The true contraindications of breast feeding are?

KPSC Staff Nurse - 2017

Obstetrics & Gynaecology

Easy

Appeared in: KPSC Staff Nurse - 2017

Explanation

This option correctly pairs an absolute infant contraindication (Galactosemia) with a significant maternal contraindication (Active TB).
Galactosemia is a metabolic disorder in which the infant cannot process galactose, a sugar in breast milk, making breastfeeding dangerous and absolutely contraindicated.
Active, untreated tuberculosis in the mother is a contraindication to direct breastfeeding to prevent transmitting the infection to the newborn. While it is temporary and expressed breast milk can be given, it is considered a valid reason to stop direct feeding.
This combination represents two clear and widely accepted contraindications, making it the most accurate choice among the options.

Option A: Maternal HIV infection is a contraindication in high-resource countries, but the WHO recommends breastfeeding with ART in resource-limited settings. Lithium is a relative contraindication requiring careful monitoring, not an absolute one. Therefore, this pair is not universally considered 'true contraindications'.
Option B: Cystic fibrosis in an infant is not a contraindication to breastfeeding. In fact, breast milk is often recommended for infants with cystic fibrosis.
Option C: Phenylketonuria (PKU) in an infant is not an absolute contraindication. Infants with PKU can be breastfed in combination with a special low-phenylalanine formula under strict medical supervision.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain This question tests the knowledge of absolute and relative contraindications to breastfeeding, involving both maternal and infant conditions as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in educating and supporting mothers regarding safe infant feeding practices. It is vital to correctly identify true contraindications to prevent harm to the infant while also avoiding unnecessary cessation of breastfeeding.
Accurate assessment of maternal and infant conditions is essential. For conditions like active TB, the nurse must provide clear instructions on expressing milk, temporary separation, and when it is safe to resume direct breastfeeding.
What if? If a mother with active TB has been on treatment for three weeks and is confirmed non-infectious by her physician, direct breastfeeding is no longer contraindicated and can be safely initiated or resumed.

How to Approach the Question

First, read the question carefully, noting the term 'true contraindications'. This implies looking for the most definitive and widely accepted reasons to avoid breastfeeding.
Evaluate each option by considering both conditions listed. An option is incorrect if even one of the conditions is not a true contraindication.
Recall or look up the status of each condition. Differentiate between absolute contraindications (must stop), relative contraindications (weigh risks vs. benefits), and conditions that are not contraindications at all.
Analyze Option A: HIV is context-dependent, and Lithium is relative. Not the strongest answer.
Analyze Option B: Cystic fibrosis is not a contraindication. Eliminate this option.
Analyze Option C: PKU is not an absolute contraindication. Eliminate this option.

Concept Tested & Keywords

Concept Tested: This question tests the knowledge of absolute and relative contraindications to breastfeeding, involving both maternal and infant conditions.
Stem keywords: true contraindications, breast feeding
Lead-in keywords: TRUE
Negative lead-in flag: false

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E6 Obstetrics Williams p. 49-70

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 455-457