Q 1:
An 18-year-old girl presents to your school-based clinic with her 3-day-old newborn for an early
discharge follow-up visit. The young mother looks very tired and is tearful. She states that she is
trying to breastfeed but has to supplement the feeding with a bottle because she “doesn’t have
any milk.”
Of the following, the MOST appropriate course of action is to
A. call the infant’s grandmother immediately to come to the office
B. recommend that she stop breastfeeding
C. schedule a same-day visit with a lactation consultant in the office or hospital
D. schedule another follow-up visit in 1 month
E. suggest that she attend prenatal classes for her next pregnancy
Answer
C
For the young mother described in the vignette, community resources such as referral to a
lactation consultant at the hospital where she delivered or in the community, low-cost infant care
classes, videotapes of infant care topics, and child care resources for resumption of school or
work are important. Cessation of breastfeeding almost never is indicated. Calling the
grandmother to help may be appropriate if there are signs of postpartum depression, as might
rehospitalization or referral to a mental health professional, but such action is unlikely to
empower the young mother. Recommending a prenatal visit for subsequent pregnancies does
not help the mother with her current difficulties in caring for her infant. Delaying a follow-up visit
for 1 month is inappropriate for a breastfed infant who has risk factors for poor weight gain and
for this mother, who is at risk for postpartum depression.
Answer
C
For the young mother described in the vignette, community resources such as referral to a
lactation consultant at the hospital where she delivered or in the community, low-cost infant care
classes, videotapes of infant care topics, and child care resources for resumption of school or
work are important. Cessation of breastfeeding almost never is indicated. Calling the
grandmother to help may be appropriate if there are signs of postpartum depression, as might
rehospitalization or referral to a mental health professional, but such action is unlikely to
empower the young mother. Recommending a prenatal visit for subsequent pregnancies does
not help the mother with her current difficulties in caring for her infant. Delaying a follow-up visit
for 1 month is inappropriate for a breastfed infant who has risk factors for poor weight gain and
for this mother, who is at risk for postpartum depression.
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