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Lactation Case Study

25 points

Wendy Barth

INSTRUCTIONS: Respond to each question, add your name to the document, and submit into the Dropbox
labeled “Lactation Case Study” on D2L.

Consider information from the following scenario to answer questions 2 – 7 below.

A single 22-year old mother, Jessica, had an uncomplicated delivery and is exclusively breastfeeding her newborn son,
Sam. Sam was born with no health problems at a birth weight of 7 lbs 4 oz. Three days after discharge from the hospital,
Jessica and Sam had a follow-up visit with his pediatrician and the baby’s weight was 5 oz less than his birth weight. This
was alarming to Jessica. However, the pediatrician had no concerns about Sam’s weight and explained to her that a
healthy newborn is expected to lose 7% to 10% of the birth weight but should regain that weight by about 2 weeks after
birth. The pediatrician told her he was confident the baby was being fed adequately. She was encouraged to continue
breastfeeding on demand and scheduled a routine 1-month well baby visit.

One week later, Jessica brings Sam to the WIC clinic where you are working. Jessica is still very concerned about whether
her son is getting adequate nourishment because she can’t tell how much milk he is consuming. She worries whether she
is making enough milk and states that “he wants to nurse all day and night.” During a health and diet assessment, the
following information on the mother and baby is gathered:

Sam
- Sam now weighs 7 lbs 11 oz
- Sam nurses vigorously for about 10-15 minutes on one breast every 1.5-3 hours. Jessica alternates the breast that is
offered with each feeding- just like the lactation consultant in the hospital instructed her to do. She states she can hear
the infant rhythmically sucking and swallowing throughout the feeding.
- Sam has at least 6-8 wet diapers and 3-4 soft yellow stools daily
- Sam is alert, bright, and responsive. He wakes on his own to nurse and Jessica notices that he sucks on his hands or
displays the “rooting reflex” to show he is hungry.

Jessica
- Jessica feels that her milk “came in” on the third day postpartum and feels like all she does right now is nurse
- Jessica had nipple discomfort in the first week, but states it is getting better. She doesn’t have any cracking or
bleeding.
- Jessica has help from her older sister in the evenings at home, but feels like she can’t catch up on sleep and is
exhausted
- With limited time for herself, Jessica has been eating a lot of convenience foods. Her appetite has been fair since she
is more concerned about caring for Sam than her diet right now. A 24-hour recall shows this typical dietary intake:
o Breakfast: a bowl of breakfast cereal, 1 cup 1% milk, 1 small banana, 2 cups coffee
o Lunch: peanut butter sandwich, handful of chips, diet coke
o Supper: frozen burrito with salsa or a can of soup with crackers
- She has been feeling very thirsty since coming home from the hospital and tries to drink fluids throughout the day.
Most often she drinks water, diet coke, or coffee.
- Jessica is a CNA (certified nursing assistant) and works in a nursing home. She is on her feet and busy caring for
residents through every 8-hour shift. She doesn’t usually have formal breaks, but the workplace does encourage
employees to take a 30-minute meal break. She doesn’t work consistent hours, sometimes she will work early
mornings and later nights. Jessica recently found out that she will have to return to work in 4 weeks and is very
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anxious about how she will continue to feed her son breastmilk while being away from him for about 9 hours at a
time. She is worried about asking her male boss about taking time to express milk with the electric pump she already
has.

Questions

1) The American Academy of Pediatrics (AAP) Policy Statement on Breastfeeding and the Use of Human Milk
describes multiple infant, maternal, and economic benefits of breastfeeding in the U.S. This document is posted
on D2L. What are 3 health benefits of breastfeeding for infants and postpartum women? Briefly explain each
one. (5 points)
a) Three health benefits of breastfeeding for infants and postpartum women are:
i. Economic benefits- The mother is producing the milk for the infant, therefore saving money, rather
than spending it on formula that tends to be very pricey. It’s basically “free food”.
ii. Lower chance of obesity- There is a 15% to 30% reduction in adolescent and adult obesity rates if
the infant is breastfed opposed to not being breastfed in infancy.
iii. Decreased chance of allergic disease- Mothers exclusively breastfeeding for 3 to 4 months
demonstrate a protective effect that reduces the incidence of asthma, atopic dermatitis, and eczema by
27% in a low-risk population and 42% in infants with a positive family history of allergic diseases.

