Breastfeeding Problems, Advice and Suggestions
The US researchers said the discovery could offer a genetic basis for breastfeeding problems, which are experienced by around 5% of women. UK breastfeeding experts say some women experience problems, not because of genetics, but because they are not shown the best way to breastfeed their babies - and so give up. Problems might be associated with the following:
When enough milk is not removed due to inadequate suckling, poor attachment, or separation, the breasts may become engorged. Engorged breasts are painful, look tight and shiny because of edema in the soft tissue and milk may stop flow. Once the engorgement occurs, it becomes difficult to attach properly and damages the nipple skin- making nipple sore and fissure.
Relieve the engorgement through expression of breast milk, encouraging mother for demand feeding and helping mother with position and attachment. In case of sore nipple, also apply the hind milk in the nipple and expose the nipple to dry. If the soreness and sharp pain continues in spite of above measures, it may be due to candidal infection; associated with oral thrush of the baby and requires treatment of both mother and baby with antifungal agents.
A painful lump form in the breast due to block in the duct which may be result of tight clothing or poor draining out of the milk by the baby from that part of the breast. The skin over the lump may be red but mother feels well and has no fever. Blocked duct could be relieved by improving suckling position, wearing loose clothes and gently messaging the lump towards the nipple.
Mastitis and breast abscess:
If blocked duct or engorged breast is not cleared the breast become infected-called mastitis and untreated mastitis may develop breast abscess. The abscess swelling is painful, hot and fluctuant.
The treatment includes- rest to mother, removal of the milk several times a day through expression, a course of antibiotic and analgesics. The baby will continue sucking from the unaffected breast. Additionally an abscess requires incision and drainage under anesthesia.
The important is not the length of the resting nipple but breast tissue beneath the areola to pull out or protract to form the "teat" and occasionally a nipple does not really protract what is called inverted nipple and not very common. The inverted nipple can be made protracted by vacuum suction with a plastic syringe with cut end of nozzle. The alternative is to use nipple shield.
Baby refuses breasts:
The situation may be due to illness, oral thrush, or blocked nose of the baby. But more common is - bad experience of the baby due to too much milk coming too fast, bottle-feeding leading to nipple confusion, restricted breast feeding and getting little milk.
Breasts leak milk:
This is often due to production of large volume of milk during first few weeks after delivery. It usually occurs when it is time for feed, delay in feeding, loving thinking of baby and at the time of feeding from the other breast due to oxytocin reflex. Reassure the mother that will stop. One can put a pad of cloth inside to soak up and at work place one can express some of the milk.
This is one of the commonest cause that mothers started supplements to baby. But in most of the cases, it is the perceived status of the mother. If a baby urinate colorless or pale yellow urine 6 or more time in 24 hours, it seems that a baby is gelling enough milk (wetness test). Alternatively, a baby gains weight of 15-30mg/kg/day with adequate nutrition.
A baby cries when there is something wrong and crying is the only way for help. The causes may be as follows-
i) Baby is hungry, dirty, lonely, uncomfortable or afraid.
ii) Lactation crisis of mother: The baby at the age of about 2-3 months, temporarily outgrown the milk supply and demand to be breast fed frequently. Advise the mother to give frequent feeding rather not to start supplements. Discuss ways to increase production of milk.
iii) Baby is sick: The crying pattern is altered and examination may find out the nature of the illness.
IV) Abdominal colic:
Sometimes it is called "three months colic' as it rarely persists beyond 3 months of age. The baby usually has the colic during evening hours. The attack usually begins suddenly; the cry is loud and more or less continuous and may persist for several hours. The face is flushed, may be circumoral pallor; the abdomen distended and tense; the legs are drawn up on the abdomen, the hands are clenched. The attack may terminate only when the infant is completely exhausted, but often there is apparent relief with the passage of feces or flatus.
It may associate with hunger and with swallowed air. Overfeeding, high carbohydrate, intestinal allergy may cause colic. Careful physical examination is important to eliminate the possibility of intussusceptions, strangulated hernia, hair in the infant's eye, otitis, pyelonephritis, or other disorders.
Holding the baby upright or permitting the baby to lay prone helps occasionally. Prevention sought by improving feeding techniques, including burping, providing a stable emotional environment, identifying possible allergenic foods in the infant's or nursing mother's diet, and avoiding underfeeding or overfeeding. A supportive, sympathetic physician is important for successfully resolving the problem.
v) Working mother: The mother can alter the rhythm for breast feeding from day to night. She may express the breast milk to feed the baby during her absence. She may express at office to maintain lactation. Building up crèches also can help the mother to continue breast feeding for her baby.
vi) Although anxiety temporarily inhibits the let-down reflex, with continued, frequent breastfeeding and conscious efforts to relax, the mother's milk supply will soon be regulated with baby's demand. Mothers who live in areas that are in constant state of war report no inhibition of let-down, as they have adapted to their circumstances.
vii) Women who are breastfeeding should also take KI, to protect both themselves and their breast milk. The FDA and the World Health Organization (WHO) recommend that children from newborn to 18 years of age all take the recommended dose of KI unless they have a known allergy to iodide.
Given the many benefits breastfeeding provides, it should continue to be promoted as the best way to feed infants - exclusively for the first six months and then to two years and beyond along with solid foods. According to the Australian Breastfeeding Association, there is nothing in this study to justify calling for any changes to the recommendations on breastfeeding. The causes of allergy and asthma are complex. Breastfeeding mothers should be reassured that one study is not a reason to ignore a large body of evidence that shows breastfeeding is the best way to feed an infant.
The American Academy of Pediatrics recommends that mothers breastfeed exclusively for the first six months of an infant's life, then continue for another six months as they introduce other foods, and thereafter for "as long as mutually desired.
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