common maternal breastfeeding problems

8/14/2019 Common Maternal Breastfeeding Problems

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“Breastfeeding

difficulties”and

Common

Maternal



Maternal

‘‘Not enough milk’Not enough milk’

One of commonest reasons for stoppingOne of commonest reasons for stoppingbreastfeedingbreastfeeding

Mother thinksMother thinks she does not haveshe does not haveenough breast milk (can produce for enough breast milk (can produce for twins)twins)

Baby does notBaby does not get enough breast milk.get enough breast milk.(ineffective suckling.(ineffective suckling.

mother cannot produce enough )mother cannot produce enough )



Reasons why a baby may not get enoughReasons why a baby may not get enoughbreast milk breast milk

1.1. Breastfeeding factorsBreas

tfeeding factors

Delayed startDelayed start

Feeding at fixed timeFeeding at fixed timeInfrequent feedsInfrequent feedsNo night feedsNo night feedsShort feedsShort feeds

Poor attachmentPoor attachment

Bottles, pacifiersBottles, pacifiersOther foodsOther foodsOther fluidsOther fluids

2. Baby’s condition2. Bab

y’s condition :: IllnessIllness

AbnormalityAbnormality



Reasons why a baby may not get enough breastReasons why a baby may not get enough breastmilk milk

3. Mother:3. Mother:Psychological factorsP

sychological factors

Lack of confidenceLack of confidenceWorry, stressWorry, stressDislike of Dislike of breastfeedingbreastfeedingRejection of babyRejection of babyTirednessTiredness

4. Mother: Physical4. Mother: P

hysicalConditionCondition

Contraceptive pillsContraceptive pillsPregnancyPregnancySevere malnutritionSevere malnutritionAlcoholAlcoholSmokingSmokingRetained piece of Retained piece of placentaplacentaPoor breastPoor breastdevelopmentdevelopment



Reliable signs that a baby is not getting Reliable signs that a baby is not getting

enough milk enough milk Poor weight gainPoor weight gain

< than 500 grams per month< than 500 grams per monthcheck growth chartcheck growth chart

Small amount of concentratedSmall amount of concentrated

urineurine< than 6 times per day< than 6 times per daystrong smellingstrong smellingdark orange in color dark orange in color



The Crying BabyThe Crying Baby

Possible reasons:Possible reasons:

Discomfort – dirty / cold / hotDiscomfort – dirty / cold / hotTiredness – too many visitorsTiredness – too many visitors

Illness / pain- changed pattern of cryingIllness / pain- changed pattern of crying

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



The Crying Baby - The Crying Baby -reasonsreasons

Mother’s food – some food substanceMother’s food – some food substancepass into her milkpass into her milk

Drug mother takes – caffeine ,Drug mother takes – caffeine ,

cigarette etccigarette etc

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

““high needs” babies – “KSP”/ needs tohigh needs” babies – “KSP”/ needs tobebe carried morecarried more



The Crying BabyThe Crying Baby

Unnecessary introduction of food / fluidsUnnecessary introduction of food / fluids

Can upset relationship between mother &Can upset relationship between mother &babybaby



Some Different Ways to Hold aSome Different Ways to Hold aColicky BabyColicky Baby



Reasons why babies refuse toReasons why babies refuse to breastfeedbreastfeed

2. Difficulty with breastfeeding technique2. Difficulty with breastfeeding techniqueUse of bottles, pacifiers whilstUse of bottles, pacifiers whilstbreastfeedingbreastfeeding

Poor attachmentPoor attachmentPressure on back of headPressure on back of headMother shaking breastMother shaking breast

Restricting length of feedsRestricting length of feedsDifficulty co-ordinating suckleDifficulty co-ordinating suckle



Reasons why babies refuse toReasons why babies refuse tobreastfeedbreastfeed

3.3. Change which upsets the babyChange which upsets the baby(especially aged 3-12 mos)(especially aged 3-12 mos)

Separation from mother (work)Separation from mother (work)

New carer or too many carersNew carer or too many carers

Change in family routinesChange in family routines

Mother ill / breast problem (mastitis)Mother ill / breast problem (mastitis)

