Item

Responses from Literature

Olds, London & Ladweig, Chapter 30, page 895; Mohrbacher & Stock, chapter 2, page 21

This response should be determined locally

II.1 Describe signs and symptoms of mastitis and of yeast infection of the breast.

Þ any inflammation of the breast which covers both the possibility of the inflammation due to an infection or a plugged duct

Þ tender spot, redness or a sore lump in a mother’s breast without a fever is most likely caused by a plugged duct

Þ if a soreness or lump is accompanied by a fever and/or flu-like symptoms (feeling tired and achy or run-down) it is most likely a breast infection

Þ abrupt onset of extremely sore nipples, burning or itching, possibly shooting pain in the breast

Þ persistent sore nipples

Þ inflammation of nipples/breast, usually striking deep pink, sometimes with tiny blisters

Þ severe tenderness and discomfort, especially during and immediately after feedings

Þ baby may have diaper rash with raised, red pustules or red scalded-looking buttocks; mouth may have diffuse redness with white patches

II.2 List 2 factors that may contribute to sore nipples for the mother.

1. uterine cramps & increase blood flow (during the first few days after birth)

2. a "pins & needles" or achy feeling in breasts

3. milk leaking from the other breast

4. a change in the baby’s suck-swallow rhythm, from quick to long sucks

5. gulping

6. milk appearing in the corner of the baby’s mouth

7. a feeling of relaxation in the mother

Mohrbacher & Stock, chapter 3, page 32

Þ massage and/or apply heat(warm soaks or hot shower) before breastfeeding to stimulate let-down reflex and help the milk flow

Þ breastfeed frequently - if baby will not breastfeed long enough to soften both breast, encourage mother to hand-express or pump milk after nursing

Þ if the mother’s areola is engorged, encourage her to express enough milk to soften the aerola so that the baby will latch on well. Also suggest the mother try other nursing positions such as the football hold which may give her more control and making latching-on easier

Þ apply cold compresses between feedings to reduce swelling & pain

Þ a well-fitting, supportive bra may make the mother feel more comfortable (a bra that does not fit well may constrict her milk ducts and cause mastitis)

Þ if mother is experiencing severe pain, suggest she discuss pain medication that is compatible with breastfeeding with her medical care provider

Þ Check positioning, latch, and suck. Try making adjustments.

Þ Treat engorgement, if present.

Þ Avoid artificial nipples.

Þ Use proper technique for detaching baby from breast.

Þ Treat inverted nipple, if present.

Þ Check baby for short frenulum and assess effect, if present.

Þ Check mom for white nipple during feeding (indicates clenching).

Þ Check for other possible causes and treat if necessary: thrush, teething, improper breast pump use, chapped nipples, nipple skin problems (eczema, dermatitis, impetigo, bacterial infection), bra that is tight or has rough seam, hormonal changes of pregnancy, irritation from creams or ointments

Þ Encourage mother to leave a small amount of expressed milk on the nipple.

Þ Avoid plastic liners or synthetic fabrics in bra or breast pad.

Plugged Ducts and Mastitis

Þ massage breasts from chest wall forward to the nipple while standing in a warm shower or following the application of hot packs to the breasts

Þ encourage mother to contact her medical care provider for possible medical treatment of mastitis

Þ apply wet or dry heat to the affected area

Þ gently massage the area while it is warm & remove any dried milk secretions on the nipple by soaking it with plain water

Þ breastfeed the baby frequently on the affect side - this will keep the breast from becoming overly full and keep the milk flowing freely

Þ loosen constrictive clothing, especially mother’s bra

Þ make sure the baby is well positioned & has a good latch

Þ vary nursing positions

Þ rest

Þ suggest the mother "eat to hunger." It is recommended that lactating women consume 2700 calories per day (about 500 calories a day more than a non-pregnant, non-nursing woman), however, many nursing mothers take in closer to 220 calories per day or less

Þ encourage mother to trust her appetite and choose nutritious foods that will help her feel energetic

Þ routine vitamin-mineral supplements are not necessary for the nursing mother if she eats a healthy, balanced, and varied diet

Þ the nursing mother should be encouraged to drink to thirst. Drinking more than that is not beneficial and will not increase her milk supply

Þ if mother is not drinking enough fluids, her urine will be concentrated (darker in color and with a stronger smell) and she may become constipated

III.1 Lists 3 signs of effective latch

1. the baby’s body is facing the mother so that he doesn’t have to turn his head

2. the baby’s mouth should be directly in front of or slightly below the nipple

3. the baby has taken the baby’s breast deeply into his mouth; the lower jaw is as far back from the nipple as possible

4. the baby is pulled in so close that his chin is pressed into the breast and his nose may rest on the breast

