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Difficulty with breast feeding

Specialties > Child health

Differential Diagnosis Schema 🧠

Infant-related Causes

  • Poor latch: Common, often due to incorrect positioning or anatomical issues like tongue-tie.
  • Tongue-tie (Ankyloglossia): Restricts tongue movement, causing difficulty latching.
  • Prematurity: Weak suck reflex, difficulty coordinating suck-swallow-breathe.
  • Cleft palate: Structural issue preventing effective suction.

Maternal-related Causes

  • Flat or inverted nipples: Makes latching difficult for the infant.
  • Breast engorgement: Painful, firm breasts making latching difficult.
  • Mastitis: Inflammation of breast tissue, painful to breastfeed.
  • Low milk supply: Causes frustration for the infant leading to poor feeding.

Technical Issues

  • Incorrect positioning: Common cause of poor latch, leading to ineffective feeding.
  • Improper use of breast pumps: Can cause nipple pain or damage, leading to reluctance to feed.
  • Use of nipple shields: May interfere with the infant’s ability to latch effectively.

Psychological Causes

  • Maternal anxiety: May affect milk let-down reflex and create stress during feeding.
  • Postpartum depression: Can reduce motivation or ability to breastfeed.
  • Previous traumatic breastfeeding experience: May lead to avoidance or difficulty with breastfeeding.

Key Points in History 🥼

Feeding Patterns and Latch

  • Frequency and duration of feeds: Determines adequacy and possible issues with feeding.
  • Pain during breastfeeding: May suggest poor latch, mastitis, or nipple trauma.
  • Infant’s weight gain: Poor weight gain can indicate ineffective feeding or insufficient milk supply.

Nipple and Breast Assessment

  • Nipple shape and condition: Assess for flat, inverted nipples, or signs of trauma.
  • Breast fullness and engorgement: May suggest issues with milk flow or blocked ducts.
  • Signs of infection: Redness, heat, or lumps suggesting mastitis or abscess.

Background

  • Pregnancy and birth history: Any complications that might impact breastfeeding (e.g., premature birth).
  • Previous breastfeeding experience: Any history of difficulties or success with past children.
  • Maternal mental health: History of anxiety or depression which could affect breastfeeding.
  • Medication use: Any medications that could affect milk supply or infant health.

Possible Investigations 🌡️

Clinical Examination

  • Breast examination: Look for signs of engorgement, mastitis, or abscess.
  • Nipple inspection: Check for signs of trauma, cracks, or inversion.
  • Infant oral examination: Assess for tongue-tie, cleft palate, or other anatomical issues.

Investigations

  • Ultrasound: If suspected breast abscess or blocked duct.
  • Milk sample culture: If mastitis is suspected to identify causative organism.
  • Lactation consultation: Specialist assessment for feeding technique and support.
  • Infant weight monitoring: Regular checks to assess adequacy of feeding.

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Child health