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
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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
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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
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4
Q

Should flat or inverted nipples be a deterrent to breastfeeding?

A

NO

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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.
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6
Q

Inverted nipples need

A

immediate attention after birth

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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
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8
Q

Plugged ducts - causes

A
  • Associated with an overabundant milk supply
  • or inadequate drainage of the breasts
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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
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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.
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11
Q

If a duct remains plugged, it can lead to

A
  • mastitis
  • as milk escapes into the tissues surrounding the blockages
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12
Q

Mastitis appearance

A

Reddened, hard area anywhere on or outside the breast

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13
Q

Mastitis

A
  • nfection in the breast
  • presents with a localized, tender, reddened area anywhere on the breast.
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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.
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15
Q

MAstitis infection is usually

A

unilateral

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16
Q

If a mother suspects she has mastitis, they should

A

contact their doctor or lactation consultant

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17
Q

common organism involved in mastitis

A

Staphylococcus aureus.

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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.
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19
Q

Mastitis treatment

A
  • Medical attention
  • prescribed appropriate antibiotic
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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)
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21
Q

Sore/cracked nipples

A

a very common problem that many women experience in the early days of breastfeeding.

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22
Q

Most common causes of sore/cracked nipples

A

poor latch and incorrect positioning in early days of breastfeeding

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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.

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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.
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25
Q

SORE/CRACKED NIPPLES

Observation

A

close assessment for improper latch/positioning

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26
Q

SORE/CRACKED NIPPLES

Teaching

A
  • Demonstrating correct positioning
  • use of different feeding positions
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27
Q

SORE/CRACKED NIPPLES

Nipple shields

A
  • 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.
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28
Q

SORE/CRACKED NIPPLES

Breast shells

A
  • Recommending breast shells for the management of damaged nipples
  • they allow air circulation around the affected area and keep clothing off the nipple.
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29
Q

SORE/CRACKED NIPPLES

Nurse on what breast first?

A

Unaffected breast

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30
Q

SORE/CRACKED NIPPLES

Apply what to affected nipple?

A
  • Expressed breast milk
  • apply and then air-dry
  • Do not use if there is a yeast infection
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31
Q

SORE/CRACKED NIPPLES

Keep nipples dry by

A
  • exposing them to the air
  • using warm, dry heat from a hair dryer for 3 minutes following feeding.
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32
Q

SORE/CRACKED NIPPLES
Washing

A

Recommending no application of soap to the nipples during bath and shower.

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33
Q

SORE/CRACKED NIPPLES

Allowing nipples to heal

A
  • use electric breast pump to drain the breast
  • allows damaged nipple to heal while stimulating milk supply.
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34
Q

SORE/CRACKED NIPPLES

Pain Relief

A

Use analgesics prior to breastfeeding when necessary

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35
Q

Normal breast fullness occurs when?

A

2-4 days following birth

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36
Q

What causes fullness

A
  • 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
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37
Q

Normal fullness causes breasts to be

A
  • larger, warmer, and somewhat uncomfortable
  • milk flow will be normal.
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38
Q

When does problematic engorgement occur?

A
  • when milk is produced at a rate greater than it can be removed and stored
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39
Q

Problematic engorgement is usually a result of

A

ineffective latching and ineffective emptying of the breast

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40
Q

Problematic engorgement will cause breasts to be

A
  • painful
  • to look tight and shiny
  • may cause a decrease in milk flow.
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41
Q

It is important to differentiate normal fullness from

A

engorgement

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42
Q

When will women have fewer symptoms of engorgement

A
  • When they breastfeed frequently
  • have adequate breast emptying
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43
Q

Mothers who think that engorgement is normal may not

A
  • identify causative issues, such as poor latch.
  • This can have a negative impact on the breastfeeding dyad.
44
Q

During engorgement, the infant may have difficulty

A

latching correctly

45
Q

Management strategies for engorgement

A
  • Reducing distention and engorgement of the breast
  • so infants can nurse effectively
46
Q

Treatments for engorgement

A
  • 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
Q

Treatments for engorgement

Moist heat

A
  • 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
Q

Treatments for engorgement

Warm showers

A

Allowing some milk to be removed from the breast while standing in a warm shower.

49
Q

Treatments for engorgement

Manual expression

A

Manually expressing breastmilk to reduce engorgement and facilitate latching on.

50
Q

Treatmemt for engorgement

Pumping

A

Pumping the breast with a manual or electric automatic pump.

51
Q

Treatment for engorgement

Feeding

A

Encouraging the infant to have frequent, unrestricted, and effective suckling at the breast.

52
Q

Treatment for engorgement

Cold compresses

A
  • 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
Q

Treatment for engorgement

pain relief

A

Administering an analgesic if there is discomfort from the engorgement.

54
Q

What is the major reason given by mothers for the discontinuation of breastfeeding during the first 6 to 8 weeks postpartum

A

An insufficient milk supply

55
Q

What is important to determine if a mother reports an insufficient milk supply?

A
  • careful history
  • breastfeeding assessment
  • both important to ascertain whether the problem is real or perceived
56
Q

True low milk supply can be caused by

A

a number of factors

all of which are RARE

57
Q

What is more common than true low milk supply?

A

Perceived low milk supply

58
Q

When may perceived low milk supply occur?

