Breastfeeding medicine and lactation support — formative SAQs

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]

SAQ 2 — The fussy, frequently feeding infant (10 marks, 15 minutes)

A three-week-old exclusively breastfed infant feeds every ninety minutes and is fussy between feeds, but has at least six heavy wet nappies a day, frequent stools, and has gained 250 grams in the past week. The mother believes her milk supply is low and asks whether she should give formula. [3]

a) Is this infant's milk supply truly low? Give your reasoning using the clinical assessment of effective feeding. (3 marks) [3]

b) Outline the stepwise management of suspected low supply, including what you would do first and what you would reserve for later. (4 marks) [3] [8]

c) The infant is found to be late-preterm (born at 36 weeks). How does this change your assessment and plan? (3 marks) [12]