Elliot WOMEN’S & CHILDREN’S Services
The Elliot Women's
& Children's Services
Elliot’s Pediatric/Adolescent Center
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This is The Elliot Maternity Center
Lactation FAQ's
What is insufficient milk supply?
The majority of women are able to produce enough milk to feed their babies for at least 4-6 months and even longer. Only a small number of women are unable to produce enough milk. Even in this circumstance, a woman can still breastfeed, but will need to supplement with formula.
What is the cause?
Possible causes are:
Poor or inadequate breast stimulation
Unrelieved breast engorgement
Overuse of supplemental formula/water
Any breast surgery particularly breast reduction or augmentation
Hormonal imbalance
What are the symptoms?
• Your milk is not in by 3-5 days after giving birth. There's minimal or no swallowing at feedings
• Your baby has fewer than 6 noticeably wet diapers of clear urine every 24 hours
• Your baby has a poor grasp of the nipple and doesn't suck vigorously
• Your baby's stool hasn't changed from black to yellow by day 4
• Your baby breastfeeds less than 8 times or greater than 12 times in 24 hours
• Your baby weight is not back up to birth weight by 2 weeks of age
* If you are experiencing any of these symptoms, call the Lactation Office to schedule an appointment for a breastfeeding evaluation ASAP or contact your medical care provider.
What is the treatment?
• Breastfeed your baby on demand with no restriction regarding frequency or duration.
• Get the best latch possible. Make sure the baby has enough nipple tissue in its mouth and you hear audible swallowing. Wake your baby for feedings if he/she is sleeping too long.
• When possible, breastfeed in a quiet, relaxed atmosphere. Some babies won't settle down and nurse if there's too much activity around them.
• If your baby is no longer drinking on his own, use compression to increase the flow
• Hold the baby in one arm. Hold the breast with the other, thumb on one side of the breast, your fingers on the other, fairly far back from the nipple.
• Watch the baby's drinking. The baby gets a substantial amount of milk when he/she is drinking with an OPEN-PAUSE-CLOSE motion (the pause is not a pause between sucks. It's during one suck.)
• When the baby is nibbling or no longer drinking with the OPEN-PAUSE- CLOSE type of suck, compress the breast (but not so hard that it hurts.) The baby should start drinking again with the OPEN-PAUSE-CLOSE type of suck.
• When your baby no longer drinks even with compression, switch sides and repeat the process. Keep going back and forth until the baby stops drinking.
• Prior to feedings, try warm compresses on the breast for 5-10 minutes or gently massage the outer and lower breast with the knuckles of your hand.
• Express each breast manually or mechanically for 5 minutes after feedings to increase nipple stimulation and empty as much as possible.
• Express your breasts when separated from your baby or if your baby has had an ineffective feeding. Looking at pictures of your baby, smelling its blanket or visualizing your baby at the breast will help your milk let down.
References: Davis, Marie,The Lactation Consultants Clinical Practice Manual, 1998.
Newman, Jack; The Ultimate Breastfeeding Book of Answers; Prima Publishin, 2000
Lawrence Ruth, Breastfeeding: A Guide for the Medical Profession Mosby, 1999
What is over-supply (overactive let-down) syndrome ?
Your baby is getting too much milk, too fast. The milk flow is so fast and strong that your baby can't swallow fast enough to keep up with it or your baby may ingest too much foremilk (lactose) and not enough hind milk, causing colic-like symptoms. There is no known cause for this syndrome.
What are the symptoms?
Baby Symptoms :
• Your baby is colicky, fussy, or gassy; burps like an adult or burps poorly
• Spits up frequently, often in large amounts
• Gains weight quickly (1-2 pounds/week), often 1 lb. or more over birth weight at two weeks of age
• Gulps with feeding, often chocking when let down occurs, often pulls off or chews at the breast
• Your baby's abdomen may appear full and distended after feeds and may have hyperactive or gurgling bowel sounds
He/she may latch onto just the nipple or bite the nipple to slow down the flow
• He/she may want to nurse very frequently and often has short feedings (5-7 minutes)
• May have stuffy nose after feeds or frequent ear infections
• May have unusual stool patterns – stool may be either semi-thick (peanut butter consistency), infrequent, large and remain liquid to soft in consistency, or frequent diarrhea-like that appears slimy, foul-smelling or bright green
Maternal Symptoms :• You may have persistent sore nipples often with linear crack across nipple face
• Your nipple may appear pinched, not round or white when released
• You may feel that you have too much milk or are constantly leaking
• You may feel you don't have enough milk because your baby always appears hungry
• You may experience deep pain in the breast between feedings from nerve irritation due to persistent nipple pinching
• You may experience painful let downs that sting or burn
• You may have a history of repeated engorgement or plugged ducts
• You may question your diet as the cause of your baby's fussiness
What is the treatment?
