Common Maternal Breastfeeding Problems

“Breastfeeding difficulties” and

Common Maternal

‘Not enough milk’ One of commonest reasons for stopping breastfeeding 

Mother thinks she does not have enough breast milk (can produce for twins)

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Baby does not get enough breast milk. (ineffective suckling. mother cannot produce enough )

Reasons why a baby may not get enough breast milk 1. Breastfeeding factors     

Delayed start Feeding at fixed time Infrequent feeds No night feeds Short feeds 2. Baby’s condition :

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Poor attachment Bottles, pacifiers Other foods Other fluids

Illness Abnormality

Reasons why a baby may not get enough breast milk

3. Mother: Psychological factors     

Lack of confidence Worry, stress Dislike of breastfeeding Rejection of baby Tiredness

4. Mother: Physical Condition       

Contraceptive pills Pregnancy Severe malnutrition Alcohol Smoking Retained piece of placenta Poor breast development

Reliable signs that a baby is not getting enough milk 

Poor weight gain < than 500 grams per month check growth chart

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Small amount of concentrated urine < than 6 times per day strong smelling dark orange in color

The Crying Baby Possible reasons: 

Discomfort – dirty / cold / hot

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Tiredness – too many visitors

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Illness / pain- changed pattern of crying

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Hunger – not getting enough milk / growth spurt (2 weeks ,6 weeks , 3mos )

The Crying Baby reasons

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Mother’s food – some food substance pass into her milk

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Drug mother takes – caffeine , cigarette etc

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Colic – may have very active gut … lessen after 3 mo old

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“high needs” babies – “KSP”/ needs to be carried more

The Crying Baby

m a y

Unnecessary introduction of food / fluids Can upset relationship between mother & baby

Some Different Ways to Hold a Colicky Baby

Babies refuse to breastfeed Reasons

1. Baby ill, sedated or in pain  Infection  Brain

damage  Pain from bruise (forceps / vacuum)  Blocked nose  Sore mouth (thrust / teething)

Reasons why babies refuse to breastfeed

2. Difficulty with breastfeeding technique  Use of bottles, pacifiers whilst breastfeeding  Poor attachment  Pressure on back of head  Mother shaking breast  Restricting length of feeds  Difficulty co-ordinating suckle

Reasons why babies refuse to breastfeed 3.

Change which upsets the baby (especially aged 3-12 mos) 

Separation from mother (work)

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New carer or too many carers

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Change in family routines

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Mother ill / breast problem (mastitis)

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Mother menstruating

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Change in smell of mother

Reasons why babies refuse to breastfeed

4. Apparent refusal  Newborn

– rooting  Age 4-8 mos – distraction  Above 1 year – self weaning

Helping a mother & baby to breastfeed again Help her do these things:    

Keep her baby close to her Offer breast whenever baby is willing Feed by cup Help baby to take your breast

How to help mother 

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Listening & learning skills

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Good counseling skills

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Assess

Confidence & support skills

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Praise when relevant

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Empathize

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Assessing a breastfeed

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Helping mother to position & attach her baby

Give relevant information

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Give practical help

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Taking a detailed feeding history

Establish the

the confidence of mother that

she

CAN DO IT

Nipple / Breast Forms 

Large / small breasts various positions

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Flat / inverted / retracted nipple syringe / pump / cup feeding EBM

Baby sucks from breast not from

Long or big nipples use football hold , C position / cup feeding using expressed breastmilk (EBM) 

Reassure mother… baby’s mouth will grow, nipples will not

What do you think of the nipple ?

What breast condition do you see ?

Sy ri nge meth od f or retr act ed ni pple

Pull plunger to maintain steady gentle pressure Do it for 30 sec to 1 min several x a day Push plunger back to reduce suction – if there is pain

Causes of sore nipple    

Poor attachment Candidiasis Not properly positioned pump Too much stretching of nipple caused by the pump / wrong position

Management of sore nipple    

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Observe feeding session Reassure mother Help improve attachment / positioning Treat skin condition … fungal ? Soreness ? Big /small lesion ? Short frenulum ?

What conditions are shown here ?

Full Breast

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Full breast Milk has “come in” Hot heavy and hard Milk flowing well Sometimes feels lumpy

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Normal fullness

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Treatment : frequent feeds

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Breast is OVERFULL Engorged breast Partly filled with milk Partly with tissue fluid and blood Interferes with milk flow Breast shinny – edematous Painful Milk does not flow well Nipple – stretched tight

Causes and Prevention of Engorgement Causes

Prevention

Plenty of milk Delay starting to BF

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Start BF soon after delivery

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Poor attachment to breast

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Ensure good attachment

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Infrequent removal of milk Restriction of length of feeds

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Encourage on demand feeding

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Management of engorged breast General procedure: Stimulate her oxytocin reflex  Warm compress  Massage back / breast / nipple skin  Make her relax  Warm shower / bath  After feed put cold compress to help reduce edema  Built mother’s confidence

Engorgement in an HIV infected woman who is stopping breastfeeding 

SHOULD express milk ONLY to relieve congestion and not to increase production

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Express ONLY when breast are OVERFULL to make her comfortable

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May give analgesic to relieve inflammation and discomfort (ibuprofen or paracetamol)

What condition is this ?

Causes of blocked duct and mastitis 

Poor drainage of whole breast: • infrequent feeds / ineffective suckling • pressure from clothes • pressure from fingers during feeds • (Scissors’ hold ) • Large breast draining poorly

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Stress, overworked

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Trauma to breast Cracked nipple

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reduces frequency of feeds damages to tissue allows bacteria to enter

Treatment of blocked duct and mastitis   

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Most important – improve drainage of milk Look for cause and correct Suggest:  FREQUENT feeds / rest with baby  gentle breast massage towards nipple  warm compress between feeds  Start feed on unaffected side IF in pain  Express if necessary  vary feeding position Antibiotics, analgesics, rest (flucloxacillin, erythro)

Mastitis in an HIV infected mother  

Mastitis Abscess ON SIDE

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Fissure

AVOID BREASTFEEDING THAT

Mastitis in an HIV infected mother 

SHOULD AVOID breastfeeding on the AFFECTED side

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Express the milk effectively to ensure adequate removal  to help prevent condition from becoming worst  to help breast recover n maintain production 

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Can feed from the Unaffected side Frequent and longer feeding increase production

Mastitis in an HIV infected mother 

Discuss feeding options • • •

heat treat expressed breastmilk home-prepared formula feed by cup

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Give antibiotics 10-14 days to avoid relapse / pain reliever if needed / rest

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If decided to stop BF, cont to express just enough until production ceases

What do you notice about the breasts ?

What condition is this ?

Candida Infection 

Shiny red area skin sore

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flaky / itcy / whitish

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Burning / stinging sensation

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which continues after a feed / pain that shoots deep into her breast

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Check baby for thrust inside the mouth or rash at his bottom

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Treat BF dyad

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Nystatin cream Nystatin Suspension Stop using pacifiers, teats, nipple shields

IN HIV infected women, treat breast thrush and infant oral thrush PROMPTLY

Reminder s

Ensure privacy Explain what you want to do

Ask permission before breast is exposed Talk with mother and look at breast without touching

Explain what you found  

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Reminders

Highlight the positive signs Don’t sound critical about her breast Build her confidence in her ability to breastfeed. Thank her for her cooperation

Summary   

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Not enough milk Crying baby Refusal to feed Nipple & breast forms Sore nipple

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Engorgement

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Blocked duct / mastitis

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Breast abscess

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Candidiasis

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Unequal breast

she

CAN DO IT !