3.2 Nutrition - breastfeeding part 4

Question 1

Why is the pinch test helpful for flat or inverted nipples

Answer 1

determines what happens to the nipple during breastfeeding

Question 2

Is it necessary to do a pinch test on nipples that look flat or inverted

Answer 2

yes because nipples can look inverted but you need to know what will happen during breastfeeding

Question 3

If the nipple pulls in on the pinch test what does that indicate

Answer 3

it is inverted

Question 4

If then nipple does not pull in, or everts with compression what does that mean

Answer 4

it is a flat nipple, not inverted

Question 5

Can you breastfeed with inverted or flat nipples

Answer 5

yes, it can be more difficult but possible

Inverted nipples can make it more difficult for the infant to
latch on in the early days because it is harder to pull the nipple into
the mouth for suckling. As the baby continues to breastfeed, the
nipple tissue elongates; with time, the problem usually becomes
less severe, and successful breastfeeding is possible. Flat nipples do
not generally change over time; rather, the infant develops a style
to more easily latch on successfully. Adhesions cause retraction or
inversion of the nipples. Flat nipples are often found in women
with larger, pendulous breasts.

Question 6

What can be done prenatally to help with inverted nipples

Answer 6

breast shells are worn which applies gentle sucture to stretch nipple tissue in last trimester

Question 7

Which breastfeeding hold is best for flat or inverted nipples

Answer 7

football hold- have mother lean slightly forward as she latches the baby

Question 8

Tips for breastfeeding with flat or inverted nipples:

• wear _________inbetween feedings
• manually _____________________immediately before latch
• use a _____for 1-2 mins before latching baby
• put a ____on the nipple for a few seconds before latching
• use a _____to cover the nipple to privide a rigid teat to help infant latch

Answer 8

• wear breast shells inbetween feedings
• manually pull or roll nipples immediately before latch
• use a breast pump for 1-2 mins before latching baby
• put a cold cloth or ice cube on the nipple for a few seconds before latching
• use a nipple shield to cover the nipple to privide a rigid teat to help infant latch

Question 9

What do flat or inverted nipples increase the risk of

3

Answer 9

• engorgement
• plugged ducts
• mastitis

related to breastfeeding difficulties

Question 10

What are common causes of sore nipples

4

Answer 10

• poor latch
• yeast infection
• mastitis/abscess
• milk plugs at nipple pores

Question 11

Management strategies for sore nipples:

• improve ___
• rub nipple with ____ after feeding and let air dry
• expose nipples to ____ for short periods several times daily
• use ____to stop clothing from rubbing on nipples
• use ___ when feeding

Answer 11

• improve latch
• rub nipple with colostrum after feeding and let air dry
• expose nipples to **air **for short periods several times daily
• use breast shells to stop clothing from rubbing on nipples
• use nipple shield when feeding

use mild analgesic as needed

Question 13

When dealing with sore nipples in which order should a women breastfeed off of each breast

Answer 13

least sore side first
use frequent short feedings

Question 14

What is severe engorgement

Answer 14

bilateral extreme fullness, soreness, swelling of breasts

Question 15

What causes engorement

Answer 15

milk statis from inadequate emptying

Question 16

On exam what findings indicate engorgement besides pain

3

Answer 16

• painful, lumpy, hard swollen breasts
• warm breasts
• nipples flattened by swelling

Question 17

What is a differential to be aware of for severe engorgement

Answer 17

bilateral mastitis

Question 18

What are management strategies for severe engorgement

3

Answer 18

• avoid long stretches between feedings
• warm breasts with wet heat wraps or running water from shower/sink for 5-10 mins before feeding
• massage breast after wet heat and express milk

Question 19

What is mastitis

Answer 19

infection of breast

Question 20

What is the typical causative agent in mastitis

Answer 20

staph aureus

Question 21

What are risk factors for mastitis

5

Answer 21

• stress
• cracked nipples, plugged ducts
• constricting bra
• inadequate emptying
• sudden weaning

Question 22

What are common clinical findings in mastitis

4

Answer 22

• malasie
• breast pain
• red, warm lump or streaking
• flulike symptoms

Question 23

flulike symptoms in a breastfeeding woman is considered to be
___ unless proven otherwise

Answer 23

mastitis

Question 24

What are common differentals for mastitis

3

Answer 24

plugged ducts
severe engorgement
abscess

Question 25

What is important to consider if mastitis treatment doesn’t resolve symptoms

Answer 25

imflammatory breast cancer

Question 26

How can you prevent mastitis

4

Answer 26

• frequent feedings
• tend to cracked or sore nipples right away
• treat plugged ducts
• Oral Lactobacillus salivarius PS2 probiotics in late pregnancy can prevent mastitis

Question 27

How do you treat plugged ducts or blocked nipple pores to prevent mastitis

3

Answer 27

• warm compress
• massage
• lecithin supplementation
• (reducing milk viscosity)

Question 28

Can you breast feed with mastitis

Answer 28

yes- even out of infected side

the milk is not infected so it is safe to give

Question 29

How are you treat mastitis?

3

Answer 29

• empty breast- continue to feed or pump until breast is emptied at every feed
• increase fluids
• analgestics PRN

Question 30

Are abx required right away for mastitis

Answer 30

no- conservative tx first

Question 31

When do you use abx for mastitis

Answer 31

if conservative tx fails after 12-24 hours of trying

Question 32

What is given for mastitis abx and for how long

Answer 32

dicloxacillin, cephalexin, clindamycin 10-14 days

Mastitis that is not respon-
sive to empiric antibiotic use should be evaluated for possible MRSA and treated appropriately

Question 33

What are two complications of mastitis

Answer 33

abscess and sepsis