• dry mucous membranes

Question 20

Clinical factors of technique with poor wt gain

Answer 20

• ineffective latch or sucking
• short time at the breast
• infant kept on a preset schedule despite hunger cues
• infant given water between feeds to “get through”
• allowed to sleep through the night before 8-12 weeks old
• fewer than 8 feeds in 24 hours
• fed in a distracting environment
• infant in daycare that does not facilitate breastfeeding

Question 21

Clinical factors r/t maternal factors for poor wt gain

Answer 21

• does not respond to infants feeding cues
• hectic schedule
• recent illness
• significant wt loss
• oral contraceptives or other hormones that dec. production of breast milk

Question 22

obstructed lactiferous duct

Answer 22

clogged milk duct
- hard lump with pain that is worse with feeding
Inadequate milk removal

Question 23

Clogged duct management

Answer 23

heat and massage before feed
loose fitting cloths
cold application after feed

Question 24

physiologic jaundice (neonatal)

Answer 24

day 3-5 of life
infrequent feedings
Risk factors
- blood group incompatibility
- cephalohematoma
- gestational age < 37 
- excessive wt. gain
- difficulty establishing breast feeding 
- East Asian or Native
- maternal illness
- GDM 
- previous pregnancy with high bili

Question 25

pathologic jaundice

Answer 25

occurs too early, lasts too long, involves bili levels that are too high - rapid rising levels - require phototherapy to prevent kernicterus - - bili moves from bloodstream into brain tissue