Section 3: Prevention and Treatment of Breastfeeding Problems Flashcards
1
Q
Most babies that gain too slowly, or lose weight, do so why?
A
- not because the mother does not have enough milk
- but because the baby does not get the milk that the mother has.
- eg due to poor latch
2
Q
Is it normal for breastfeeding to hurt?
A
- No
- Some tenderness in first few days is common
- Should be temporary
- Any pain more than mild is usually d/t poor latch
- New onset of pain may be d/t yeast infection of nipples
3
Q
Is it true that there is not enough milk during the first 3-4 days after birth?
A
- NO
- Poor latch may make it seem like this - baby is not getting enough colostrum
4
Q
Should flat or inverted nipples be a deterrent to breastfeeding?
A
NO
5
Q
How to determine if nipples are flat or inverted
A
- The areola is pressed between the thumb and forefinger
- A flat or normal nipple will protrude, whereas an inverted nipple will retract.
6
Q
Inverted nipples need
A
immediate attention after birth
7
Q
If the baby cannot latch onto the breast because of inverted nipples,
A
- the mother may need to pump her breasts to initiate milk supply and bring out flat or inverted nipples
- Using breast shells between feeds can also help
- Silicone nipple shields during feeds
8
Q
Plugged ducts - causes
A
- Associated with an overabundant milk supply
- or inadequate drainage of the breasts
9
Q
Management of a plugged duct
A
- breastfeeding often
- beginning on affected breast
- applying moist heat, especially prior to a breastfeed
- massaging the affected area prior to and during feeding to encourage milk flow
- alternating infant’s position during a feeding to ensure effective drainage of milk from the breast
- no constricting clothing (eg underwire bras)
- having the baby’s chin pointing toward the blockage during feeds
10
Q
Plugged duct signs/symptoms
A
- obstructs milk flow
- milk builds up behind the blockage, forming a hard lump.
- lump may be tender to touch.
11
Q
If a duct remains plugged, it can lead to
A
- mastitis
- as milk escapes into the tissues surrounding the blockages
12
Q
Mastitis appearance
A
Reddened, hard area anywhere on or outside the breast
13
Q
Mastitis
A
- nfection in the breast
- presents with a localized, tender, reddened area anywhere on the breast.
14
Q
Mastitis symptoms
A
- fever
- chills
- a localized, hard, reddened, very tender area on the breast,
- sudden onset of flu-like symptoms,
- elevated temperature >38.5 °C, and
- headache.
15
Q
MAstitis infection is usually
A
unilateral
16
Q
If a mother suspects she has mastitis, they should
A
contact their doctor or lactation consultant
17
Q
common organism involved in mastitis
A
Staphylococcus aureus.
18
Q
Factors that predispose women to mastitis
A
- damaged nipples;
- milk stasis;
- poor latch and ineffective suckling;
- tight-fitting bras;
- restricted or delayed feedings;
- an unresolved blocked duct
- stress and fatigue.
19
Q
Mastitis treatment
A
- Medical attention
- prescribed appropriate antibiotic
20
Q
Other management strategies for mastitis
A
- continued breastfeeding to remove milk from breast
- use of an electric breast pump if the infant is unable to drain the affected breast
- moist heat for comfort
- adequate fluid intake by mother
- use of analgesics for pain management
- antipyretics (if needed)
21
Q
Sore/cracked nipples
A
a very common problem that many women experience in the early days of breastfeeding.
22
Q
Most common causes of sore/cracked nipples
A
poor latch and incorrect positioning in early days of breastfeeding
23
Q
. Infant suckling patterns can contribute to nippletenderness in the mother, particularly if
A
the baby’s first suckling has been conditioned by bottle feeding.
24
Q
Treatment of sore/cracked nipples
A
- Observing both mother and baby during a breastfeed
- Correct positioning
- No nipple shields
- Breast shells
- Nurse on unaffected breast first
- Apply expressed breastmilk to nipples
- Keep nipples dry
- No soap
- Pumping to allow nipples to heal
- Analgesics.
