Breastfeeding — Principles and Problems

A 14-day-old male infant born to a 32-year-old multiparous mother is brought to the clinic for poor weight gain. Birth weight was 3.2 kg; current weight is 3.0 kg. The mother reports breastfeeding 8–10 times daily for 10–15 minutes per side, but the infant appears hungry after each feed and cries excessively. On examination, the infant has dry mucous membranes, sunken fontanelle, and poor skin turgor. The mother's breasts are soft with no engorgement. Lactation assessment reveals shallow latch with clicking sounds during suckling. What is the most likely diagnosis and the best next step?

A 2-week-old exclusively breastfed infant born to a primigravida mother presents with poor weight gain and excessive crying. On examination, the infant has a shallow latch and the mother reports severe nipple pain during feeds. What is the most common cause of breastfeeding failure in this scenario?

A 32-year-old lactating mother develops sudden onset of severe breast pain, localized erythema, induration, and fever (38.5°C) on day 10 postpartum. Milk culture is pending. What is the drug of choice for empirical treatment of acute mastitis in a breastfeeding woman?

A 3-week-old exclusively breastfed infant presents with poor weight gain (regained only to birth weight by day 21), frequent feeds (10–12 per day), and visible milk transfer during feeds. The mother reports breast engorgement, occasional leaking, and adequate milk supply. On examination, the infant is alert, has moist mucous membranes, and passes 6–8 wet diapers daily. What is the most appropriate next step in management?

A 26-year-old mother on day 5 postpartum develops unilateral breast abscess confirmed on ultrasound. She wishes to continue breastfeeding from the affected breast. What is the drug of choice for antibiotic therapy?