Section 3: Prevention and Treatment of Breastfeeding Problems Flashcards
Most babies that gain too slowly, or lose weight, do so why?
- 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
Is it normal for breastfeeding to hurt?
- 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
Is it true that there is not enough milk during the first 3-4 days after birth?
- NO
- Poor latch may make it seem like this - baby is not getting enough colostrum
Should flat or inverted nipples be a deterrent to breastfeeding?
NO
How to determine if nipples are flat or inverted
- The areola is pressed between the thumb and forefinger
- A flat or normal nipple will protrude, whereas an inverted nipple will retract.
Inverted nipples need
immediate attention after birth
If the baby cannot latch onto the breast because of inverted nipples,
- 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
Plugged ducts - causes
- Associated with an overabundant milk supply
- or inadequate drainage of the breasts
Management of a plugged duct
- 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
Plugged duct signs/symptoms
- obstructs milk flow
- milk builds up behind the blockage, forming a hard lump.
- lump may be tender to touch.
If a duct remains plugged, it can lead to
- mastitis
- as milk escapes into the tissues surrounding the blockages
Mastitis appearance
Reddened, hard area anywhere on or outside the breast
Mastitis
- nfection in the breast
- presents with a localized, tender, reddened area anywhere on the breast.
Mastitis symptoms
- 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.
MAstitis infection is usually
unilateral
If a mother suspects she has mastitis, they should
contact their doctor or lactation consultant
common organism involved in mastitis
Staphylococcus aureus.
Factors that predispose women to mastitis
- damaged nipples;
- milk stasis;
- poor latch and ineffective suckling;
- tight-fitting bras;
- restricted or delayed feedings;
- an unresolved blocked duct
- stress and fatigue.
Mastitis treatment
- Medical attention
- prescribed appropriate antibiotic
Other management strategies for mastitis
- 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)
Sore/cracked nipples
a very common problem that many women experience in the early days of breastfeeding.
Most common causes of sore/cracked nipples
poor latch and incorrect positioning in early days of breastfeeding
. Infant suckling patterns can contribute to nippletenderness in the mother, particularly if
the baby’s first suckling has been conditioned by bottle feeding.
Treatment of sore/cracked nipples
- 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.
SORE/CRACKED NIPPLES
Observation
close assessment for improper latch/positioning
SORE/CRACKED NIPPLES
Teaching
- Demonstrating correct positioning
- use of different feeding positions
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.
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.
SORE/CRACKED NIPPLES
Nurse on what breast first?
Unaffected breast
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
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.
SORE/CRACKED NIPPLES
Washing
Recommending no application of soap to the nipples during bath and shower.
SORE/CRACKED NIPPLES
Allowing nipples to heal
- use electric breast pump to drain the breast
- allows damaged nipple to heal while stimulating milk supply.
SORE/CRACKED NIPPLES
Pain Relief
Use analgesics prior to breastfeeding when necessary
Normal breast fullness occurs when?
2-4 days following birth
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
Normal fullness causes breasts to be
- larger, warmer, and somewhat uncomfortable
- milk flow will be normal.
When does problematic engorgement occur?
- when milk is produced at a rate greater than it can be removed and stored
Problematic engorgement is usually a result of
ineffective latching and ineffective emptying of the breast
Problematic engorgement will cause breasts to be
- painful
- to look tight and shiny
- may cause a decrease in milk flow.
It is important to differentiate normal fullness from
engorgement
When will women have fewer symptoms of engorgement
- When they breastfeed frequently
- have adequate breast emptying