Mother menstruatingMother menstruating

Change in smell of mother Change in smell of mother



Reasons why babies refuse toReasons why babies refuse tobreastfeedbreastfeed

4. Apparent refusal4. Apparent refusal

Newborn – rootingNewborn – rootingAge 4-8 mos – distractionAge 4-8 mos – distraction

Above 1 year – self weaningAbove 1 year – self weaning



Helping a mother & babyHelping a mother & baby

to breastfeed againto breastfeed again

Help her do these things:Help her do these things:

Keep her baby close to her Keep her baby close to her Offer breast whenever baby is willingOffer breast whenever baby is willing

Feed by cupFeed by cupHelp baby to take your breastHelp baby to take your breast



How to help mother How to help mother

Listening & learningListening & learningskillsskills

Confidence & supportConfidence & support

skillsskillsAssessing a breastfeedAssessing a breastfeed

Helping mother toHelping mother to

position & attach her position & attach her babybaby

Taking a detailedTaking a detailedfeeding historyfeeding history

Good counseling skillsGood counseling skills

AssessAssess

Praise when relevantPraise when relevant

EmpathizeEmpathize

Give relevantGive relevantinformationinformation

Give practical helpGive practical help



Establish the confidence ofEstablish the confidence ofthe mother thatthe mother that

shesheCAN DO IT CAN DO IT



Nipple / Breast FormsNipple / Breast Forms

Large / small breastsLarge / small breasts

various positionsvarious positions

Flat / inverted /Flat / inverted /retracted nippleretracted nipple

syringe / pump / cupsyringe / pump / cupfeeding EBMfeeding EBM

Baby sucks fromBaby sucks frombreast not frombreast not from



What do you thinkWhat do you thinkof the nipple ?of the nipple ?



What breast condition do you see ?What breast condition do you see ?



Causes of sore nippleCauses of sore nipple

Poor attachmentPoor attachment

CandidiasisCandidiasisNot properly positioned pumpNot properly positioned pumpToo much stretching of nippleToo much stretching of nipple

caused by the pump / wrongcaused by the pump / wrongpositionposition



Management of sore nippleManagement of sore nipple

Observe feeding sessionObserve feeding sessionReassure mother Reassure mother Help improve attachment / positioningHelp improve attachment / positioningTreat skin condition …Treat skin condition …fungal ? Soreness ? Big /small lesion ?fungal ? Soreness ? Big /small lesion ?

Short frenulum ?Short frenulum ?



What conditions are shownWhat conditions are shownhere ?here ?



Full breastFull breastMilk has “come in”Milk has “come in”Hot heavy and hardHot heavy and hardMilk flowing wellMilk flowing wellSometimes feels lumpySometimes feels lumpy

Normal fullnessNormal fullness

Treatment : frequentTreatment : frequentfeedsfeeds

Full BreastFull Breast



Causes and Prevention of EngorgementCauses and Prevention of Engorgement

CausesCauses

Plenty of milkPlenty of milkDelay starting to BFDelay starting to BF

Poor attachment toPoor attachment tobreastbreast

Infrequent removal of Infrequent removal of milkmilkRestriction of length of Restriction of length of

feedsfeeds

PreventionPrevention

Start BF soon after Start BF soon after deliverydelivery

Ensure goodEnsure goodattachmentattachment

Encourage onEncourage ondemand feedingdemand feeding



Management of engorged breastManagement of engorged breast

General procedure:General procedure:

Stimulate her oxytocin reflexStimulate her oxytocin reflexWarm compressWarm compressMassage back / breast / nipple skinMassage back / breast / nipple skinMake her relaxMake her relaxWarm shower / bathWarm shower / bathAfter feed put cold compress to helpAfter feed put cold compress to helpreduce edemareduce edemaBuilt mother’s confidenceBuilt mother’s confidence



Engorgement in an HIV infected woman who isEngorgement in an HIV infected woman who isstopping breastfeedingstopping breastfeeding

SHOULD express milk ONLY to relieveSHOULD express milk ONLY to relievecongestion and not to increasecongestion and not to increase

productionproduction

Express ONLY when breast areExpress ONLY when breast areOVERFULL to make her comfortableOVERFULL to make her comfortable

May give analgesic to relieveMay give analgesic to relieveinflammation and discomfort (ibuprofeninflammation and discomfort (ibuprofen

or paracetamol)or paracetamol)



What condition

is this ?



Causes of blocked duct and mastitisCauses of blocked duct and mastitis

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

Stress, overworked Stress, overworked reduces frequency of reduces frequency of feedsfeeds

Trauma to breast Trauma to breast damages to tissuedamages to tissue

Cracked nippleCracked nipple allows bacteria to enter allows bacteria to enter



Treatment of blocked duct and mastitisTreatment of blocked duct and mastitis

Most important – improve drainage of milkMost important – improve drainage of milkLook for cause and correctLook for cause and correctSuggest:Suggest:

FREQUENT feeds / rest with babyFREQUENT feeds / rest with babygentle breast massage towards nipplegentle breast massage towards nipplewarm compress between feedswarm compress between feedsStart feed on unaffected side IF in painStart feed on unaffected side IF in painExpress if necessaryExpress if necessaryvary feeding positionvary feeding position

Antibiotics, analgesics, rest (flucloxacillin,Antibiotics, analgesics, rest (flucloxacillin,

erythro)erythro)



Mastitis in an HIVMastitis in an HIVinfected motherinfected mother

MastitisMastitisAbscessAbscess AVOIDAVOID

BREASTFEEDINGBREASTFEEDINGONON THATTHAT

SIDESIDEFissureFissure



Mastitis in an HIV infected mother Mastitis in an HIV infected mother

SHOULD AVOIDSHOULD AVOID breastfeeding on thebreastfeeding on theAFFECTED sideAFFECTED side

Express the milk effectivelyExpress the milk effectivelyto ensure adequate removalto ensure adequate removalto help prevent condition from becoming worstto help prevent condition from becoming worstto help breast recover n maintain productionto help breast recover n maintain production

Can feed from the Unaffected sideCan feed from the Unaffected sideFrequent and longer feeding increaseFrequent and longer feeding increase

productionproduction



Mastitis in an HIV infectedMastitis in an HIV infectedmothermother

Discuss feeding optionsDiscuss feeding options• heat treat expressed breastmilkheat treat expressed breastmilk• home-prepared formulahome-prepared formula•

feed by cupfeed by cupGive antibioticsGive antibiotics 10-14 days to avoid10-14 days to avoidrelapse / pain reliever if needed / restrelapse / pain reliever if needed / rest

If decided to stop BFIf decided to stop BF ,, cont to express justcont to express justenough until production ceasesenough until production ceases



What do you noticeWhat do you notice

about the breasts ?about the breasts ?



What condition isthis ?



Candida InfectionCandida Infection

Shiny red area skin soreShiny red area skin soreflaky / itcy / whitishflaky / itcy / whitish

Burning / stinging sensationBurning / stinging sensation

which continues after a feed / pain thatwhich continues after a feed / pain thatshoots deep into her breastshoots deep into her breast

Check baby for thrust inside the mouthCheck baby for thrust inside the mouth

or rash at his bottomor rash at his bottom

Treat BF dyadTreat BF dyad



IN HIV infected women,IN HIV infected women,treat breast thrush andtreat breast thrush and

infant oral thrushinfant oral thrushPROMPTLY PROMPTLY

Nystatin creamNystatin cream

Nystatin SuspensionNystatin SuspensionStop usingStop using pacifiers, teats, nipplepacifiers, teats, nippleshieldsshields



ReminderReminderss

EnsureEnsure privacyprivacy

Explain what youExplain what youwant to dowant to do

Ask permission beforeAsk permission beforebreast is exposedbreast is exposed

Talk with mother and lookTalk with mother and lookat breast without touchingat breast without touching



RemindersRemindersExplain what you foundExplain what you found

Highlight the positive signsHighlight the positive signsDon’t sound critical about her Don’t sound critical about her breastbreastBuild her confidence in her Build her confidence in her

ability to breastfeed.ability to breastfeed.Thank her for her cooperationThank her for her cooperation



SummarySummary

Not enough milkNot enough milkCrying babyCrying baby

Refusal to feedRefusal to feed

Nipple & breastNipple & breast

formsformsSore nippleSore nipple

EngorgementEngorgement

Blocked duct /Blocked duct /

mastitismastitisBreast abscessBreast abscess

CandidiasisCandidiasis

Unequal breastUnequal breast



sheshe CAN DO IT !CAN DO IT !

common maternal breastfeeding problems

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