25
SORE/CRACKED NIPPLES
Observation
close assessment for improper latch/positioning
26
SORE/CRACKED NIPPLES
Teaching
* Demonstrating correct positioning
* use of different feeding positions
27
SORE/CRACKED NIPPLES
Nipple shields
* a nipple shield should not be used for sore nipples
* reduces the milk transfer to the baby
* over time, will reducethe mother’s milk supply due to poor stimulation of the breast.
28
SORE/CRACKED NIPPLES
Breast shells
* Recommending breast shells for the management of damaged nipples
* they allow air circulation around the affected area and keep clothing off the nipple.
29
SORE/CRACKED NIPPLES
Nurse on what breast first?
Unaffected breast
30
SORE/CRACKED NIPPLES
Apply what to affected nipple?
* Expressed breast milk
* apply and then air-dry
* Do not use if there is a yeast infection
31
SORE/CRACKED NIPPLES
Keep nipples dry by
* exposing them to the air
* using warm, dry heat from a hair dryer for 3 minutes following feeding.
32
SORE/CRACKED NIPPLES
Washing
Recommending no application of soap to the nipples during bath and shower.
33
SORE/CRACKED NIPPLES
Allowing nipples to heal
* use electric breast pump to drain the breast
* allows damaged nipple to heal while stimulating milk supply.
34
SORE/CRACKED NIPPLES
Pain Relief
Use analgesics prior to breastfeeding when necessary
35
Normal breast fullness occurs when?
2-4 days following birth
36
What causes fullness
* Nipple stimulation with suckling causes a **prolactin surge** and **increased blood flow to the breast**
* increased blood flow +
* increase in milk volume +
* interstitial tissue edema= **fullness**
37
Normal fullness causes breasts to be
* larger, warmer, and somewhat uncomfortable
* milk flow will be normal.
38
When does problematic engorgement occur?
* when milk is produced at a rate greater than it can be removed and stored
39
Problematic engorgement is usually a result of
ineffective latching and ineffective emptying of the breast
40
Problematic engorgement will cause breasts to be
* painful
* to look tight and shiny
* may cause a decrease in milk flow.
41
It is important to differentiate normal fullness from
engorgement
42
When will women have fewer symptoms of engorgement
* When they breastfeed frequently
* have adequate breast emptying
43
Mothers who think that engorgement is normal may not
* identify causative issues, such as poor latch.
* This can have a negative impact on the breastfeeding dyad.
44
During engorgement, the infant may have difficulty
latching correctly
45
Management strategies for engorgement
* Reducing distention and engorgement of the breast
* so infants can nurse effectively
46
Treatments for engorgement
* Applying moist heat to the breast
* Allowing some milk to be removed from the breast while standing in a warm shower.
* Manually expressing breastmilk
* Pumping
* Frequent, unrestricted feeds
* Cold compresses
* Analgesics if needed
47
Treatments for engorgement
Moist heat
* Apply moist heat to the breast
* **just prior to feeding**
* encourages milk flow to **soften the areola** so that the infant can latch onto the breast more easily and effectively.
48
Treatments for engorgement
Warm showers
Allowing some milk to be removed from the breast while standing in a warm shower.
49
Treatments for engorgement
Manual expression
Manually expressing breastmilk to reduce engorgement and facilitate latching on.
50
Treatmemt for engorgement
Pumping
Pumping the breast with a manual or electric automatic pump.
51
Treatment for engorgement
Feeding
Encouraging the infant to have frequent, unrestricted, and effective suckling at the breast.
52
Treatment for engorgement
Cold compresses
* Applying cold compresses to reduce edema of the engorged breast.
* Finely crushed ice or small frozen vegetables in a leak-proof bag, wrapped in a dishtowel, will mould well around the breast tissue.
53
Treatment for engorgement
pain relief
Administering an analgesic if there is discomfort from the engorgement.
54
What is the major reason given by mothers for the discontinuation of breastfeeding during the first 6 to 8 weeks postpartum
An insufficient milk supply
55
What is important to determine if a mother reports an insufficient milk supply?
