CBS Maternal & Infant Health 3 — Questions and Answers
Question 1: A newborn has lost 9% of birth weight by day 3. The mother has flat nipples and reports pain during feeding. What is the priority intervention?
- Initiate formula supplementation immediately and discontinue breastfeeding
- Assess latch, offer hands-on positioning support, and consider nipple eversion techniques (Correct answer)
- Schedule a follow-up appointment in one week
- Recommend nipple shields without a latch assessment
Correct answer: Assess latch, offer hands-on positioning support, and consider nipple eversion techniques
Addressing latch and positioning problems is the first step; weight loss up to 10% in the first week can often be managed by improving feeding technique.
Question 2: Mastitis most commonly occurs in which postpartum timeframe?
- First week postpartum
- Second to third week postpartum (Correct answer)
- Three to six months postpartum
- After weaning begins
Correct answer: Second to third week postpartum
Mastitis most frequently occurs in the second and third weeks postpartum, though it can happen at any point during lactation.
Question 3: What is the most common bacterial organism responsible for infectious mastitis?
- Streptococcus pyogenes
- Staphylococcus aureus (Correct answer)
- Escherichia coli
- Candida albicans
Correct answer: Staphylococcus aureus
Staphylococcus aureus, often from the infant's oral flora, is the predominant pathogen in lactational mastitis.
Question 4: A mother with mastitis asks if she should stop breastfeeding on the affected side. What is the evidence-based recommendation?
- Stop breastfeeding completely until antibiotics are finished
- Continue breastfeeding or pumping on the affected side to promote drainage (Correct answer)
- Breastfeed only on the unaffected side
- Apply ice and avoid any breast stimulation
Correct answer: Continue breastfeeding or pumping on the affected side to promote drainage
Continued milk removal from the affected breast is essential to resolve mastitis and prevent abscess formation.
Question 5: Which maternal medication is considered safe during breastfeeding for pain management of mastitis?
- Aspirin
- Ibuprofen (Correct answer)
- Codeine
- Naproxen sodium
Correct answer: Ibuprofen
Ibuprofen is preferred for breastfeeding mothers because it transfers minimally into breast milk and has anti-inflammatory properties beneficial for mastitis.
Question 6: A CBS notices a mother's nipple blanches white after feeding, followed by burning pain. This presentation is MOST consistent with:
- Nipple thrush
- Raynaud's phenomenon of the nipple (Correct answer)
- Contact dermatitis
- Bacterial mastitis
Correct answer: Raynaud's phenomenon of the nipple
Nipple blanching followed by color changes (white, then blue/red) and burning pain after feeding is the classic presentation of Raynaud's phenomenon affecting the nipple.
Question 7: Which vitamin deficiency is of particular concern in exclusively breastfed infants and requires supplementation per AAP guidelines?
- Vitamin C
- Vitamin D (Correct answer)
- Vitamin B12
- Vitamin K
Correct answer: Vitamin D
Breast milk contains insufficient vitamin D for most infants; the AAP recommends 400 IU/day of vitamin D supplementation starting within the first few days of life.
CBS Maternal & Infant Health 3
A newborn has lost 9% of birth weight by day 3.
The mother has flat nipples and reports pain during feeding.
What is the priority intervention?