1Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak Malaysia.
2Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Selangor Malaysia.
Int Breastfeed J. 2019 Apr 18;14:17. doi: 10.1186/s13006-019-0210-4. eCollection 2019.
Pre-pubescent girls with chest burns are at risk of complication associated with scarring and impairment in breast development. This case illustrates how burn injuries in childhood in a first-time mother have affected her in terms of breastfeeding.
In May 2015, a 20 year old first-time mother at 36 weeks gestation was seen in a district health clinic in Kuching, Sarawak in regards to her ability to breastfeed. She had a history of a flame burn at the age of 5 years old to her chest, abdomen, upper limb and part of her trunk. A skin graft was done on her whole chest and abdomen. Despite the injuries, she had pubertal and antenatal breast development. Her abdomen was able to stretch to accommodate her pregnancy. Physical examination showed a pregnancy which corresponded to date. The skin over her chest and abdomen appeared tight with areas of hyperpigmentation and hypopigmentation due to scarring from the skin graft. Breast tissues were palpable over her chest. The areola and nipple tissue were completely absent with complete scarring of the nipple-areolar complex. There was no duct opening to the areola for milk expression or leakage. Counselling regarding her breastfeeding issues was done. She delivered her baby at full term via spontaneous vaginal delivery with no complication. Oral cabergoline 1 mg was given on the first day postpartum. The baby was given infant formula via bottle feeding as the feeding method of choice.
Counselling plays an important part in the management of a mother with breastfeeding difficulty. Allaying the possible guilty feelings of not being able to breastfeed will fulfil the emotional gap which may arise in a mother with these challenges.
患有胸部烧伤的青春期前女童有发生与瘢痕形成和乳房发育受损相关并发症的风险。本案例说明了一位初为人母的女童在儿童时期的烧伤如何影响其母乳喂养能力。
2015 年 5 月，一位 20 岁的初产妇在妊娠 36 周时，因母乳喂养能力问题在砂拉越古晋的一家地区保健诊所就诊。她在 5 岁时胸部、腹部、上肢和部分躯干被火焰烧伤，曾行全胸部和腹部植皮术。尽管有这些损伤，但她的青春期和产前乳房发育正常。她的腹部能够伸展以适应妊娠。体格检查显示妊娠与孕周相符。她的胸部和腹部皮肤紧绷，由于植皮后的瘢痕形成，存在色素沉着过度和色素减退区。胸部可触及乳腺组织。乳晕和乳头组织完全缺失，乳头乳晕复合体完全瘢痕化。乳晕没有导管开口用于溢乳或漏乳。对其母乳喂养问题进行了咨询。她足月经阴道自然分娩，无并发症。产后第一天给予 1mg 卡麦角林口服。因首选喂养方式为瓶喂，婴儿给予配方奶喂养。
咨询在母乳喂养困难的母亲的管理中起着重要作用。缓解因不能母乳喂养而产生的可能的内疚感，可填补母亲在面对这些挑战时可能出现的情感空白。