* careful history
* breastfeeding assessment
* both important to ascertain whether the problem is real or perceived
56
True low milk supply can be caused by
a number of factors
all of which are RARE
57
What is more common than true low milk supply?
Perceived low milk supply
58
When may perceived low milk supply occur?
when there are **unrealistic expectations** or **misinterpretations** of infant behaviour
59
What are some perceived indicators of low milk supply that may be incorrect
* Frequent and lengthy feedings
* Patterns of wakefulness and feeding at night
* Breasts are soft
* All of these are NORMAL
60
When may mothers also perceive they have low milk supply
when they lack confidence in their ability to breastfeed
61
What can have the potential to inhibit milk production?
Any event, behaviour, custom, or practice that keeps the baby away from the breast or causes milk to remain in the breast for long periods (more than 4–6 hours)
62
What are some factors that can inhibit milk production\>
* scheduled feeds
* use of bottles without corresponding expression of milk
* ineffective latching or decreased suckling time
* maternal or infant illness.
63
Assessment of milk supply
* **correct positioning and latch**
* **audible swallowing**, ensuring an **adequate milk transfer**.
* Assessing **glandular tissue.**
* Checking the **baby’s weight**.
* **frequency** and colour of the baby’s stools
* **number of wet diapers in a 24-hour period**
64
Assessment of milk supply
Observation
Observing for correct positioning and a good latch-on
65
Assessment of milk supply
Check for audible
* SWALLOWING
* Ensuring milk transfer
66
Assessment of milk supply
Assess what part of the breast?
Glandular tissue
67
Assessment of milk supply
Assessing the baby
* Check baby's **weight**
* Frequency and colour of **stools**
* number of **wet diapers** in a 24 hour period
* Determine if baby's **urine is oncentrated**
68
Normal infant stools after birth
* **First stool passed**: Meconium
* Green-brown "transition" stool
* **By day 5:** Yellow, curdy stools
69
Colostrum acts as a
laxative to stimulate passage of meconium
70
Normal wet diapers in a 24 hour period
6-8 wet diapers a day by about day 4 of life
71
Why do baby's pass small amounts of urine after birth
because of the high levels of anti-diuretic hormone in their circulation.
72
Concerns about milk supply
**Stated concern or worry**
baby is fussy, irritable, cries, or whimpers frequently
**What is probably/actually happening:**
* Hungry for milk/sucking/mother, and/or all of the above
* If not hungry and being carried, then possibly sick/ijnured
**Solution:**
* Breastfeed again
* increase carrying and skin-to-skin
* Check for poor latch/poor suck/scheduled feeds
73
Concerns about milk supply
**Stated concern or worry**
baby sucks fist or roots again soon after a feed
**What is probably/actually happening:**
* Probably hungry again, or low intake in previous feed
**Solution:**
* Breastfeed again
* Increase carrying and skin-to-skin contact
* Check for poor latch/poor suck/scheduled feeds
74
Concerns about milk supply
**Stated concern or worry**
Baby shakes head, can't stay latched, comes off nipple frequently
**What is probably/actually happening:**
* Breasts too full
* Suck problem and/or tongue tie
*
**Solution:**
* Express milk and feed by cup
* Get baby's suck evaluated
75
Concerns about milk supply
**Stated concern or worry**
Baby has consistently long (\>30 min per side) feeds or short (\<5 minutes per side) feeds
falls alseep but doesn't release breast
**What is probably/actually happening:**
* May be normal if baby is thriving and healthy
* If baby is not thriving or mother is exasperated, seep skilled help
**Solution:**
* Express milk and feed by cup while baby is thoroughly evaluated
76
Concerns about milk supply
**Stated concern or worry**
Baby eagerly takes formula or pumped milk from a bottle right after a feeding
**What is probably/actually happening:**
* Normal if suck is poor
* May be a very rapid flow nipple and baby can't control flow of milk easily
**Solution:**
* express milk and feed by cup while baby and mother are evalutated thoroughly