• Use the same breast per feeding for up to a 3-hour period
• Hand-express the opposite breast between feedings for comfort only
• For engorgement, hand-express to soften the areola before feedings
• Watch for plugged ducts or mastitis
• Consider Simethicone infant drops for gas every 6 hours before feedings with MD permission
• Try nursing with your baby in a sitting position to help control the milk flow. You may also sit back in a recliner or lay flat in bed with your baby on your chest to nurse
• Burp the baby more frequently, especially after let down
• Use pacifier as needed to satisfy your baby's sucking need
• If baby starts to choke or sputter with let downs, take him off the breast and sit him up until he catches his breath, then put him back on when he's calm. Have a cloth under the breast to catch the spray of milk
• Meet with Lactation Consultant for evaluation.
References:
Martin, C., The Nursing Mother's Problem Solver , Fireside, 2000.
Davis, M., The Lactation Consultants Clinical Practice Manual , 1 st Ed., 1998.
Can I breastfeed if I am sick?
Many mothers worry about nursing their infant if they are sick. In almost all cases she should continue nursing her infant. Many illnesses are contagious in the incubation stage; however by the time the mom knows she is sick, the infant has already been exposed to the illness. When a breastfeeding mother is sick, she builds antibodies against the illness and will pass these on to her baby through her breast milk. Often, the baby may not get sick at all or will have a much less severe illness.
What is the treatment?
Good hand washing is the key to controlling the spread of most illnesses.
The most common illnesses are colds and flu. Assess for possible mastitis, as these symptoms can be similar to flu-like illness. The symptoms of mastitis are breast pain, hard, reddened area of the breast with fever and chills. If you have these symptoms, you should speak with your doctor. You may continue nursing.
Breastfeeding may continue with the following illnesses:
• Colds and Flu
• Fever
• Most bacterial infections being treated by antibiotics
• Rubella, which is contagious in the incubation stage. It is transmitted to infant before symptoms appear in the mother
• Chicken pox is contagious in incubation period and is transmitted to infant before symptoms appear in the mother. Cover any open lesions that may come in contact with the baby. Change dressing every feeding. May continue breastfeeding if lesions are not on the breast/nipple.
• Measles and Mumps are contagious in the incubation stage, and are transmitted before symptoms appear in the mother.
• Herpes is contagious in the incubation stage and while lesions are draining.
• Hepatitis B: May breastfeed. Hepatitis C: More controversial.
Cannot breastfeed with the following illnesses/conditions:
• Active Cancer (Most treatments like surgery and Chemotherapy should not be postponed.)
• AIDS or HIV Positive: This virus may be transmitted through the breast milk. Risks of postpartum transmission are yet to be determined.
• Any life-threatening illness.
• Illegal drug use is never acceptable for a breastfeeding mother.
Recommendations:
• Get lots of rest and increase fluids to help maintain supply.
• Observe infants for changes in feeding patterns, voiding, stooling and sleeping and report any concerns to your pediatrician.
Most moms report a decreased milk supply with a fever/flu like illness, but with rest, increased fluids and frequent nursing, milk should increase.
Can I take medication while breastfeeding?
During the breastfeeding period, it is likely that a mother may need to take medication. Each time she considers taking medication, she must weigh the benefits of the medication use for herself against the potential risk of exposing her infant to the medication (or choosing to not breastfeed .) A drug that is not safe during pregnancy may be compatible with breastfeeding or vice versa.
We know that most drugs do pass into breastmilk, but usually in very small amounts (usually less than 1 % of the maternal dose). Very few medications are contraindicated for breastfeeding moms. The transfer of medications into breastmilk and then absorption by the baby depends on many factors. Most medications have few side effects in breastfeeding infants because the dose transferred via milk is almost always too low to be clinically significant.
What should I consider before choosing or taking a medication?
