CMS Breastfeeding & Lactation Support 2 — Questions and Answers
Question 1: A breastfeeding mother presents with a red, warm, tender wedge-shaped area on one breast along with fever of 38.5°C and flu-like symptoms. This presentation is most consistent with:
- Breast engorgement
- Blocked milk duct without infection
- Mastitis (Correct answer)
- Breast abscess requiring surgical drainage
Correct answer: Mastitis
Mastitis presents with localized breast erythema, warmth, tenderness, and systemic symptoms including fever above 38.5°C and flu-like illness, typically caused by Staphylococcus aureus.
Question 2: What is the recommended management for lactational mastitis in an otherwise healthy breastfeeding mother?
- Immediate cessation of breastfeeding from the affected breast
- Antibiotics (e.g., dicloxacillin) and continued breastfeeding or pumping (Correct answer)
- Surgical drainage and temporary breastfeeding cessation
- Antihistamines and cold compresses only, without antibiotics
Correct answer: Antibiotics (e.g., dicloxacillin) and continued breastfeeding or pumping
Mastitis treatment includes appropriate antibiotics targeting Staphylococcus aureus while continuing to breastfeed or pump to prevent milk stasis, which could lead to abscess formation.
Question 3: Which medication is contraindicated in breastfeeding mothers due to significant risk of infant harm and milk supply suppression?
- Ibuprofen
- Acetaminophen
- Ergotamine (Correct answer)
- Amoxicillin
Correct answer: Ergotamine
Ergotamine is contraindicated during breastfeeding because it transfers into milk, can cause neonatal vomiting, diarrhea, and seizures, and also suppresses prolactin-mediated milk production.
Question 4: Which assessment finding would most strongly suggest insufficient breast milk supply in a breastfeeding newborn?
- Six to eight wet diapers per day after day 4
- Infant regaining birth weight by day 10 to 14
- Feeding sessions consistently lasting 45 to 60 minutes with continued signs of hunger (Correct answer)
- Feeding every 2 to 3 hours around the clock
Correct answer: Feeding sessions consistently lasting 45 to 60 minutes with continued signs of hunger
Excessively prolonged feeding sessions with persistent infant dissatisfaction and hunger cues suggest poor milk transfer or inadequate supply and warrant lactation assessment.
Question 5: Which finding indicates a correct and effective breastfeeding latch?
- Infant's lips are pursed inward around the nipple tip
- Only the nipple is visible in the infant's mouth with the areola exposed
- Infant's chin touches the breast, mouth is wide open, and lips are flanged outward (Correct answer)
- Clicking or smacking sounds are audible during feeding
Correct answer: Infant's chin touches the breast, mouth is wide open, and lips are flanged outward
An effective latch is characterized by a widely open mouth, chin pressed against the breast, lips flanged outward, and asymmetric coverage of the areola ensuring efficient milk transfer without nipple trauma.
Question 6: Domperidone is classified as a galactogogue. By what mechanism does it increase milk supply?
- It directly stimulates oxytocin release from the posterior pituitary
- It acts as a dopamine antagonist, increasing prolactin secretion (Correct answer)
- It provides phytoestrogens that mimic estrogen effects on breast tissue
- It enhances nutrient absorption improving overall milk fat content
Correct answer: It acts as a dopamine antagonist, increasing prolactin secretion
Domperidone is a dopamine D2-receptor antagonist; by blocking dopamine's inhibitory effect on the pituitary, it elevates prolactin levels, thereby stimulating increased milk production.
Question 7: What is the most effective first-line management for breast engorgement in a breastfeeding mother?
- Applying ice packs continuously and restricting oral fluid intake
- Binding the breasts tightly between each feeding session
- Frequent nursing or pumping with warm compresses before feeding and cold compresses after (Correct answer)
- Transitioning immediately to formula feeding to relieve pressure
Correct answer: Frequent nursing or pumping with warm compresses before feeding and cold compresses after
Engorgement is managed by regularly removing milk through frequent breastfeeding or pumping; warm compresses before feeding promote let-down while cold compresses afterward reduce inflammation.
CMS Breastfeeding & Lactation Support 2
A breastfeeding mother presents with a red, warm, tender wedge-shaped area on one breast along with fever of 38.5°C and flu-like symptoms.
This presentation is most consistent with: