Breastfeeding

Question 1

Management of mastitis

Answer 1

• Continue breastfeeding
• PO Abx
  
  • Flucloxacillin/Dicloxacillin 500mg PO QID x 5 days or Cephalexin 500mg PO QID x 5 days if delayed nonsevere penicillin allergy.
  • Clindamycin 450mg PO TDS x 5-10 days if immediate non-severe or delayed severe penicillin allergy
  • If longer response, take for 10 days.
• Feed from affected side first.
• Massage affected area
• Analgesia - Paracetamol 1g PO QID PRN Max 4g per 24hours
• Apply cold packs to affected area for 10minutes on after each breastfeed.
• Review efficacy of treatment within 48 hours
• Refer to lactation consultant.

Question 2

Signs of low breast milk supply

Answer 2

• < 3 wet nappies/24 hours after 72 hours of age
• < 5 wet nappies/24 hours after day 5
• concentrated urine
• Weight loss > 10% birth weight and further weight loss after 96 hours.
• Failure to regain birthweight within 14 days
• < 20g weight gain per 24 hours after day 4
• Prolonged or continuous feeding with little evidence of satiety or milk transfer during feeds
• Excessive crying or weak cry.

Question 3

Practical points to increase milk supply

Answer 3

• Hold baby skin to skin at the breast
• Breastfeed Q2H-Q3Hourly
• Make sure attachment is good and baby is both sucking and swallowing.
• Switch feed (offer each breast twice)
• Compress or massage breasts during breastfeed to assist with milk flow and drainage
• If baby not feeding well, cut short feed and express each breast twice
• Domperidone 10mg PO TDS

Question 4

Pharmacological management of suppression of breastmilk production

Answer 4

Cabergoline 1mg PO Stat dose
Most effective if given within 12 hours of birth
Contraindications - Pre-ecclampsia, Hyper
Precaution - Metoclopramide, prochlorperazine and promethazine inhibit effect of cabergoline. Take at cabergoline at least 4 hours after use of any of these drugs.

Question 5

Management of Nipple Thrush

Answer 5

Mother: Fluconazole 150mg PO every 2nd day for 3 doses
Follow with Nystatin 2 * 500,000 Tablets TDS
and Miconazole oral gel to nipple QID

Baby: Miconazole oral gel four times a day
Review in 1 week.

Clean dummy daily with boiled water

Sanitize hands regularly

Change nipple pads regularly

Keep nipples dry

Question 6

Management of lactose intolerance

Answer 6

• Refer to lactation consultant to improve breast feeding technique
• Consider block feeding (Same breast for all feeds over 3 hours (Down-regulate milk production to receive more cream-based breastmilk at end of a feed)
• Acknowledge impact of crying on parental mental health
• Arrange follow up in 1 week.
• Refer to community resources such as early childhood nursing centres and parental groups.