breastfeeding

Question 1

major breastfeeding contraindications

Answer 1

drugs

galactosaemia

viral infections

Question 2

drugs that can be used in breastfeeding

Answer 2

• antibiotics: penicillins, cephalosporins, trimethoprim
• endocrine: glucocorticoids (avoid high doses), levothyroxine*
• epilepsy: sodium valproate, carbamazepine
• asthma: salbutamol, theophyllines
• psychiatric drugs: tricyclic antidepressants, antipsychotics**
• hypertension: beta-blockers, hydralazine
• anticoagulants: warfarin, heparin
• digoxin

Question 3

drugs that should be avoided in breastfeeding

Answer 3

• antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
• psychiatric drugs: lithium, benzodiazepines
• aspirin
• carbimazole
• methotrexate
• sulfonylureas
• cytotoxic drugs
• amiodarone

Question 4

why is aspirin contraindicated in breastfeeding

Answer 4

ass w reye’s syndrome - cause liver and brain damage.

Question 5

minor problems in breastfeeding

Answer 5

• frequent feeding in a breastfed infant is not alone a sign of low milk supply
• nipple pain: may be caused by a poor latch
• blocked duct (‘milk bleb’): causes nipple pain when breastfeeding. Breastfeeding should continue. Advice should be sought regarding the positioning of the baby. Breast massage may also be tried
• nipple candidiasis: treatment for nipple candidiasis whilst breastfeeding should involve miconazole cream for the mother and nystatin suspension for the baby

Question 6

first line Mx of mastitis

Answer 6

continue breastfeeding and use simple analgesia and warm compresses.

Question 7

when are oral ABx indicated for mastitis

Answer 7

infected nipple fissure

symptoms not improving after 12-24 hours despite effective milk removal

and/or breast milk culture positive.

Question 8

what will be prescribed in mastitis

Answer 8

flucloxacillin for 10-14 days or erythromycin or clarithromycin if penicillin allergic.

Question 9

when will mastitis be referred to hospital

Answer 9

if mastitis is left untreated it may become an abscess

This patient has no palpable lump therefore an abscess is unlikely.

Question 10

what is engorgement

Answer 10

breast pain - affects both mostly

first few days after the infant is born

pain or discomfort is typically worse just before a feed.

ot flow well from an engorged breast and the infant may find it difficult to attach and suckle.

fever - settle within 24 hours

red

Question 11

complications of engorgement

Answer 11

blocked milk ducts
mastitis
difficulties with breastfeeding
milk supply

Question 12

what is raynauds disease of the nipple

Answer 12

pain intermittent and present during and immediately after feeding.

Blanching of the nipple may be followed by cyanosis and/or erythema.

Nipple pain resolves when nipples return to normal colour.

Question 13

options of treatment for raynaud’s disease of the nipple

Answer 13

• minimising exposure to cold
• use of heat packs following a breastfeed
• avoiding caffeine
• stopping smoking.

If symptoms persist consider specialist referral for a trial of oral nifedipine (off-license).