Pathology: Maternal and Infant Conditions
Maternal and infant pathology
Maternal: engorgement (diffuse, bilateral, relieved by milk removal) is distinct from a plugged duct (focal tenderness, no systemic symptoms) and from mastitis (focal redness, fever ≥38.4°C, flu-like symptoms, usually Staphylococcus aureus). Continuing milk removal is part of treatment for all three; an abscess is fluctuant and needs ultrasound-guided drainage, not weaning. Nipple pain has causes beyond latch: candidiasis, eczema, vasospasm/Raynaud's, and trauma. Insufficient glandular tissue presents with widely spaced, tubular breasts and little pregnancy-related growth and is managed with supplementation, not more pumping alone. Prior breast reduction surgery, periareolar incisions and some implants raise risk of low supply.
Infant: jaundice has two patterns - "breastfeeding jaundice" (early, from insufficient intake, treated by improving transfer) and "breast milk jaundice" (later, gradual, usually benign, continue feeding). Hypoglycemia risk rises with prematurity, small or large for gestational age, and maternal diabetes. Cleft palate (not cleft lip) impairs suction and needs a specialized feeder. Galactosemia is an absolute contraindication to breast milk; phenylketonuria allows partial breastfeeding with monitoring.
Trap: assuming every red, painful breast is mastitis, or stopping feeding to "rest" the breast.
Rule of thumb: focal redness plus fever means mastitis; fluctuance means abscess; both still allow feeding.