Key Feature 12: In a breastfeeding woman, screen for and characterize dysfunctional breastfeeding (ex: poor latch, poor production, poor letdown).
Skill: Clinical Reasoning, Patient Centered
Phase: Hypothesis generation, History
Along with postpartum depression (see my last post), screening for problems with breastfeeding is standard of care when providing healthcare to women who are postpartum. Difficulties with breastfeeding are common and often lead to early termination of breastfeeding. This is unfortunate for two reasons: 1. There are many established benefits of breastfeeding, 2. The problems that lead to cessation of breastfeeding are often easily treatable. Being vigilant about assessing for and managing problems with breastfeeding can help address issues with breastfeeding before mom switches to formula-feeding, thereby increasing the opportunity for mom and baby to receive the many benefits that breastfeeding has to offer.
The most common problems with breastfeeding fall under 1 of 2 categories: 1. Inadequate milk intake or nipple/breast pain. An approach to concerns that fall within these categories are outlined below.
Inadequate milk intake:
DDx: A differential diagnosis for nipple and/or breast pain is provided below. Note that the reasons that nipple and/or breast pain occur are often at least in part consequences of poor feeding technique. So when it comes to the approach to nipple/breast pain in a woman who is breastfeeding, you pretty much do the same as above but also clinical assess for features suggesting any of the following issues may be occurring: