Breastfeeding

Question 1

For how long should infants be exclusively breastfed?

Answer 1

First 6 months of life, continuing up to 2 years of age or beyond

Question 2

List some factors that are causing worldwide decline in breastfeeding

Answer 2

Marketing of formula substitutes
Lack of education
Cultural/social influences
Difficulties (pain)

Question 3

What is the likely aetiology behind “milk insufficiency” in breastfeeding?

Answer 3

Ineffective attachment

Infrequent feeding

Question 4

What are the consequences of ineffective attachment while breastfeeding?

Answer 4

Pain, damage, cracks
Engorgement/stasis of milk
Baby unsatisfied, frustrated, refuses
Baby fails to gain weight
Milk production decreases

Question 5

How can nipple cracks/sores be managed?

Answer 5

Observe/demonstrate positioning and attachment techniques
Creams, sprays
Nipple shields

Question 6

What is engorgement?

Answer 6

Breast fullness with oedema and milk flattening/poor flow

Question 7

How can engorgement be managed?

Answer 7

Expression prior to feed
Warm compresses
Ensure good attachment

Question 8

List the clinical features of mastitis

Answer 8

Tenderness
Sore lump (blocked duct)
Red streaks/pus in milk
Typically post-partum

Question 9

How can mastitis be managed?

Answer 9

Continue breastfeeding
Frequent feed on affected side
Manual expression
Anti-inflammatory medication
Antibiotic if unresolved

Question 10

Which antibiotics are ok to use for mastitis?

Answer 10

Flucloxacillin

Clindamycin if pen-allergic

Question 11

Which organism causes breast thrush?

Answer 11

Candida albicans

Question 12

List the clinical features of breast thrush

Answer 12

Pain in both breasts
Pain after every feed
No change in nipple shape/colour
Oral swab +ve for Candida

Question 13

How can breast thrush be managed?

Answer 13

Boil teats
Continue feeding
Miconazole cream if superficial
Fluconazole cream if deep