Paeds SAQs · gastroenterology-hepatology-and-nutrition
Breastfeeding medicine and lactation support — formative SAQs
Two formative SAQs on breastfeeding medicine and lactation support: a mother with a hot, tender, wedge-shaped breast and fever at three weeks, testing the recognition of the mastitis spectrum, the stepwise management from continued milk removal to antibiotics, and the red flags of abscess; and a fussy, frequently feeding but thriving three-week-old, testing the distinction between perceived and true low supply, the assessment of latch and transfer, and the stepwise management that protects supply.
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SAQ 1 — The mother with mastitis (10 marks, 15 minutes)
A 28-year-old first-time mother at three weeks postpartum presents with fever of 38.6 degrees Celsius, malaise, and a hot, tender, wedge-shaped area of erythema in the upper outer quadrant of the right breast. Her infant is feeding well and gaining weight. She is worried she will have to stop breastfeeding. [5]
a) What diagnosis does this represent, and what is the first-line management? (3 marks) [5]
b) She does not improve on conservative care and you diagnose bacterial mastitis. Name the first-line antibiotic, its dose, route, frequency and duration, and an alternative for penicillin allergy. (4 marks) [5]
c) Two days later she still has fever and now has a fluctuant mass. What complication has developed, and what is the management? (3 marks) [5]
References5ShowHide
- [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
- [8]Paul C; Zenut M; Dorut A; et al Use of domperidone as a galactagogue drug: a systematic review of the benefit-risk ratio. J Hum Lact, 2015.PMID 25475074
- [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