Study note
PediatricsNewborn Care

Breast engorgement, breast abscess, and assessment of milk supply

THE CONTEXT
Breastfeeding difficulties require attention to feeding technique, breast complications, and objective evidence of milk intake.

Preventing and treating breast engorgement

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Early and frequent feeding with correct breastfeeding technique helps prevent breast engorgement.
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Treatment consists of hot fomentation, massage, and frequent feeding or expression of milk. Analgesics may be given for pain.

Breast abscess

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An engorged breast, cracked nipple, blocked duct, or mastitis can progress to an abscess if not treated early.
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Breast abscess is associated with high-grade fever, malaise, and profound breast inflammation.
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Management includes analgesics and, when required, incision and drainage. Mothers can often continue breastfeeding.

Assessing perceived insufficient milk

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First establish whether the perception of insufficient milk is correct. A satisfied neonate who sleeps for 2–3 hours after breastfeeding, passes urine at least 6–8 times in 24 hours, and gains weight is receiving enough milk.
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Possible reasons for insufficient milk include incorrect breastfeeding technique, supplementary or bottle feeding, absence of night breastfeeding, breast engorgement, maternal illness, stress, and tiredness. Identify the cause and take appropriate action.
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Keeping the mother and neonate in the same bed allows frequent, on-demand breastfeeding. The mother needs sufficient rest and fluids.
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