Breast

Question 1

Difficult breast feeding

Answer 1

Hx: Onset of nipple pain within first few days of birth (usually poor latch), When milk came in ?adequate supply, Frequency/duration of BF, use of pump/shield, medications, associated breast pain/fevers, history of dermatitis/psoriasis, previous surgeries (reduction/implants/piercings), auto-immune disease/Reynauds (can predispose to nipple vasospasm), low mood/anhedonia, history of yeast infections

Question 2

Pain on breast feeding - causes

Answer 2

Suboptimal fit and hold/poor latch

Excessive suck vacuum/biting nipple

Inappropriate breast pump use - high suction, incorrect pump shield size

Nipple candidiasis (Rx: Fluconazole 150mg every 2nd day for 3 doses, followed by oral nystatin 2x500,000 TDS + miconazole oral gel to nipples QID. Also commence baby on miconazole oral gel QID. Sterilise dummy daily, hand hygiene, keep nipples dry)

Nipple bacterial infection

Nipple contact dermatitis

Blocked milk duct

Nipple vasospasm (if blanching/exacerbated by cold