This document summarizes lactation physiology and management. It reviews the health impacts of breastfeeding, the anatomy and hormones involved in milk production and letdown, common breastfeeding problems like low milk supply and mastitis, and their diagnosis and treatment. The goals are to establish normal lactation physiology from the start and provide evidence-based early breastfeeding care.
Babies should be breastfed and/or receive expressed human milk exclusively for the first six months of life. Breastfeeding should continue with the addition of complementary foods throughout the second half of the first year.
Babies should be breastfed and/or receive expressed human milk exclusively for the first six months of life. Breastfeeding should continue with the addition of complementary foods throughout the second half of the first year.
Lactation management is the science and art of assisting women and infants with breastfeeding, because the mother-infant pair is dynamically interrelated for breastfeeding, it is imperative to consider both individuals when attempting to assess and “manage” breastfeeding.
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Lactation management is the science and art of assisting women and infants with breastfeeding, because the mother-infant pair is dynamically interrelated for breastfeeding, it is imperative to consider both individuals when attempting to assess and “manage” breastfeeding.
Best Ever Guide Shared by Rosa Belinda Sanchez About Importance of Antenatal ...Rosa Belinda Sanchez
Rosa Belinda Sanchez Shared a detailed presentation on importance of antenatal care. This will defiantly help you. If you have any other queries related antenatal care do share in comment section. Find Rosa Belinda Sanchez at https://www.crunchbase.com/organization/rosa-belinda-sanchez-mother-children-care-specialists
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2. Objectives
• Review public health impact of
breastfeeding
• Understand physiology of lactation
• Identify the differential diagnosis and
treatment for common breastfeeding
problems
» Low milk supply
» Mastitis
» Breast abscess
3. Health Impact of
Not Breastfeeding
INFANT MOTHER
Illness OR Illness OR
Diarrhea 2.8
Premenopausal
breast cancer
1.4
Otitis media 2.0 Ovarian cancer 1.3
Pneumonia 3.6 Type 2 Diabetes 1.2
SIDS 1.6
Asthma 1.4
Leukemia 1.2
Formula-feeding vs. breast-feeding: risk of adverse outcomes.
Breastfeeding and Maternal and Infant Health Outcomes in
Developed Countries. AHRQ Evidence Report Number 153. April 2007.
4. AAP Recommendations
• Exclusive
breastfeeding for
the first six months
of life
• Continued
breastfeeding for
at least one year,
‘As long as is
mutually desired
by mother and
child’
American Academy of Pediatrics (2005). "Breastfeeding and the Use of Human
Milk." Pediatrics 115(2): 496-506.
5. Contraindications
• HTLV-1 and HTLV-2
• HSV with lesion on
the breast
• Active tuberculosis
• Medications that
contraindicate
breastfeeding
• Newborn with
galactosemia
• Maternal HIV
» US: not recommended
» UNICEF: When
replacement feeding is
acceptable, feasible,
affordable, sustainable
and safe, avoidance of
all breastfeeding is
recommended;
otherwise, exclusive
breastfeeding is
recommended during
the first months of life.
8. Oxytocin
• Moves milk from
lobules to sinuses,
so baby can eat
• Inhibited by stress,
pain, anxiety
• Triggered by sound,
smell, sight of infant
Let Down: Ejection, not suction,
moves milk to the areola.
9. Stress and Milk Volume
0
50
100
150
200
Control Ice water Math + shock Toe Pull
Distraction and Milk Volume (g)
saline oxytocin
J. Pediatr 1948; 33:698-704.
10. Milk Transfer
• Infant grasps most
of the areola in his
mouth
• Tongue “milks”
milk to the back of
the mouth prior to
swallowing.
Latch: The baby’s tongue moves
milk from areola to nipple.
11. Negative feedback
• Milk in lobules contains
whey protein called
Feedback Inhibitor of
Lactation (FIL)
• If milk is not removed,
and lumen is full,
production will decrease
• Goal: 10-12 feeds in 24
hours, until baby is done.
Moving Milk:
Demand drives supply.
13. Low Milk Supply
• Primary lactation failure
» Anatomic abnormality
» Sheehan’s syndrome
• Disruption of normal physiology
» Infrequent or inadequate milk removal
» Postpartum depression
• First line therapy:
» Lactation consultation
» Mechanical expression after breastfeeding
• If needed:
» Supplement after breastfeeding as indicated
» Continue pumping during supplementation
» Consider metoclopramide
14. Mastitis
• Definition: tender, swollen, wedge-shaped
area of breast, usually unilateral, with fever,
malaise, chills, and systemic symptoms
• Incidence: 3 to 20%
• Treatment
» Rest, fluids
» Antibiotics – Dicloxicllin 500mg QID x 10-14d
» Empty the breast
• Evaluate latch
• Continue frequent breast feeding
• Milk is not harmful to healthy, term infant
• Abrupt weaning slows maternal recovery
• Poor response requires further evaluation
Academy of Breastfeeding Medicine. ABM Clinical Protocol #4: Mastitis.
Breastfeeding Medicine 3(3); 2008.
15. Breast abscess
• 3% of women with mastitis
• Diagnosis
» Hard, red, tender mass after appropriate
treatment
» Diagnostic ultrasound
• Treatment
» Needle aspiration for culture / treatment
» Surgical drainage for large or multiple
abscesses
• Follow-up care
» Antibiotics
» Continue breastfeeding
16. For more information
• American Academy of Pediatrics (2005).
Breastfeeding and the Use of Human Milk.
Pediatrics 115(2): 496-506.
• American Academy of Family Physicians.
(2001, 2/26/2007). Breastfeeding (Position
Paper).
• American College of Obstetrics and
Gynecology (2007). Breastfeeding: Maternal
and Infant Aspects. Special Report from
ACOG. ACOG Clinical Review 12(1
(supplement)): 1S-16S.
• Academy of Breastfeeding Medicine
www.bfmed.org
