Nutrition Through The Life Cycle

7th Edition
Brown + 1 other
ISBN: 9781337919333



Nutrition Through The Life Cycle

7th Edition
Brown + 1 other
ISBN: 9781337919333
Textbook Problem

This was an unremarkable first pregnancy for 29-year-old Barbara Ann. Barbara Ann has reported experiencing “a little” breast enlargement during her pregnancy.

Her infant is first put to the breast at two hours postpartum, and the infant latches well according to mom, and suckles vigorously. The infant nurses every two hours over the first 3-4 days postpartum. Barbara Ann's breasts became noticeably fuller during the third postpartum day, and by the fourth postpartum day they are painfully engorged. In addition, Barbara Ann reports painful, burning, cracked nipples. The engorgement makes it difficult for her baby to latch at the breast. The baby becomes irritable, and Barbara Ann experiences a significant amount of pain. A lactation consultant gives Barbara Ann guidelines for engorgement management.

On day 5, the engorgement is still causing discomfort. Barbara Ann's nipples have become more cracked and painful. The lactation consultant notes that the infant's latch has become shallow and tight, probably in an attempt to control the flow of milk. However, the infant shows all the signs of adequate intake, including 10 very wet and 5 soiled diapers during the 24 hours prior to the consultation.

By day 7 postpartum, Barbara Ann has mastitis. She is treated with a seven-day course of dicloxacillin. A lactation consultant assists her in achieving a proper infant latch.

By day 14, Barbara Ann is feeling much better. The mastitis has resolved, and her nipples are healing. She still has tenderness during infant feedings and a healing crack on the right side. Her breasts are still uncomfortably full and are occasionally swollen and tender.

At three weeks postpartum, Barbara Ann develops an inflamed area on the right breast that remains red and tender despite applying warmth and massage to the area. The lactation consultant helps Barbara Ann to position the infant in a way that allows drainage of the inflamed area and recommends she pump the affected side to relieve the discomfort. The crack on the right nipple has improved, but is still not completely healed. Barbara Ann continues to show signs of oversupply, such as breasts feeling uncomfortably full, even after feeding, and excessive milk leakage between feedings. The lactation consultant provides Barbara Ann with techniques to decrease her overproduction.

After 10 days of persistent burning pain in the nipple area, Barbara Ann is treated with fluconazole for a yeast infection. Seven days after starting the fluconazole, a topical nystatin ointment is prescribed for her nipples and an oral suspension for her infant.

At seven weeks postpartum, Barbara Ann calls the lactation consultant to report another flare -up of mastitis. Her health care provider prescribes a 10-day course of dicloxacillin. Barbara Ann is still treating her nipples with nystatin ointment. At eight weeks postpartum her mastitis resolved; her nipple pain is still present, but improving. Barbara Ann is nursing the infant on one side only per feeding and reports that the infant latches better when she is in a more reclined position.

Name the causes of engorgement.

Summary Introduction

To mention: The cause of engorgement.

Introduction: Chronic mastitis is a breast disease that leads to prolonged inflammation. This disease occurs in case of mother who avoids breastfeeding. Breastfeeding is the most important and natural way to feed a new born baby. Mother’s milk provides all the nutrition and immunity to the baby, which is needed during the first six months; breastfeeding satisfies their hunger and thirst and provides the proper amount of protein, minerals, and immunity to the child, which helps to deal with the environment.


Person B was pregnant at the age of 29 and during her pregnancy she has reported experiencing breast enlargement. At two hours postpartum, the infant is put to the breast and the infant handles well. The infant nurses over the initial 3-4 days postpartum in every two hours. Person B noticed fuller during third of postpartum and gradually she fells painful engorgement by fourth postpartum day. During this time, she also reports painful, burning, and cracked sensation in her nipples. At this time, the infant is unable to latch properly at the breast. This leads to irritable sensation for the infant and painful sensation for Person B. Person B consulted a lactation consultant and follows engorgement management. On 5th day, the engorgement causes discomfort. The nipples of Person D become more cracked and painful because the latch of infant has become shallow and tight to control the milk flow. In case of infant, all symptoms show about the adequate intake of nutrition. By day 7 of postpartum, Person D has mastitis and consulted lactation consultant for treatment. By day 14, her symptoms become very less and she feels much better. At three weeks she still has inflammation during infant feeding and a healing crack and still some symptoms of chronic mastitis are present.

Again she consulted the lactation consultant who helps Person B to position the infant in a comfortable way that mostly allows the drainage of the inflamed area and recommends her to pump the affected side to relieve the discomfort during breastfeeding. Then Person B continues to show the signs of oversupply like breast feeling full after feeding and excess leakage of milk between feedings. Her lactation consultant provides techniques to decrease the overproduction of milk. After 10 days of burning pain in the nipple Person B is treated with fluconazole for a yeast infection. Again after seven weeks of postpartum, Person B consulted lactation consultant to report about another mastitis condition. Her consultant prescribes dicloxacillin for treatment. At eight week of postpartum, her mastitis condition resolved but pain is still present in her nipple also she is improving from mastitis condition.

In this case study the cause of engorgement are as follows:

  • • Instability between the demand of milk and the supply of milk.
  • • Abundant amount of milk.
  • • Improper breast feeding techniques.
  • • Infrequent or ineffective removal of milk from breast.

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