Breastfeeding Problems Flashcards
What are 3 common causes of breastfeeding issues?
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
When is mastitis treated?
if systemically unwell
if nipple fissure present
if symptoms do not improve after 12-24 hours of effective milk removal
if culture indicates infection
What can untreated mastitis lead to?
Breast abscess requiring incision and drainage
How is mastitis treated?
Flucloxacillin for 10-14 days.
Breastfeeding or expressing should continue during treatment.
What is engorgement and when does it occur?
Cause of pain in breastfeeding women and occurs in the first few days after birth, usually present bilaterally.
Pain/discomfort is worst before a feed - fever may be present (settles in 24 hours) and breasts may appear red
How is engorgement treated?
Hand expression of milk
What are features of Raynaud’s disease of the nipples?
Pain is 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
How is Raynaud’s of the nipples treated?
minimising exposure to cold
use of heat packs following a breastfeed
avoiding caffeine
stopping smoking
specialist referral for a trial of oral nifedipine
When is infant weight gain a concern?
Babies may initially lose up to 10% of birth weight but usually regain this quickly.
If >10% of weight lost (as is the case with 1 in 10 breastfed babies), an expert review of feeding needed (midwife led breastfeeding clinic) and monitoring of weight until weight gain satisfactory.
What drugs are contraindicated in breastfeeding?
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
How can lactation be suppressed?
stop the lactation reflex i.e. stop suckling/expressing
supportive measures: well-supported bra and analgesia
cabergoline is the medication of choice if required
What is a galactocoele?
typically occurs in women who have recently stopped breastfeeding
Caused due to occlusion of a lactiferous duct - build up of milk creates a cystic lesion in the breast
How is a galactocoele differentiated from an abscess?
Galactocele is usually painless, with no local or systemic signs of infection
