Breastfeeding - Common problems, Drugs

Question 1

Common breastfeeding problems

Answer 1

Nipple pain - poor latch
Blocked duct => pain
-continue breastfeeding, adjust positioning of baby, breast massage
Nipple candida - miconazole cream for mother and nystatin suspension for baby

Question 2

Mastitis
-presentation
-management

Answer 2

Red, hot, swollen, painful breast
Can be systemically unwell

Continue breastfeeding
If no improvement in 12-24hrs OR systemically unwell OR nipple fissure OR cultures suggest infection => fluclox 10-14days (erythromycin/clari if pen allergic)

If no improvement => surgical referral to drain abscess

Question 3

Engorgement
-what is it
-presentation
-management

Answer 3

Swelling, tightness, redness from large volume of milk
-first few days after birth
-bilateral
Results in difficulty attaching

Hand expression of milk can relieve discomfort

Question 4

Concerns about poor infant weight gain
-what is normal
-what is not

Answer 4

Up to 10% of birth weight lost but regained within 1st 2wks

If weight loss more than 10% => refer to midwife led breastfeeding clinic and monitoring of weight until gain is satisfactory

Question 5

Contraindications to breastfeeding
-medical conditions

Answer 5

Galactosemia => infant cannot break down galactose, which builds up in organs

Viral infections

Question 6

Contraindications to breastfeeding
-drugs

Answer 6

ABx - cipro, tetracycline, chloramphenicol, sulphonamides

Psych - Lithium, BZ, clozapine

Cardio - Aspirin, amiodarone

Endo - Carbimazole, sulphonylureas

AI, cancer - Methotrexate, cytotoxics

Question 7

Drugs safe in breastfeeding

Answer 7

ABx - penicillins, cephalosporins, trimethoprim

Endocrine - GC, levothyroxine

AEDs - Valproate, carbemazepine

Resp - Salbutamol, theophyllines

Psych - TCAs, antipsychotics

Cardio - Bb, hydralazine, warfarin, heparin, digoxin