Breast Engorgement

PLAB 2 CaseBank
1

History:

  • Painful at the starts of fews days after birth but it can occur later
  • Often bilateral
  • Worse before feeding
  • The whole breast is swollen and tender
  • Nipple is stretched and looks flat.
  • Infant attachment may be difficult due to breast fullness and milk flow may be reduced.
  • The infant may cough and pull off the breast on feeding or clamp down on the nipple during feeding to control flow.

Other history

  • PMAFTOSA
  • ICE (is anything you fear to be the cause of systems , anything you worried about)
  • Effect of symptoms

Examination :

  • Observations: As a part of examination, I’d like to check your vitals; your BP – Pulse Oxygen – RR – Temp
  • Specific Examinations: Breast examination
  • Findings
    – temp 36.7°c
    – Breast examination: Tenderness and swelling around the areola. No redness, discharge, no fissures, No lymphadenopathy

Provisional Diagnosis:

  • From what you have told me and what I can see, I think it does look like a BREAST ENGORGEMENT
  • PAUSE
  • DEFINE THE DIAGNOSIS: This is when the breast becomes overly full. The breast may feel hard, tight and painful When the breast is engorged, it may become difficult for the baby to latch on to the breast.
  • The nipple can become overstretched and flattened.

MANAGEMENT
TREATMENT

  • Simple analgesia (paracetamol or ibuprofen). These are safe to use in breastfeeding.
  • A little expression of milk may relief the pain
  • Excessive expression of milk may lead to over production of milk supply
  • Expressing of little milk before breast feeding to soften the areola
  • Use heat packs before breast feeding or expression may stimulate milk let-down
  • Wearing a well fitting bra and wearing that doesn’t restrict the Breast feeding
  • Continuing feeding the baby in demand
  • Offer a leaflet and website where you get more information like the NHS website
  • Advice to see the health visitor or the breastfeeding specialist

How to latch the baby to the breast?

  • Hold the baby close to you with their nose level with the nipple
  • Let the baby’s head tilt a little bit backwards
  • Baby’s mouth should be wide and mouthful of breast
  • Baby’s chin touching the breast and nose not squashed to the breast

How to know baby latching well?

  • If baby has wide mouth full of breast
  • If baby chin is touching the breast
  • Nose is not squached to breast
  • You shouldn’t feel pain while feeding
  • You can see dark skin ( areola) around the nipple above baby upper lip than below lower lip

Baby positioning during breastfeeding

  • Baby’s head and body should be in straight line
  • Hold the baby close to you facing your breast
  • Support the baby’s head, body and back
  • You should sit comfortable yourself and avoid leaning your breast towards the baby
  • Always bring your baby to the breast and let the baby latch themselves
  • Safety netting
1 Like
2

Breast engorgement and mastitis

Per rectal RELIEVE"

P PCM
R Rest and hydration
R - Regular Feeding: Breastfeed frequently to prevent milk buildup.
E - Express Milk: Use a breast pump or hand express if the baby is not nursing effectively.
L - Latch Correctly: Ensure a proper latch to help drain the breast more effectively.
I - Ice Packs: Apply cold compresses or ice packs after feeding to reduce swelling and discomfort.
E - Ensure Comfort: Wear a supportive bra that is not too tight to avoid restricting milk flow.
V - Warm Compress: Use warm compresses or take a warm shower before feeding to help with milk flow.
E - Empty One Breast: Allow the baby to empty one breast completely before switching to the other.

Add antibiotics above for mastitis

3

Breast Engorgement
Definition: Breast engorgement is a common condition where the breasts become overly full of milk, causing swelling and discomfort.

Causes:

Usually occurs when milk production increases more than the baby’s milk intake, especially in the early days of breastfeeding or if feedings are missed.
Can happen when there is a sudden change in the frequency of feedings or if the baby is not latching properly.
Symptoms:

Breasts feel firm, swollen, heavy, and tender.
Skin over the breast may feel tight and appear shiny.
Discomfort or pain, but no signs of infection.
May have mild fever or feel slightly warm to the touch, but generally does not cause systemic symptoms.
Treatment:

Frequent breastfeeding or pumping to relieve the fullness.
Applying warm compresses before feeding and cold compresses after feeding to reduce swelling.
Gentle breast massage to help milk flow.
Ensuring proper latch and feeding techniques.
Mastitis
Definition: Mastitis is an inflammation of the breast tissue, often caused by a bacterial infection, which can occur when milk is not effectively removed from the breast.

Causes:

Often results from untreated or severe engorgement or blocked milk ducts.
Bacteria entering the breast through a cracked or sore nipple.
Sudden weaning or infrequent breastfeeding, leading to milk stasis.
Symptoms:

Affected breast is red, swollen, warm, and very painful.
A distinct, hard, and red area on the breast.
Fever (often higher than 101°F or 38.4°C) and flu-like symptoms such as chills, fatigue, and body aches.
The symptoms tend to develop quickly and may worsen without treatment.
Treatment:

Continued breastfeeding or pumping to keep milk flowing and relieve engorgement.
Antibiotics to treat the infection if caused by bacteria.
Pain relievers like ibuprofen or acetaminophen to reduce pain and inflammation.
Warm compresses to help milk flow and cold compresses to reduce swelling.