ITEMS IN AFP WITH MESH TERM:
Initial Management of Breastfeeding - Article
ABSTRACT: Breast milk is widely accepted as the ideal source of nutrition for infants. In order to ensure success in breastfeeding, it is important that it be initiated as early as possible during the neonatal period. This is facilitated by skin-to-skin contact between the mother and infant immediately following birth. When possible, the infant should be allowed to root and latch on spontaneously within the first hour of life. Many common nursery routines such as weighing the infant, administration of vitamin K and application of ocular antibiotics can be safely delayed until after the initial breastfeeding. Postpartum care practices that improve breastfeeding rates include rooming-in, anticipatory guidance about breastfeeding problems and the avoidance of formula supplementation and pacifiers.
Returning to Work While Breastfeeding - Article
ABSTRACT: Mothers who work outside the home initiate breastfeeding at the same rate as mothers who stay at home. However, the breastfeeding continuance rate declines sharply in mothers who return to work. While the work environment may be less than ideal for the breastfeeding mother, obstacles can be overcome. Available breast pump types include manual pumps, battery-powered pumps, electric diaphragm pumps, electric piston pumps, and hospital-grade electric piston pumps. Electric piston pumps may be the most suitable type for mothers who work outside the home for more than 20 hours per week; however, when a mother is highly motivated, any pump type can be successful in any situation. Conservative estimates suggest that breast milk can be stored at room temperature for eight hours, refrigerated for up to eight days, and frozen for many months. A breastfeeding plan can help the working mother anticipate logistic problems and devise a practical pumping schedule. A mother's milk production usually is well established by the time her infant is four weeks old; it is best to delay a return to work until at least that time, and longer if possible.
ABSTRACT: The postpartum period (typically the first six weeks after delivery) may underscore physical and emotional health issues in new mothers. A structured approach to the postpartum office visit ensures that relevant conditions and concerns are discussed and appropriately addressed. Common medical complications during this period include persistent postpartum bleeding, endometritis, urinary incontinence, and thyroid disorders. Breastfeeding education and behavioral counseling may increase breastfeeding continuance. Postpartum depression can cause significant morbidity for the mother and baby; a postnatal depression screening tool may assist in diagnosing depression-related conditions. Decreased libido can affect sexual functioning after a woman gives birth. Physicians should also discuss contraception with postpartum patients, even those who are breastfeeding. Progestin-only contraceptives are recommended for breastfeeding women. The lactational amenorrhea method may be a birth control option but requires strict criteria for effectiveness.
Rickets: Not a Disease of the Past - Article
ABSTRACT: Rickets develops when growing bones fail to mineralize. In most cases, the diagnosis is established with a thorough history and physical examination and confirmed by laboratory evaluation. Nutritional rickets can be caused by inadequate intake of nutrients (vitamin D in particular); however, it is not uncommon in dark-skinned children who have limited sun exposure and in infants who are breastfed exclusively. Vitamin D-dependent rickets, type I results from abnormalities in the gene coding for 25(OH)D3-1-alpha-hydroxylase, and type II results from defective vitamin D receptors. The vitamin D-resistant types are familial hypophosphatemic rickets and hereditary hypophosphatemic rickets with hypercalciuria. Other causes of rickets include renal disease, medications, and malabsorption syndromes. Nutritional rickets is treated by replacing the deficient nutrient. Mothers who breastfeed exclusively need to be informed of the recommendation to give their infants vitamin D supplements beginning in the first two months of life to prevent nutritional rickets. Vitamin D-dependent rickets, type I is treated with vitamin D; management of type II is more challenging. Familial hypophosphatemic rickets is treated with phosphorus and vitamin D, whereas hereditary hypophosphatemic rickets with hypercalciuria is treated with phosphorus alone. Families with inherited rickets may seek genetic counseling. The aim of early diagnosis and treatment is to resolve biochemical derangements and prevent complications such as severe deformities that may require surgical intervention.
Initiating Hormonal Contraception - Article
ABSTRACT: Most women can safely begin taking hormonal birth control products immediately after an office visit, at any point in the menstrual cycle. Because hormonal contraceptives do not accelerate cervical neoplasia or interfere with cervical cytology, women who have not had a recent Papanicolaou smear can begin using hormonal contraceptives before the test is performed. After childbirth, most women can begin using progestin-only contraceptives immediately. Estrogen-containing methods can safely be initiated six weeks to six months postpartum for women who are breastfeeding their infants and three weeks postpartum for women who are not breastfeeding. Women can begin any appropriate contraceptive method immediately following an early abortion. Delaying contraception may decrease adherence. Physicians can help patients improve their use of birth control by providing anticipatory guidance about the most common side effects, giving comprehensive information about available choices, and honoring women's preferences. An evidence-based, flexible, patient-centered approach to initiating contraception may help to lower the high rate of unintended pregnancy in the United States.
