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 Dept. Pediatrics


  

    

Breastfeeding
EXPECTED COMPETENCIES

By completion of this module, the resident should be able to….

  1. identify advantages of breast-feeding that you could discuss with your patients. 
  2. identify common barriers to breastfeeding.
  3. manage common breastfeeding-related clinical problems.
  4. advise mothers about what resources might be helpful to her

RESOURCES:

Articles

Evans Garret D. ; Danda Caroline E. Emotional and Physical Preparation for Breast Feeding.  Univ. Florida, IFAS Extension.

 

Databases

Drugs and Lactation Database (LactMed) at National Library of Medicine,

       http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

           A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.

 

Policy Statements

American Academy of Pediatrics.  Policy statement on Breastfeeding and the Use of Human Milk, Pediatrics, Vol. 115 No. 2 February 2005, pp. 496-506

 

Websites

AAP.   http://www.aap.org/breastfeeding/

 

www.breastfeeding.com from The Bump, a part of The Knot, Inc. family of brands.

Started in 1998, the site has grown into the leading Web site for breastfeeding information and support.  The Web site is home to an enthusiastic online community of mothers and birth related medical professionals who log on for support and advice.   Breastfeeding.com also provides information and support on a wide range of child health and growth issues, from child care and child safety to potty training and teething. 

Breastfeeding FAQ's: Getting Started.  from kidshealth.org or Nemours Children's Health System.

 

US Department of Health & Human Services.  Breastfeeding — Best for Baby. Best for Mom

QUESTIONS:
Submit this module to Dr. Niebuhr vniebuhr@utmb.edu  and Dr. Gundlach magundla@utmb.edu .

Case#1
 Mrs. Smits is a 30-year-old mother who presents to your office for aprenatal visit, 32 weeks pregnant with her first baby.  During the visit, you ask,  "Have you decided whether you are going to breastfeed or formula feed?" She replies,  "Well, of course I will try to breastfeed, but all of my friends have tried and quit after two weeks because it was so hard."

  1. What are some things that she can do before delivery to ensure success at breastfeeding? after delivery?

  2. Under what conditions would you recommend that Mrs. Smits not breastfeed?

You later see Mrs. Smits with her newborn son, Sam, in the office at day of life four. You learn the following history:  Sam was born at 3825 grams via spontaneous vaginal delivery. There were no perinatal complications. They went home at 36 hours of life. 

Mrs. Smits states that she is breastfeeding exclusively. At today’s visit Sam weights 3555gs. 

  1. What percentage of his birth weight has Sam lost?

  2. Is this concerning?

  3. What questions will you ask Mrs. Smits to determine if Sam is getting enough milk? 

Mrs. Smits mentions that this morning she woke up and her breasts were painful and hard. She hasn’t been able to get Sam to latch on. She has had some nipple pain with feeding but nothing like this. How would you counsel her in regards to the following: 

  1. Sore nipples? 

  2. Engorgement? 

  3. How do you differentiate engorgement from mastitis? 

Mrs. Smits listens attentively to your advice and seems confident when she leaves the office. You ask her to come back and see you in 2 days.  Mrs. Smits misses the appointment (at 6 days of life) but returns for the 2-week well child exam she scheduled when she left the hospital.  At this visit, Sam is still 100 grams below his birth weight. 

  1. How are you going to differentiate a "slow gainer" from a baby with failure to thrive?

A week later, Mrs. Smits calls your office in tears because her family physician recommends she start fluoxetine (Prozac) for her depression and has advised her she would have to stop breastfeeding.  Mrs. Smits has a difficult decision - she wants her depression lifted but she does not want to stop breastfeeding.   (note: LactMed database resource above)

  1. How do you advise her about starting  fluoxetine while breastfeeding, and about how to talk to her family physician about this?

  2. Would your advice be any different if the decision were whether to continue  taking fluoxetine which she had been taking throughout her pregnancy?

How would you counsel Mrs. Smits if she asked about breastfeeding in combination with the following:

  1. codeine for pain from a long-standing shoulder injury

  2. oral contraceptive pills?

  3. mixed breastfeeding and bottle-feeding

Case #2
Mrs. Garazola and Jonathan come into your office for Jonathan’s 2-month well child exam. Mother has been exclusively breastfeeding Jonathan and is extremely happy. She tells you that she is already back to her pre-pregnancy weight even though it took her almost a year to do the same after her first child who did not breastfeed. She asks, "How long do I have to breastfeed?" She mentions that she wants to get back to work and doesn’t see how she can work and breastfeed. 

  1. For how long would you recommend Mrs. Garazola continue breastfeeding? 

  2. What three pieces of advice could you give her about going back to work? 

  3. How could she get access to a breast pump? 

Systems-Based Practice

Read the AAP policy statement related to breastfeeding  (see above  under Resources). 

  1. What parts of the AAP policy recommendations are being implemented in the UTMB hospital or clinics? what parts are not being implemented?  What strategies do you think might work to affect change?

This module was originally developed by Krystal Revai MD, former UTMB Faculty member.

last updated 11-12-08,  4-19-2010