2) List and explain 3 specific ways Jessica can be reassured that Sam is getting adequate nutrition through
breastfeeding. (6 points)
a) Malnourished infants become sleepy, non-responsive, have a weak cry, and wet few diapers. Three specific
ways Jessica can be reassured that Sam is getting adequate nutrition through breastfeeding are:
i. Sam has 6-8 wet diapers.
ii. He is alert, bright, and responsive.
iii. Sam awakes on his own and shows when he is hungry by sucking on his hand displaying the “rooting
reflex”.

These are all signs that he is getting adequate nutrition, otherwise he would be showing the malnourishment signs.
He is showing the opposites which I listed above.

3) Jessica knows she doesn’t eat a perfect diet and asks whether her lack of a balanced diet right now will affect
the nutrients that Sam receives through her breastmilk. What would you tell Jessica regarding her diet and
how it may affect her breastmilk? and why? (4 points)
a) The things I would address regarding Jessica’s diet and how it affects the nutrients that Sam receives through
her breastmilk are:
i. First off total calorie intake should not be <1800 kcal. Less than 1800 kcal diet unlikely to meet
nutrient needs.
ii. Since she’s concerned about her lack of a balanced diet with the nutrient needs of her baby, she will
need to incorporate more of a variety to her diet or start taking vitamins and minerals.
iii. Based off her diet recall she consumes very little fruit, vegetable, and protein options and is heavier
on carbohydrates, fats, and sugars. Sam is not being getting the protein or vitamins and minerals he
needs or at least not great enough amounts. He is getting fats and sugars which isn’t good for Sam’s
health if this diet is continued because it could lead to the development of diabetes, obesity, or a
preference for such foods when she does try solid foods with Sam.
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4) Is Jessica’s current diet adequate to maintain her own nutritional status? Yes or No and why? List at least 2
easy and practical recommendations to help her meet nutritional needs while balancing the new demands of an
infant (keep in mind that she is exhausted and may have a limited budget for food). Describe why you are
making each recommendation (to meet a specific nutrient need, etc.). (4 points)
a) I would say that Jessica’s current diet is not adequate enough to maintain her own nutritional diet because if
she continues to opt for more convince foods she will be lacking in various vitamins and minerals while
increasing the amount of saturated fats, sodium, and sugar she is consuming. Someone that wasn’t lactating
could probably get away with this diet but since she is breastfeeding she needs extra calories due to the
expenditure of calories from producing milk.
b) Two easy and practical recommendations I have to help her meet nutritional needs while also balancing the
new demands of her baby would be to add a snack or two into her day, such as yogurt, mixed nuts, granola
bar, or a fruit/ veggie. Snacks like this are usually very easy to come by and very cost efficient. They would
provide Sam with calcium and vitamin D, protein and fats, and vitamin and minerals.
c) Another easy and practical recommendation I could make to Jessica would be to take a postnatal or multi-
vitamin to ensure she is getting the right vitamins and minerals passed on to her baby through her breast milk.
d) If she is unable to do both of these suggestions, I would refer her to a WIC clinic so that if she has a limited
budget she can get the foods she needs from the program to ensure Sam is getting the proper nutrition he
needs to grow healthy.

5) Explain 3 factors that put Jessica at high risk for early termination of breastfeeding? (4 points)
a) Three factors that put Jessica at high risk for early termination of breastfeeding are:
i. Her job as a CNA working 8 hours, constantly taking care of her patients.
ii. The fact that she has to go back to work in 4 weeks and will be away from her baby for 9 hours at a
time.
iii. That she is afraid to talk to her male boss about expressing milk during the work day. If she doesn’t
do this she will eventually stop producing milk.

6) The Position of AND: Promoting and Supporting Breastfeeding describes several ways that food and nutrition
professionals can promote and support breastfeeding (begins on page 1937 of the document). As a future
dietitian or professional in the food systems and technology field, what roles or responsibilities do you see
yourself engaging in to promote and support breastfeeding? Give specific examples and details. (2 points)

Some roles I would see myself as a future dietitian engaging in to promote and support breastfeeding
would be providing up-to-date, practical information to pregnant and postpartum women, involving family and
friends in the education and counseling of breastfeeding. I could also advocate for the removal of institutional
barriers to breastfeeding, collaborate with community orgs. and other programs that promote and support
breastfeeding, and advocate for policies that position breastfeeding as the most socially normal for infant feeding.