5. once the baby is latched - on, the baby’s lips are flanged out & relaxed

6. the baby’s tongue is cupped beneath the mother’s breast

7. breastfeeding is comfortable for the mother

III.2 Lists 3 characteristics of effective suck/swallow pattern

1. breastfeeding is comfortable for the mother

2. after the initial let-down occurs, the mother should be able to hear him swallow after every one to two sucks

3. the suck-swallow pattern should last on average about ten to twenty minutes

4. the mother should see a "wiggle" at the junction of the bay’s temples and ears

 

1. rooting

2. smacking of lips

3. sucking on fingers or hands

4. flexed arms, clenched fists

5. placing hands to mouth

6. mouth opening in response to tactile stimulation

7. rapid eye movement under closed lids

8. arm or leg movements

9. lip movements

10. changes in facial expressions

1. gradual decrease in number of sucks over course of feeding

2. purses lips followed by pulling away from the breast & releasing the nipple

3. relaxed body

4. legs extended

5. absence of hunger cues

6. sleep

7. small amount of milk drools from the mouth

8. contented state

Þ daily nursing patterns will vary from baby to baby, and an individual baby’s nursing pattern may change from day to day and vary as he grows

Þ most newborns nurse an average of eight to twelve times in 24 hours

Þ due to individual differences, some babies may nurse as often as every hour or a infrequently as every four hours

Þ during the early months, many babies "cluster feed", i.e. they space feedings closer together at certain times of the day (typically during the evening) and go longer between feedings at other times

 

Þ During a growth spurt, the baby wants to nurse more often

Þ Twenty minutes of vigorous nursing every hour or two is more effective in building up the mother’s milk supply than less frequent or longer breastfeeding sessions

Þ listlessness

Þ lethargy

Þ skin losing its resiliency (when pinched it stays pinched looking, tenting)

Þ dry mouth, dry eyes

Þ weak cry

Þ minimal urine output

Þ fever

Þ depressed fontanel

Mohrbacher & Stock, chapter 3, pages 23-24, 26 and p. 115

Þ weight loss of up to 10% of the baby’s birthweight is normal over the first 3-4 days of life

Þ most babies regain their birthweight within two to three weeks of age

Þ typical weight gain for the first 3 to 4 months is 4-8 ounces a week, doubling birthweight by 5-6 months

Þ supplements fill up the baby, making him less interested in breastfeeding

Þ water supplements contribute to newborn jaundice

Þ formula supplements in the newborn period can sensitize some babies to mil allergy or intolerance

Þ when given an artificial nipple, supplements can cause breastfeeding problems, weakening a baby’s suck or causing baby to refuse the breast

Þ supplements contribute to engorgement because they decrease the amount of time baby spends breastfeeding

Þ supplements interfere with the establishment of a mother’s milk supply

III.9 Lists signs and symptoms of newborn jaundice. Describes the effect of breastfeeding on jaundice.

Þ Yellowish cast of skin

Þ Yellowish cast of sclera

Þ Progressively higher bilirubin levels are associated with involvement of complete trunk, extremeties, and palms/soles

Þ Frequent breastfeeding helps eliminate excess bilirubin (if the baby is sleepy, the mother may need to stimulate him/her to breastfeed frequently and long enough)

Þ Fatty hindmilk promotes stooling which eliminates excess bilirubin

Þ The American Academy of Pediatrics states that giving water or sugar water supplements to breastfed babies does not lower bilirubin levels

Þ Formula supplementation may be recommended on a short term basis if the bilirubin level is high enough that treatment is necessary and the mother does not yet have enough milk to increase the baby’s stooling

Mohrbacher and Stock, chapter 11

1. mother presses down on her breast near the baby’s mouth or

2. the mother pulls down on the baby’s chin or

3. the mother inserts a finger into the corner of the bay’s mouth

1. hold the infant upright on the shoulder or hold the infant in a sitting position on lap with chin and chest supported with one hand

2. gently pat or stroke the back with the other hand

3. burp at intervals, preferably at the middle and end of feeding

Þ Milk storage - refrigeration 32 to 39 F - 8 days

IV.2 List at least 3 alternative methods of feeding expressed breast milk.

Þ The mother needs to begin by washing her hands and making sure the pump & storage container are clean (containers washed in hot, soapy waters then rinsed well)

Þ The mother will get the best results if she follows the pump directions, centers her nipple in the proper nipple adapter, moistens her breasts and begins at the lowest pressure setting

Þ Stimulating a milk let-down is crucial to successful milk expression

Þ Setting up a milk-expression routine and finding a comfortable time and place to express can help stimulate a good milk flow

Mohrbacher & Stock, supplement B, pages 546-548