Comment on the baby feeding from the tip of the nipple
Poor positioning and latching can lead to poor breast drainage
What happens if Cindy's breast draining is incomplete?
Ducts and lobules remain constantly full leading to milk stasis and blocked ducts
Outlet obstruction leads to lactiferous duct colic (characterised by a sharp, knife-like pain that radiates deep into the breast)
What syndrome does Cindy have?
Is Cindy's milk production abnormal?
Yes, because John sputters and chokes when he is put on his mother's breast
How do Cindy's breast feel on palpation?
How is the exam of baby John?
Breasts feel very full
Baby John is thriving
What are 3 ways to manage infant hyperlactation syndrome?
Decrease milk production
Decrease milk transfer
Increase quality of milk uptake
Describe how to decrease milk production
Improve breast drainage --Start with fullest breast --Use proper breastfeeding technique --Baby should remain on breast until all segments are drained and breast feels soft
Decrease breast stimulation --Reduce duration of feeds --Reduce frequency of feeds
Describe how to decrease milk transfer
Breastfeeding technique -Correctly latch the baby -Mother relaxed
Improve milk ejection reflex -Avoid over stimulation -Spray off milk before latching -Decrease maternal fluid intake
Describe how to increase quality of milk uptake
Frequency and duration -Shorten breast feeds -Avoid overfeeding
Decrease breast stimulation -Start on fullest side -Burp carefully when baby pulls off -Avoid switching sides too often
Summary strategy to deal with infant hyperlactation syndrome
Reduce quantity of milk
Increase quality of milk
How common is transient nipple soreness?
What is the cause (with respect to baby)?
80% of mothers
Caused by tongue friction and gum compression by the baby from an incorrect latch
What is the technique to prevent nipple soreness? (4)
Good latch and proper positioning
Semi-upright breastfeeding position
Heat and gentle manipulation of nipple may elongate it for a better latch
Baby's mandible with elongate and nipple will become more distensible with time
Medically, what causes sore nipples? (6)
Infections (S. aureus, C. albicans)
Harsh breast cleansing (chapped nipples)
Use of irritating products (contact dermatitis)
Skin disorders like psoriasis and Paget disease
Cindy comes in with mastitis (acute or inflammatory mastitis probably from a duct blockage)
How common is mastitis?
Majority of cases of mastitis occur when?
Describe the symptoms of mastitis?
20% of lactating mothers get mastitis
Occurs within 6 weeks of beginning lactate typically, but can occur any time
Tender, hot swollen wedged-shaped area of one breast associated with fever greater than 38.5
Complaints include myalgia, chills, malaise and flu-like symptoms
Distinguish mastitis from breast engorgement **
Mastitis: Unilateral, focal
Engorgement: Bilateral, generalized
What are causes of mastitis? (5)
Abrupt change in feeding frequency
Poor latch-on resulting in inadequate drainage of the breast
Maternal hyperlactation syndrome resulting in excessive milk supply
First step in managing mastitis?
Frequent and effective milk removal (because milk stasis is often the initiating factor)
Breastfeed more frequently
Switch to affected breast as soon as letdown reflex is achieved
Position baby with chin or nose towards blockage
How to reduce pain due to mastitis?
Anti-inflammatory like ibuprofen along with cold compresses or ice packs to reduce local pain and swelling (ibuprofen not detected in breast milk)
Breast massage during nursing (manual stripping) may reduce discomfort and dislodge obstruction
Correct breast feeding technique
What is breastfeeding not sufficient to remove thickened milk?
Then manual (ie. "mechanical expression") of milk is necessary
Compress breast firmly using a cupped hand squeezing nipple gently
Manual stripping: Cupping of breast between finger and thumb and applying firm pressure over the tender section starting from the periphery and moving towards nipple (repeat this every few hours until milk flowing)
What if symptoms of mastitis are not improving and Cindy is acutely ill looking?
Most common organism is penicillin-resistant S. aureus
Use cloxacillin or flucloaxcillin
Cephalexin can be used in case of penicillin allergy (if allergy severe use Clindamycin, 10% risk that penicillin allergy translate into cephalosporin allergy)