Breastfeeding medicine and lactation support — structured clinical encounter

Structured encounter testing the approach to a mother at three weeks postpartum with fever and a hot, tender breast: the recognition of the mastitis spectrum, the stepwise management from continued milk removal to antibiotics, the red flags of abscess, the assessment of latch and transfer, and the counselling of the mother on continued breastfeeding and follow-up, with a pivot to a late-preterm infant needing intensified support.

structured clinical encounter2 min readVerification in progress

Prompt

A 28-year-old first-time mother at three weeks postpartum has two days of fever, malaise and a hot, tender, wedge-shaped area of erythema in the right breast. Her infant feeds well and is gaining weight. You are the paediatric registrar working through assessment, management, the red flags of abscess, and the counselling of the mother, before addressing a late-preterm infant at risk.

Station 1 — assessment and diagnosis

Asked for my first impression, I explain that a three-week postpartum mother with fever, malaise and a unilateral wedge of erythema and induration has the mastitis spectrum, not simple engorgement, because engorgement is usually bilateral, firm and non-erythematous in the first week. I would examine the breast for the extent of induration, any fluctuant mass suggesting abscess, and the nipple for trauma or candidiasis, and confirm the infant is feeding well and transferring. [5]

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References5Show ledger

[1]Victora CG; Bahl R; Barros AJ; et al Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 2016.PMID 26869575
[3]Meek JY; Noble L; Section on Breastfeeding Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics, 2022.PMID 35921640
[5]Mitchell KB; Johnson HM; Rodriguez JM; et al Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med, 2022.PMID 35576513
[6]Pérez-Escamilla R, Martinez JL, Segura-Pérez S Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Matern Child Nutr, 2016.PMID 26924775
[12]Busch DW; Silbert-Flagg J Breastfeeding Plan of Care for the Late Preterm Infant From Birth Through Discharge. J Perinat Neonatal Nurs, 2021.PMID 33900247