3 common breastfeeding challenges and its management


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Common challanges in Breast feeding

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3 common breastfeeding challenges and its management

  1. 1. Common Breastfeeding Challenges and its Management Dr. Varsha Atul Shah
  3. 3. Milk Production • Generally mature milk begins within 72H. MR feel that the breast is heavier and fuller • Occasionally some MR experience delayed onset of milk production. Causes include – overhydration with IV fluids – retained placental fragments(cos of hormones secreted by the fragments)
  4. 4. Delayed Onset of Milk Production • Review the hydration status of the baby- weight, IO, NNJ • Solutions for MR – Nurse frequently 2H or more depending on baby – Massage the breast while nursing – KIV pump after nursing to stimulate the breast – KIV herbal secretagogues(fenugreek), medications (domperidone 10mg TDS) – Consider weighing baby EOD
  5. 5. Breast Pain  If the MR complains of breast pain, ddx  breast engorgement  galactocele  mastitis  breast abscess  Breast engorgement  Usually occurs D2-3 as the milk production occurs and there is increased blood flow to the breast  Problems  Breast becomes swollen and tender  Nipples may flatten, difficult to latch  Nursing may be infrequent or ineffective and milk supply subsequently drops
  6. 6. Breast Pain • Breast engorgement – Solutions • Nurse frequently 1-3H • Nurse until breast is fully emptied (preferable to nurse 1 side till emptied then the other, rather than limit nursing on the first side in bid to nurse both) • Gently massage during nursing to encourage milk flow • If MR still feels full after nursing, can further express after nursing • Consider cold cabbage to relief pain and swelling • KIV analgesia(eg panadol) if pain is severe
  7. 7. Breast Pain • Galactocele/Blocked ducts – Cyst in the mammary duct containing milk – Encourage massage during nursing or expressing – Consider alternating positions for nursing to ensure the whole breast is well emptied. • Sore nipples – Types • traumatized nipples: blistered, scabbed or cracked • irritated nipples: pink with burning sensation – DDx • Nipple thrush: treat MR and BB with miconazole/nystatin • Contact dermatitis: vit E containing creams, preps with cocoa butter, lanolin • Eczema • Impetigo • Improper positioning (fail to open mouth wide or mouth slides off areola to nipple due to breast engorgement or unsupported nipple)
  8. 8. Breast Pain • Sore nipples – Solutions • Do not delay nursing, consider Q1-2H nursing for a shorter period • Start on the less tender side • Massage during nursing to speed up emptying • Release the suction carefully after the feed • In between feeds, squeeze some EBM and apply on nipple and areola(contains Ig), then apply lanolin • Consider pumping on the tender side • Consider analgesia • Wear cotton, microfiber bras(better air circulation) • Avoid excessive washing of nipples
  9. 9. Breast Pain • Traumatized nipples – Solutions • Consider alternative nursing position • If the breast is full and BB is unable to take whole areola into mouth, then compress with finger or manually express some milk before nursing • If BB does not open her mouth wide then wait for her or let her suck on MR’s finger to stimulate the sucking reflex before latching • Take the BB off once the position is suboptimal and reposition(may require help from partner) • KIV ABX if there is any evidence of infection.
  10. 10. Breast Pain  Mastitis  Inflammation of the breast ducts +/- infection  Treatment  Frequent nursing to drain the ducts KIV expressing  Analgesia +/- antibiotics  Breast abscess  Seek medical attention for drainage  Breast pain  Ddx  Let down  Refilling after nursing  Blocked ducts  Nipple irritation
  11. 11. Flow of the Milk • Let down difficulty – Stimulation • best stimulator is the suckling of the BB • MR encouraged to be relaxed and think of BB during pumping – Ddx • problem with BB latching or sucking • low milk supply • Leaking milk – Solutions • at home, open both bra flaps and lay a cloth for it
  12. 12. Difficult Latch-on • Nipple issues – flat nipple – dimpled nipple – inverted nipple • Problems that may arise – frustrated MR and BB – Poor latch may lead to nipple soreness • Solutions – Encourage nursing within 2h of birth as BB tend to latch better then to problem nipples – Get help to position the BB for nursing – Avoid artificial teats in the first few days – Consider pumping for a short while before nursing as it can help to pull nipple out for better nursing
  13. 13. Fatigue • Immediate post-partum period, MR tired from labour and taking care of BB • Enough rest and help is essential
  15. 15. NNJ • Physiological jaundice – contributed by inadequate intake -> dehydration and inadequate calories – continue to breastfeeding even during phototherapy, either via direct latching or EBM • Breast milk jaundice – many factors implicated: metabolite of progesterone in breast milk that inhibit enzymes in the metabolism of bilirubin, inflammatory cytokines contributing to cholestasis – work-up to rule out prolonged conjugated hyperbilirubinemia – no indication to stop breast feeding
  16. 16. Underfeeding and Weight Loss • Significant if BB loses >10% body weight • Consider pumping when the feed is due to estimate the amount of breast milk taken and reasses for the need to supplement • Ddx – Inaqeuate milk production – Poor latch • Solutions – Nurse often KIV supplement – Weigh BB every few days – Review BB’s latch
  17. 17. PU and BO • PU: it is acceptable to PU x 1 on D1, x2 on D2 • BO – D1-3: passing meconium – D5 onwards: passing breastfeeding stools, mustard colour
  18. 18. Sleepy Baby • Typically occurs in the 1st week of life • Ensure that BB is fed every Q3H • Solutions: – Stimulate BB when its feeding time by rubbing her back, or placing on the bare chest – If BB falls asleep latching, compress the breast to encourage more milk flow, as this may help arouse BB – Burp BB well after each feed – If unable to rouse BB, KIV feed after 1H
  19. 19. Difficult Latch On
  20. 20. Difficult Latch On • Preference for teat – Ensure that the breast is not too full->pump some before feeding, or firm it by applying ice for a few minutes – Good positioning
  21. 21. Difficult Latch On • Micronagthia – Ensure breast not too full – Tilt the BB’s head slightly backwards so that the chin touches the breast 1st • Tongue tied – May make nursing painful even with good positioning, may have “clicking” sound during suck – Consider frenotomy
  22. 22. Difficult Latch On • Protruding tongue – Encourage BB to open mouth wide and hold the tongue down – Football hold offers the best control and visibility • Tongue sucking – Latch on when the BB has his mouth open and his tongue down – Slightly depressing the lower chin may help the tongue to drop
  23. 23. »Thank You