77
Concerns about milk supply
**Stated concern or worry**
mother does not feel the let-down reflex
**What is probably/actually happening:**
* Multiple let-downs occur during feeds
* may not sense any, or only the first
**Solution:**
* Reassure and encourage mother to watch and listen for infant swallowing or milk flowing during pumping
78
Concerns about milk supply
**Stated concern or worry**
Breasts still full and hard after feeds
**What is probably/actually happening:**
* Poor milk transfer
* often d/t poor latch, poor infant suck, and/or edema
**Solution:**
* Express or pump milk
* Investigage infant suck
79
Concerns about milk supply
**Stated concern or worry**
Breasts are soft most of the time
Can't pump much milk
**What is probably/actually happening:**
* Normal
* Some mothers do not release milk to any pump
**Solution:**
* Reassure
* Breastfeed
* Handexpress or try a different pump
80
Concerns about milk supply
**Stated concern or worry**
Baby wants to breastfeed "constantly"
**What is probably/actually happening:**
* Probably normal
* Or unrealistic expectation of infant behavior
**Solution:**
* Observe
* Track length and duration of feeds and infant output
* follow up
81
Concerns about milk supply
**Stated concern or worry**
previous breast surgery
**What is probably/actually happening:**
* Surgery may affect lactation capacity
**Solution:**
* Follow closely especially in the first week postpartum
82
Concerns about milk supply
**Stated concern or worry**
Breasts too small (or large)
**What is probably/actually happening:**
* Probably a cultural myth
* Rarely is a true insufficiency
**Solution**:
* evaluate and reassure
* Refer to mother-support groups
83
Another important strategy for managing perception of too-little milk
* important to **educate families**
* eg may not know colostrum is concentrated, so a baby does not require large volumes at a feeding.
84
New mothers need lots of
reassurance, encouragement, and support while she and her baby learn the art of breastfeeding.
85
What is Thrush/Candidiasis
* yeast infection
* Candida thrive in warm, moist, dark ares
86
Symptoms of thrush (mother)
* sore, pink, burning nipples
* deep, shooting breast pain
87
Symptoms of thrush (Baby)
The baby may have a diaper rash, white buccal patches, and white tongue
88
What is *Candida*
a naturally occurring yeast in mucous membranes of the gastrointestinal and genitourinary tract and on the skin.
89
What promotes an overgrowth of candida?
The use of antibiotics
90
What has increased the incidence of thrush?
Overuse of antibiotics
91
What is the most common *Candida* species?
*Candida albicans*
92
Management of *Candida albicans*
* Oral antifungals
* Antifungal diaper ointment
* Antifungals for mom's nipples
* Change breast pads each feeding
93
Antifungals for *Candida albicans*
* antifungal oral suspension (prescribed by a physician) for baby
* antifungal ointment on diaper area if needed
* nystatin antifungal ointment (nipple and areola) following feedings,
94
*Candidas albicans*
Breast pads
instructing mother to change breast pads following each feeding.
95
A nipple shield should not be used for
sore nipples
96
A nipple shield reduces
milk transfer to the baby
97
Over time, a nipple shield will
reduce the mother’s milk supply due to poor stimulation of the breast.
98
Any pain more than mild is usually due to
poor latch
99
New onset of nipple pain may be due to
yeast infection of nipples
100
PLUGGED DUCTS
Breastfeed
**often**, with feeding beginning on affected breast
101
PLUGGED DUCT
Apply
**moist heat**, especially prior to a breastfeed
102
PLUGGED DUCT
massage
massaging the affected area prior to and during feeding to encourage milk flow
103
PLUGGED DUCT
Positioning
* **alternating** infant’s position during a feeding to ensure effective drainage of milk from the breast
* having the **baby’s chin pointing toward the blockage** during feeds
104
PLUGGED DUCT
Clothing
refrain from wearing constricting clothing (underwire nursing bras are not recommended)
105
PLUGGED DUCT
baby's chin
having the baby’s chin pointing toward the blockage during feeds
