by mtoom

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  • Comment on "snacking" on the breast
  • Can cause indigestion
  • Better for baby to finish meal 
  • 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?
Hyperlactation syndrome
  • 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)
  • Plugged ducts
  • Nipple trauma
  • 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) 
  • Nipple trauma
  • Abrupt change in feeding frequency
  • Poor latch-on resulting in inadequate drainage of the breast
  • Breast pressure
  • 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? 
Start antibiotics
  • 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)
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