A

when there are unrealistic expectations or misinterpretations of infant behaviour

59
Q

What are some perceived indicators of low milk supply that may be incorrect

A
  • Frequent and lengthy feedings
  • Patterns of wakefulness and feeding at night
  • Breasts are soft
  • All of these are NORMAL
60
Q

When may mothers also perceive they have low milk supply

A

when they lack confidence in their ability to breastfeed

61
Q

What can have the potential to inhibit milk production?

A

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
Q

What are some factors that can inhibit milk production>

A
  • scheduled feeds
  • use of bottles without corresponding expression of milk
  • ineffective latching or decreased suckling time
  • maternal or infant illness.
63
Q

Assessment of milk supply

A
  • 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
Q

Assessment of milk supply

Observation

A

Observing for correct positioning and a good latch-on

65
Q

Assessment of milk supply

Check for audible

A
  • SWALLOWING
  • Ensuring milk transfer
66
Q

Assessment of milk supply

Assess what part of the breast?

A

Glandular tissue

67
Q

Assessment of milk supply

Assessing the baby

A
  • 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
Q

Normal infant stools after birth

A
  • First stool passed: Meconium
  • Green-brown “transition” stool
  • By day 5: Yellow, curdy stools
69
Q

Colostrum acts as a

A

laxative to stimulate passage of meconium

70
Q

Normal wet diapers in a 24 hour period

A

6-8 wet diapers a day by about day 4 of life

71
Q

Why do baby’s pass small amounts of urine after birth

A

because of the high levels of anti-diuretic hormone in their circulation.

72
Q

Concerns about milk supply

Stated concern or worry
baby is fussy, irritable, cries, or whimpers frequently

A

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
Q

Concerns about milk supply

Stated concern or worry
baby sucks fist or roots again soon after a feed

A

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
Q

Concerns about milk supply

Stated concern or worry
Baby shakes head, can’t stay latched, comes off nipple frequently

A

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
Q

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

A

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
Q

Concerns about milk supply

Stated concern or worry
Baby eagerly takes formula or pumped milk from a bottle right after a feeding

A

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
Q

Concerns about milk supply

Stated concern or worry
mother does not feel the let-down reflex

A

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
Q

Concerns about milk supply

Stated concern or worry
Breasts still full and hard after feeds

A

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
Q

Concerns about milk supply

Stated concern or worry
Breasts are soft most of the time

Can’t pump much milk

A

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
Q

Concerns about milk supply

Stated concern or worry
Baby wants to breastfeed “constantly”

A

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
Q

Concerns about milk supply

Stated concern or worry
previous breast surgery

A

What is probably/actually happening:

  • Surgery may affect lactation capacity

Solution:

  • Follow closely especially in the first week postpartum
82
Q

Concerns about milk supply

Stated concern or worry
Breasts too small (or large)

A

What is probably/actually happening:

  • Probably a cultural myth
  • Rarely is a true insufficiency

Solution:

  • evaluate and reassure
  • Refer to mother-support groups
83
Q

Another important strategy for managing perception of too-little milk

A
  • important to educate families
  • eg may not know colostrum is concentrated, so a baby does not require large volumes at a feeding.
84
Q

New mothers need lots of

A

reassurance, encouragement, and support while she and her baby learn the art of breastfeeding.

85
Q

What is Thrush/Candidiasis

A
  • yeast infection
  • Candida thrive in warm, moist, dark ares
86
Q

Symptoms of thrush (mother)

A
  • sore, pink, burning nipples
  • deep, shooting breast pain
87
Q

Symptoms of thrush (Baby)

A

The baby may have a diaper rash, white buccal patches, and white tongue

88
Q

What is Candida

A

a naturally occurring yeast in mucous membranes of the gastrointestinal and genitourinary tract and on the skin.

89
Q

What promotes an overgrowth of candida?

A

The use of antibiotics

90
Q

What has increased the incidence of thrush?

A

Overuse of antibiotics

91
Q

What is the most common Candida species?

A

Candida albicans

92
Q

Management of Candida albicans

A
  • Oral antifungals
  • Antifungal diaper ointment
  • Antifungals for mom’s nipples
  • Change breast pads each feeding
93
Q

Antifungals for Candida albicans

A
  • 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
Q

Candidas albicans

Breast pads

A

instructing mother to change breast pads following each feeding.

95
Q

A nipple shield should not be used for

A

sore nipples

96
Q

A nipple shield reduces

A

milk transfer to the baby

97
Q

Over time, a nipple shield will

A

reduce the mother’s milk supply due to poor stimulation of the breast.

98
Q

Any pain more than mild is usually due to

A

poor latch

99
Q

New onset of nipple pain may be due to

A

yeast infection of nipples

100
Q

PLUGGED DUCTS

Breastfeed

A

often, with feeding beginning on affected breast

101
Q

PLUGGED DUCT

Apply

A

moist heat, especially prior to a breastfeed

102
Q

PLUGGED DUCT

massage

A

massaging the affected area prior to and during feeding to encourage milk flow

103
Q

PLUGGED DUCT

Positioning

A
  • 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
Q

PLUGGED DUCT

Clothing

A

refrain from wearing constricting clothing (underwire nursing bras are not recommended)

105
Q

PLUGGED DUCT

baby’s chin

A

having the baby’s chin pointing toward the blockage during feeds