BREASTFEEDING RISK FACTORS IN THE INFANT
Category: Child Health
Abstract : COMMON BREASTFEEDING PROBLEMS Risk factors for breastfeeding
difficulties Mother-infant pairs who are at risk for breastfeeding
difficulties should have closer follow-up care. Risk factors in the mother
include a history of poor breastfeeding with a previous newborn, flat or
inverted nipples, abnormal breast appearance, previous breast surgery, previous
breast abscess, extremely so
COMMON BREASTFEEDING PROBLEMS
Risk factors for breastfeeding
difficulties
Mother-infant pairs who are at risk for breastfeeding
difficulties should have closer follow-up care.
Risk factors in the mother
include a history of poor breastfeeding with a previous newborn, flat or
inverted nipples, abnormal breast appearance, previous breast surgery, previous
breast abscess, extremely sore nipples, minimal prenatal breast enlargement,
failure of the milk to come in abundantly after delivery, and chronic or severe
medical problems. Breastfeeding risk factors in the infant include small size or
prematurity, poor sucking, any oral abnormality, multiple gestation, medical
problems, or neurologic or muscle-tone problems.
Common breastfeeding
problems and solutions
Common breastfeeding problems and their solutions
include the following:
• Engorgement: The treatment is prevention with
frequent breastfeeding.
• Areolar engorgement: Treatment involves the
manual expression or pumping of milk to soften the areola and allow better
latch-on
• Mammary vascular engorgement: Treatment involves frequent
breastfeeding around the clock, the application of cabbage leaves, and manual or
electric pumping.
• Sore nipple: This problem is commonly associated with
improper latch-on. Help the mother with positioning and encourage her to insert
the areola and nipple into the infant's open mouth.
• Cracked nipple: The
mother should begin the breastfeeding session on the less-affected side. Placing
a drop of milk on each nipple and allowing this to air dry after breastfeeding
may help. The use of high-grade lanolin or nipple shields should be considered
if bleeding occurs.
• Mastitis: This problem is more common in engorged
breasts. The mother should continue to breastfeed while taking antibiotics.
Frequent emptying of the breast is essential for relief and recovery. The mother
may also take acetaminophen or ibuprofen for relief.
• Abscess: This
problem typically requires surgical incision and drainage, as well as
antibiotics. The mother should continue to breastfeed on the unaffected side and
pump the affected side to relieve pressure and facilitate recovery. The infant
may be breastfed on the affected side when the breast is no longer painful to
touch. Analgesia is essential for mother's comfort.
• Yeast infection of
the breast: Candida albicans, which causes thrush in infants, may infect the
nipple and intraductal system. Complaints of the mother include pain during
breastfeeding or a diminution of her milk supply. Culture samples obtained from
the skin. Treatment may begin with topical nystatin, but systematic therapy may
be required for eradication.
Engorgement
Engorgement is a common breastfeeding problem, and its
prevention is important. A mother should be encouraged to breastfeed several
times a day to establish her milk supply and to ensure relief after her milk has
come in. If a mother's breasts are so distended that the nipple is obscured, the
infant may have difficulty in latching on. A mother may manually express or pump
her milk to relieve the tension and distortion of the breast, which makes the
nipple to be available for suckling by the infant.
The mother should
continue this cycle frequently as her breasts regulate to the requirements of
her infant. Cabbage leaves, either whole or as a minced paste, have been shown
to relieve the swelling and pain of engorgement within 12-24 hours of
application. The use of lanolin is not helpful in
engorgement.
Recommending that the mother discontinue breastfeeding is
not appropriate because breast milk is the preferred source of nutrition for the
infant and because the mother has shown that she desires to breastfeed with her
action of initiating breastfeeding.
Insufficient milk supply
The
misperception of an insufficient milk supply is common, particularly with
first-time mothers. A mother who plans to breastfeed should undergo a prenatal
assessment to evaluate her breast development during pregnancy and the condition
of her nipples (eg, Are they inverted?) and to discuss strategies to achieve
successful lactation.
These strategies include frequent breastfeeding
every 1.5-2 hours during the first few days. If a mother does not breastfeed
frequently enough, her milk production is delayed. The first-line treatment for
an insufficient milk supply is to have the mother breastfeed frequently because
any milk removed is quickly replaced. If a mother has been too ill to breastfeed
or pump her milk or if her infant is too ill to breastfeed, the mother may have
an insufficient milk supply. Again, the mother should be encouraged to
breastfeed, if her infant is able, or to pump her breasts to stimulate milk
production.
Galactagogues
Galactagogues or milk production enhancers
may facilitate milk production. Probably the best known agent with the fewest
adverse effects is fenugreek, an herb used in Indian curries and cooking. It is
well-tolerated by most women. It can be taken as a tea (2-3 cups of tea per day)
or as a capsule (two 500-mg caps tid for a total of 6 caps per day). Milk
production should increase within 48-72 hours.
Other herbal remedies
include fennel seeds brewed as a tea (1 tsp boiled in water and steeped for 10
min, served 2-3 times per day), milk thistle, and goat's rue. Contraindications
to these herbal remedies include the current use of antiepileptic agents,
coumadin, or heparin because the herbs may affect drug levels or clotting
parameters.
Medical therapy
Metoclopramide (Reglan) acts as a potent
stimulator of prolactin release and has been used to treat lactation
insufficiency. Although the US Food and Drug Administration (FDA) has not
approved metoclopramide for this indication, a dose of 10 mg PO tid has been
shown to increase milk production. An increase of milk letdown response was
experienced by as many as 60% of women within 3-5 days. Limit use to a maximum
of 10-14 days. Coadministration of opioid analgesics with metoclopramide may
increase CNS toxicity.
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