Breastfeeding Problems Flashcards

1
Q

What is breast engorgement?

A

whole breast swollen + oedematous, may be shiny, diffusely erythematous + may leak excessively.

Pain in first few days after birth, often bilateral + worse before a feed.

Infant attachment may be difficult due to breast fullness + milk flow may be reduced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do blocked ducts present?

A

Localized, tender cord of tissue in one breast (a few centimetres in diameter), which may be relieved by expression of milk
Overlying skin may be erythematous.
A small white spot (bleb) ~1 mm in diameter may be present at the end of the nipple.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What may a galactocele result from and how does this present?

A

Result from blocked duct
Smooth, round, painless breast swelling which causes milky nipple discharge when pressed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the management for blocked ducts?

A

Feed from affected breast frequently

Use heat packs/ warm shower for symptom relief
Wear a well-fitting bra + non restrictive clothing
Gentle massage of the breast while baby is feeding, to help relieve the obstruction.
If there is a bleb on the nipple tip, bathe then rub the area with a warm, damp towel.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the management for engorgement?

A

Feed baby with no restrictions on frequency/ length of feeds.
Paracetamol
Breast massage after feeds
Minimal expressing of milk (excessive expression of milk may induce oversupply).
Hand expressing a little milk to soften the areola prior to feeding may help if baby is struggling to latch on due to engorgement.

Heat packs/ warm shower before feeding or expressing milk can stimulate milk let-down
Use of cold packs after feeding or expressing, to relieve pain + oedema.
Wear a well-fitting bra + non restrictive clothing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is management for a galactocele?

A

Continue breastfeeding.
Discuss with a breast specialist investigations to confirm dx + tx options if needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give 3 symptoms/ signs of a ductal infection

A

Deep burning, aching, shooting pain during + between feeds
Erythematous, flaky or shiny skin of the nipple, or a nipple fissure.
Crust/ Purulent exudate suggests bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give 3 symptoms/ signs of mastitis

A

Fever + systemically unwell
Hard painful swelling in a wedge-shaped distribution in 1 breast
Erythema of the overlying skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give 4 symptoms/ signs of a breast abscess

A

Fever + systemic Sx
Worsening painful breast lump, which may be fluctuant
Overlying skin erythematous + warm.
Hx of recent mastitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give 4 symptoms/ signs of Raynaud’s disease of the nipple

A

Intermittent nipple pain (shooting, throbbing/ burning)
Present during + immediately after breastfeeds, + in between feeds if exposed to cold temperatures.
Blanching of the nipple may be followed by cyanosis +/- erythema.
Pain resolves when nipple returns to its normal colour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is management for Raynaud’s disease of the nipple?

A

Avoid exposure to cold
Wear warm clothing
Breastfeed in a warm environment
Use heat packs/ warm shower following a breastfeed or when there is breast pain.
Avoid caffeine + stop smoking which can cause vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give 3 symptoms/ signs of bacterial nipple infection

A

purulent nipple discharge
Crusting, redness + fissuring
A/w skin trauma such as persistent cracks + fissures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give 6 symptoms/ signs of candidal nipple infection

A

Bilateral burning nipple pain
Itching
Hypersensitivity of the nipple, esp. during + soon after feeds.
Red, shiny, swollen, or fissured nipple
Pain does not resolve despite improved positioning + attachment
Clinical signs of candida infection may be present in baby’s mouth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the management of mild localised bacterial infection of the nipple?

A

Topical Fusidic acid
Avoid breastfeeding during Tx
Express milk to avoid engorgement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the management of candidal infection of the nipple?

A

Miconazole cream for mother
Nystatin suspension for baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the management for mastitis?

A

Flucloxacillin 500mg 10-14 days
Continue breastfeeding
Seek advice if not settling within 48h

17
Q

What is the management for breast abscess?

A

Urgent referral to surgeon
Confirmation of dx with USS
Incision + drainage
Culture drained fluid to guided abx choice

18
Q

What may prompt consideration of breastfeeding problems? What investigations are done?

A

Breastfed babies losing > ‘cut-off’ 10% threshold in the 1st week
Occurs in ~ 1 in 10
Infant examined
‘Expert’ review of feeding (midwife-led breastfeeding clinics)

19
Q

What is the most common cause of mastitis?

A

Staphylococcus aureus