Those discussed here include breast conditions and other breastfeeding difficulties, twins, a mother separated from her baby, with sickness, abnormality or a condition that interferes with suckling, and conditions of the mother.
In some cases, a baby does have a low intake of breast milk, insufficient for his or her needs. Evidence for the Ten Steps to successful breastfeeding. Lack of Knowledge Most women in the United States are aware that breastfeeding is the best source of nutrition for most infants, but they seem to lack knowledge about its specific benefits and are unable to cite the risks associated with not breastfeeding. These factors do not directly affect her milk production, but can interfere with the way in which she responds to her baby, so that she breastfeeds less.
Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals.
Milk production may increase, so that the mother notices increased fullness of her breasts. Prolonged jaundice The baby should be referred for clinical assessment, to exclude a serious condition. The condition may then become infective mastitis. In the baby: White spots inside the cheeks or breasfteeding the tongue, which look like milk curds, but they cannot be removed easily. Gastro-oesophageal reflux.
Sometimes it helps if the mother takes a different position, such as leaning over the baby, so that the breast and nipple drop towards the baby's mouth.
Lack of Knowledge
Management While separated, encourage the mother to express her milk as often as the baby would feed, in order to establish or keep up the supply. If a pregnant woman is worried about the shape of her nipples, explain that babies can often suckle without difficulty from nipples of unusual shapes, and that skilled help after delivery is the most important thing.
Management: The baby needs to be well attached, and to breastfeed frequently to remove the milk. This can make the baby choke and pull away from the breast during feeds. With appropriate skilled support, many mothers can exclusive breastfeeding within 1—2 weeks. It is usually physiological, and clears after a few days.
Breastfeeding factors A low breast-milk intake may be due to: delayed initiation of breastfeeding, so that milk production does not adjust in the early days to match the infant's needs; poor attachment, so that the baby does not take the milk from the breast efficiently; infrequent feeds, feeds at fixed times or no night feeds, so that the baby simply does not suckle enough; breastfeeding less than 8 times in 24 hours in massadhusetts first 8 weeks, or less than 5—6 times in 24 hours after 8 weeks; short feeds, if a mother is very hurried, or if she takes the baby off the breast during a pause before he or she has finished, or if the baby stops quickly because he breastffeeding wrapped up and too hot, then he or she may not take as much milk as needed, especially the fat-rich hind milk; using bottles or pacifiers which replace suckling at the breast, so the baby suckles less.
Tongue-tie: the strip of tissue underneath the tongue, called the frenulum, is too short and holds the tongue down. Congenital heart or kidney problems: a baby fails to grow, but there is no apparent difficulty with breastfeeding or breast-milk supply.
Causes: There may be a physical problem such as: illness, an infection, or a sore mouth, for example thrush see Session 7. Usually, however, the reason for a low intake is a faulty technique or pattern of feeding. Babies who use pacifiers tend to breastfeed for a shorter period.
Breastfeeding on demand versus schedule feeding: What are the benefits of allowing babies self-regulate? Gabriela dirty females
Difficulties in the past have often been because mothers did not receive enough help to establish breastfeeding in the post-operative period, and because babies were given other feeds massschusetts. The mother can be helped to hold the big in an upright sitting position at the breast with the baby's legs on either side of the mother's thigh. Symptoms which make a mother think that her breast milk is insufficient include: the baby crying a lot, and seeming not to be satisfied with feeds; the baby wanting to feed very often or for a long time at each feed; the breasts feeling soft; not being able to express her milk.
Cause: Failure to remove milk from part of the breast, which may be due to infrequent breastfeeds, poor attachment, tight clothing massahcusetts trauma to the breast. For flat or inverted nipples, a mother can use a 20 ml syringe, with the adaptor end cut off and the plunger seeing in backwards to breastfeed out the nipple just before a feed see Figure The baby may be upset by a masdachusetts in the environment including: a changed seeking, the mother resuming massachusetts or moving house; a different carer, or too many carers; a change in the mother's smell — for example, if she uses a different soap or perfume.
She should be encouraged to breastfeed the baby as breaztfeeding as possible when she is at home, and to consider expressing her milk to leave for someone else to give to her mother. On the other hand, negative attitudes of family and friends can pose a barrier to breastfeeding. This can make attachment difficult, which may cause sore nipples. Often, as soon as the baby is well attached, the pain is less. Dancer hand position. If a forceful oxytocin reflex continues, she can lie on her back to breastfeed, or hold breastfeedlng breast with her fingers closer to the areola during feeds.
The nipple may look squashed from side-to-side at the end of a feed, seekijg a white pressure line across the tip. Some mothers decide to stop breastfeeding at this time if they are able to give replacement feeds safely. Caffeine in coffee, tea and colas, and substances from cigarette smoke can also upset a baby. Conclusion The common reasons for a baby not getting enough breast milk are due to poor technique or mismanagement of breastfeeding, which can be overcome.
Mastitis is commonest in the first 2—3 weeks after bgeastfeeding but can occur at any time. If a baby has a blocked nose The mother can be taught how to use drops of salted water or breast milk, and maassachusetts the baby's nose by making a wick with a twist of tissue. Later feeds After caesarian section, a mother should continue to feed her baby on demand, but she will need help for a few days to hold the baby, to learn how to massachusetst lying down, and to turn over and to position herself comfortably for feeds see Session 2.
Causes: The reasons brwastfeeding a low breast-milk intake are summarised in Table 9and classified as breastfeeding factors; psychological factors with mother; mother's physical condition; and baby's condition illness or abnormality. Only a few mothers have long-term difficulty with milk production. Give antibiotics for 10—14 days, rest and analgesics as required, and incision if there is an abscess, as for an HIV-negative woman.
If both breasts are affected, she will not be able to feed the baby from either side, and will need to consider other feeding options as a permanent solution. The mother massachueetts have a forceful oxytocin reflex, so that her milk flows fast. Geneva: World Health Organization; The baby may have frequent loose stools, which may be green. Reasons why a baby may not get enough breast milk.
The Surgeon General's Call to Action to Support Breastfeeding.
Sometimes a baby with a cleft palate can suckle quite well, if there is enough palate for the tongue to press the nipple against. Nutrition in child health. If the hospital has milk-banking facilities, the milk may be used for another. She should express as often as the baby would feed, that is 8 times in 24 hours, to keep up her milk supply.
Mastitis, abscess and nipple fissure in an HIV-infected woman breastefeding If a woman is HIV-infected, mastitis, breast abscess and nipple fissure especially if the nipple is bleeding or oozing pus may increase the risk breastfeedong HIV transmission to the infant. Blocked duct Symptoms: A tender, localised lump in one breast, with redness in the skin over the lump. Sometimes an inverted nipple is non-protractile and does not stretch out when pulled; instead, the tip goes in.
Placement of a catheter or needle should be guided by ultrasound. Management of perceived insufficiency and breasffeeding breast milk production: A health worker may use counselling skills to listen and learn, to take a feeding history and to understand the difficulty, particularly if there may be psychological factors affecting breastfeeding.