Strategies for Breastfeeding Success - Article
ABSTRACT: Breastfeeding provides significant health benefits for infants and mothers. However, the United States continues to fall short of the breastfeeding goals set by the Healthy People 2010 initiative. The American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetrics and Gynecology have policy statements supporting breastfeeding that reflect recent advancements in understanding the mechanisms underlying the benefits of breastfeeding and in the clinical management of breastfeeding. Despite popular belief, there are few contraindications to breastfeeding. Providing maternal support and structured antenatal and postpartum breastfeeding education are the most effective means of achieving breastfeeding success. In addition, immediate skin-to-skin contact between mother and infant and early initiation of breastfeeding are shown to improve breastfeeding outcomes. When concerns about lactation arise during newborn visits, the infant must be carefully assessed for jaundice, weight loss, and signs of failure to thrive. If a work-up is required, parents should be supported in their decision to breastfeed. Certified lactation consultants can provide valuable support and education to patients. Physicians should educate working women who breastfeed about the availability of breast pumps and the proper storage of expressed breast milk. Physicians must be aware of their patients' lactation status when prescribing medications, as some may affect milk supply or be unsafe for breastfeeding infants. Through support and encouragement of breastfeeding, national breastfeeding goals can be met.
ABSTRACT: Although the cause or causes of sudden infant death syndrome (SIDS) remain unknown, the incidence of SIDS is on the decline in the United States and other countries. This decline has been accomplished largely through public education campaigns informing parents about several important factors associated with an increased risk of SIDS. These factors are prone and side infant sleeping positions, exposure of infants to cigarette smoke and potentially hazardous sleeping environments. Risk-reduction measures such as placing healthy infants to sleep in the supine position, avoiding passive smoke exposure both before and after birth and optimizing crib safety are beginning to lower the SIDS rate in this country. Through patient education, family physicians can further reduce the incidence of the number one cause of death in infants one week to one year old.
Medications in the Breast-Feeding Mother - Article
ABSTRACT: Prescribing medications for a breast-feeding mother requires weighing the benefits of medication use for the mother against the risk of not breast-feeding the infant or the potential risk of exposing the infant to medications. A drug that is safe for use during pregnancy may not be safe for the nursing infant. The transfer of medications into breast milk depends on a concentration gradient that allows passive diffusion of nonionized, non-protein-bound drugs. The infant's medication exposure can be limited by prescribing medications to the breast-feeding mother that are poorly absorbed orally, by avoiding breast-feeding during times of peak maternal serum drug concentration and by prescribing topical therapy when possible. Mothers of premature or otherwise compromised infants may require altered dosing to avoid drug accumulation and toxicity in these infants. The most accurate and up-to-date sources of information, including Internet resources and telephone consultations, should be used.
ABSTRACT: Mastitis occurs in approximately 10 percent of U.S. mothers who are breastfeeding, and it can lead to the cessation of breastfeeding. The risk of mastitis can be reduced by frequent, complete emptying of the breast and by optimizing breastfeeding technique. Sore nipples can precipitate mastitis. The differential diagnosis of sore nipples includes mechanical irritation from a poor latch or infant mouth anomalies, such as cleft palate or bacterial or yeast infection. The diagnosis of mastitis is usually clinical, with patients presenting with focal tenderness in one breast accompanied by fever and malaise. Treatment includes changing breastfeeding technique, often with the assistance of a lactation consultant. When antibiotics are needed, those effective against Staphylococcus aureus (e.g., dicloxacillin, cephalexin) are preferred. As methicillin-resistant S. aureus becomes more common, it is likely to be a more common cause of mastitis, and antibiotics that are effective against this organism may become preferred. Continued breastfeeding should be encouraged in the presence of mastitis and generally does not pose a risk to the infant. Breast abscess is the most common complication of mastitis. It can be prevented by early treatment of mastitis and continued breastfeeding. Once an abscess occurs, surgical drainage or needle aspiration is needed. Breastfeeding can usually continue in the presence of a treated abscess.