3.0 Case Study C (Joanne)

Key Points - Case Study C
Joanne is discharged early on day three and comes to see you for follow-up on day five. The day following discharge her breasts became painful and hard and Rosie is again having difficulty latching on to the breast. Is this normal? What would you suggest Joanne do?
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Topic 3.1: Early problems
- There is a difference between breast fullness and engorgement. Early frequent feeding and good breast drainage helps prevent and manage engorgement.
You see Joanne and Rosie again at 10 days. Joanne's breasts have settled and Rosie is feeding well. However, she has been feeding frequently at night and Joanne's husband, Tom, has suggested bringing the baby to bed with them. Joanne has heard that this increases the risk of SIDS. What would you tell her?
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Topic 3.2: Risk of SIDS
- It is normal for breastfed infants to feed frequently and wake at night in the first few weeks of life. Some continue to wake for a longer period. Many parents will co-sleep (where the infant is in close physical and/or social relationship with another person) and/or choose to bed-share (adults and infants sharing the same sleep surfaces) during this time. Safe sleeping guidelines should be followed to reduce the risk of SIDS.
Joanne had been on the combined oral contraceptive pill before becoming pregnant. She intends to not use any contraception until she is six months postpartum. Is this a realistic option?
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Topic 3.3: Contraception
- Lactational Amenorrhoea Method (LAM) of contraception is an effective method of contraception during the first six months postpartum. Non-hormonal forms of contraception are the methods of choice when another form of contraception is needed. Oestrogen containing contraceptive methods should preferably not be used during lactation.
Joanne brings Rosie for immunization at four months. She is concerned about the composition of her milk. Although Rosie had been growing along the 50th percentile, her weight gain has started to slow.
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Topic 3.4: Milk composition
- The composition of breast milk includes carbohydrates, proteins, fats, vitamins and minerals in unique combinations and concentrations ideally suited to the developing human infant.
Is there any concern about a slowing of growth around this time?
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Topic 3.5: Slowing of growth
- Infant growth is highest in the first few months postpartum and then begins to slow around four to six months. New WHO growth charts show how breastfed infants 'should' grow and may more accurately reflect normal growth than previously used charts.
Joanne asks about introducing solids at this age. How long is breast milk alone adequate for infant growth?
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Topic 3.6: Introducing solids
- Breast milk alone is sufficient for growth and development until the infant is around six months of age. Appropriate complementary foods from that time will provide extra energy (especially protein) and micronutrients such as iron and zinc.
What recommendations would you give Joanne about the appropriate time to wean Rosie from the breast?
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Topic 3.7: Weaning
- There is no set maximum time for breastfeeding to continue although the minimum recommended time for weaning is 12 months (NHMRC, AAP) or two years (WHO). Gradual weaning is ideal.