Case Study: Breastfeeding Mother

For my pregnancy nutrition class I wrote out a case study for a fictional woman who has an 8 week old baby. Below you will find out how I determined the kind of care the mother needs and when she should introduce solids to her baby. Please note: THIS IS MY OWN WORK. DO NOT COPY OR USE–EVER! Thanks. 🙂

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Part I: Overview

Susan has an 8 week old son named Ryan whom she exclusively breastfeeds on demand or every three hours. Ryan was born healthy at 7# 8oz and now weighs 11# 3 oz. Susan has complaints of fatigue and nipple soreness. She is not taking a prenatal vitamin and wants more information on when to start Ryan on solid foods.

Part II: Newborn Assessment

Ryan has gained 3# 5oz since his birth which is roughly half a pound a week. According to the graph on page 230 in Nutrition Through the Lifecycle, his weight gain is right on track for an infant between 0-3 months old in which a gain of 1# 3oz-2# is considered normal (Brown, 2011). For an 8 month old, Ryan’s feeding pattern is normal and appropriate. Susan is paying attention to his hunger cues and feeding on demand while also ensuring that he eats every three hours if he has not shown hunger signs before that time. He is gaining weight and not showing signs of failure to thrive. Susan should begin giving Ryan a daily supplement of 400 IU of vitamin D which is recommended by the APA due to increased incidence of vitamin D deficiency (Brown, 2011).

Part III: Mother’s Assessment: Nipple Soreness

Susan is breastfeeding on demand which may be why she is experiencing nipple soreness. She should use a nipple cream to ease the pain and soothe any cracking. She should also see a lactation specialist to ensure that Ryan’s latch is correct. Since he is gaining weight, it seems that his latch may be is fine. It is normal for there to be soreness the first few sucks, but breastfeeding should not be painful. “By the time the baby is 2 weeks old, nursing should be pain free. If your nipples crack or bleed, if the pain persists during the entire feeding or between feedings, if you experience a burning sensation or the pain persists beyond the first week or two, you need to seek help from an IBCLC or HCP who is knowledgeable in breastfeeding in order to identify and correct the problem” (Smith).

Susan can apply breast milk to her nipples to ease soreness or another topical ointment like Lanolin to keep her nipples moisturized. She should also leave her breasts exposed to the air after a feeding to minimize discomfort from her clothing rubbing against her sensitive nipples. When she sees her lactation specialist, she should also be checked for thrush, a bacterial yeast infection that can cause painful breastfeeding.

Part IV: Mother’s Assessment: Fatigue and Nutrition

Susan has been complaining of fatigue. Causes for her fatigue are related both to the sleep deprivation that having a newborn brings, but is more so due to her diet. She should begin taking her prenatal vitamin as soon as possible while also supplementing an extra 300 mg of calcium per day. Vitamin D helps support the loss of this vital nutrient from breastfeeding and meets her needs for calcium.

The major reason for her fatigue is due to her lack of extra caloric intake per day. “Because a woman’s body uses calories just to produce breast milk, it is important to ensure you are taking in an extra 500 calories per day to maintain adequate energy levels” (Cadena, 2007). This means Susan should be eating 2500 calories per day. Based on her caloric intake provided by her food diary, she is only eating 1600 calories a day, nearly 900 fewer than recommended. She is also not eating enough carbohydrates. Based on the MyPyramid for Moms, Susan is missing the 6.5oz of meat and beans from her diet and 2 cups of veggies. Carrots would be a great snack for her to incorporate. For dinner, if she had cooked chicken with pasta, plus an avocado as a late night snack and at least one granola bar during the day she would be eating over 2500 calories.

Susan is also dehydrated. She should be drinking at least nine 8oz glasses of water a day, if not more. She should make a habit of always having a glass of water with her while she is nursing Ryan as well as a snack like a granola bar to up her calories and energy. She should be snacking often throughout the day. As soon as she begins to drink more water and eat more calories and carbohydrates, she will notice a huge increase in energy and less fatigue. If she doesn’t, then she needs to seek medical attention from her doctor to see if there is anything else that might be causing the fatigue and lack of energy.

Part V: Introducing Solids to Ryan

“The US Surgeon General recommends human milk feeding exclusively for 6 months, noting further that it is better to breastfeed for 6 months and best to breastfeed for 12 months, with solid foods being introduced at 4-6 months” (Brown, 2011). Susan can begin to introduce rice cereal mixed with some expressed breast milk when Ryan is 4 months old, however he may not be ready. Most importantly, Susan should first discuss this with Ryan’s pediatrician. She should also pay attention to the signs Ryan is giving her, for example if he begins to reach for her food after a nursing session, he may be ready to try some rice cereal. Once he has had some rice cereal for a month or two, she can introduce fruits like banana and pear, which can also be mixed with the rice cereal. Lastly, depending on her lifestyle, she should begin to read up on baby led weaning (BLW), a new and innovative way to introduce real foods to babies at 6 months old.

Part VI: Conclusion

Ryan is a healthy 8 week old baby who is nursing often enough and gaining weight well. His mother, Susan, is exclusively breastfeeding and needs to change her eating habits by drinking more water, taking her prenatal vitamin, and eating 2500 calories a day. She needs to see a lactation specialist to figure out why she is still having nipple soreness. Once Ryan is showing interest around 4-6 months, she can offer him some rice cereal.

Part VI: References

Smith, A. Breastfeeding Basics: Sore Nipples. Retrieved on September 11, 2012 from:

http://www.breastfeedingbasics.com/articles/sore-nipples

Cadena, C. (May 31, 2007). Why Diet and Nutrition to the Breastfeeding Mother than to the Baby. Retrieved on September 11, 2012 from:

http://voices.yahoo.com/why-diet-nutrition-more-important-breastfeeding-367982.html

Brown, J. E. (2011). Nutrition Through the Life Cycle (4th Ed). Belmont, CA:Wadsworth.

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