Breastfeeding Problems Flashcards
What is breast engorgement?
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 do blocked ducts present?
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.
What may a galactocele result from and how does this present?
Result from blocked duct
Smooth, round, painless breast swelling which causes milky nipple discharge when pressed.
What is the management for blocked ducts?
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.
What is the management for engorgement?
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
What is management for a galactocele?
Continue breastfeeding.
Discuss with a breast specialist investigations to confirm dx + tx options if needed.
Give 3 symptoms/ signs of a ductal infection
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
Give 3 symptoms/ signs of mastitis
Fever + systemically unwell
Hard painful swelling in a wedge-shaped distribution in 1 breast
Erythema of the overlying skin.
Give 4 symptoms/ signs of a breast abscess
Fever + systemic Sx
Worsening painful breast lump, which may be fluctuant
Overlying skin erythematous + warm.
Hx of recent mastitis
Give 4 symptoms/ signs of Raynaud’s disease of the nipple
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.
What is management for Raynaud’s disease of the nipple?
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
Give 3 symptoms/ signs of bacterial nipple infection
purulent nipple discharge
Crusting, redness + fissuring
A/w skin trauma such as persistent cracks + fissures
Give 6 symptoms/ signs of candidal nipple infection
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.
What is the management of mild localised bacterial infection of the nipple?
Topical Fusidic acid
Avoid breastfeeding during Tx
Express milk to avoid engorgement
What is the management of candidal infection of the nipple?
Miconazole cream for mother
Nystatin suspension for baby