• Avoid or delay medication use unless necessary
• Use topical medications (such as ointments, lotions or inhalers) rather than systemic medications (such as oral pills) whenever possible
• Medications that are safe for use in a non-breastfeeding infant are generally safe for the breastfeeding mother to use
• Take the lowest possible dose for the shortest possible time
• Avoid sustained release products
• Schedule taking the medication so that the lowest amount gets into the milk (usually immediately after a feeding or prior to infant's long sleep period
• Watch for reactions such as fussiness, rash, colic or change in feeding or sleeping habits.
• If you are unsure about a medication, call your physician or the Lactation Warm Line (603) 663-4464.
References:
Hale, Medication and Mother's Milk, 10 ed, Pharmasoft Publishing, 2002
Auerbach K, Riordan J, Breastfeeding and Human lactation, 2 nd ed, Jones and Bartlett, 1998
How do I manage plugged milk ducts?
The most common cause of a plugged duct is breast milk not being properly or sufficiently drained during breast-feeding. Other causes could include: improper positioning, missed feedings, a change in your breast-feeding pattern, ineffective infant suck, over-supply syndrome, or external pressure on your breasts (ex., underwire bra). If not treated, this can develop into mastitis.
What are the symptoms?
Redness, tenderness or warmth in one area of the breast. You may actually feel a well-defined lump at the area of the plugged duct; this area may still feel firm even after nursing. Sometimes you may even notice a small white “plug” at the end of a milk duct on your nipple. Plugged ducts are usually not accompanied by fever or flu-like symptoms.
What is the treatment?
• Prevention is the best solution!
• Continue with frequent breast-feeding; begin feeds on the affected side.
• Before each nursing, apply a warm, moist compress to the affected side for approximately 5-10 minutes; follow this with breast massage. It is often helpful to continue to massage the affected area during the nursing session to help stimulate the milk flow. A good time to massage is also during a warm shower.
• Nurse more often on the affected side for a day or two. Change the baby's position often during the feeding to help sufficiently empty the breast. Try to nurse at least part of a feeding with your baby's nose being pointed towards the area where you feel the plugged duct.
• Gently clean off any dried secretions you may see blocking the pores of your nipples.
• Avoid constrictive clothing or underwire bras. Avoid positions that put pressure on one area of the breasts for a long time (example, always sleeping on one side).
• Try to get extra rest, eat well, and continue with adequate fluids. The plugged duct poses no danger to the baby. With heat, massage, and frequent nursing, these symptoms usually disappear quickly.
If you try these suggestions and don't notice an improvement within one day, contact your healthcare provider or the Lactation Consultants.
References:
Riordan, J., Auerback, K, Breastfeeding and Human Lactation , Jones & Bartlett, 2 nd edition, pp. 502-504.
Lawrence, R.J., Breastfeeding: A Guide for the Medical Profession , Mosby, 4 th edition, 1994.
Davis, M., The Lactation Consultants Clinical Practice Manual , 1 st Ed., 1998.
What is Mastitis?
Mastitis is an inflammation of the breast, and should be managed by your healthcare provider. It is usually associated with lactation, can be acute or chronic, and often occurs as a result of ineffective breast-feeding management or technique. It can progress to an infection and result in abscess formation if treated improperly. Women who have had mastitis in a previous lactation have a greater change of recurrence in the same or next lactation.
What is the cause?
Mastitis is caused by the inefficient milk removal, which leaves areas of the breast undrained for long periods of time and can cause milk to accumulate in the breast. It may be the result of:
• Engorgement or plugged ducts, possibly associated with any of the following:
- skipped feedings
- scheduled feedings
- switching to the second breast before the first is drained
- overuse of pacifiers
- sudden change in the number of feedings
- baby sleeping longer at night
- mother or baby illness
- separation of the mother and baby
• Sore, cracked nipples from poor positioning and latch-on or infant tongue-tie.
• Over-abundant milk supply.
• Maternal stress/fatigue/exhaustion.
• Poor nutrition/anemia.
Consistent pressure on the breast, e.g., tight clothing or poorly fitted bra.
What are the symptoms?
• Fever higher than 100.4 °
• Painful, red, or swollen area on the breast
• Chills
• Flu-like body aches
• Red streaks extending toward armpit
When and where does it occur?
• Highest incidence is generally at 2-3 weeks
• Usually at the upper, outer aspect of the breast (towards the armpit)
Usually occurs on one breast but can occur in both
What is the treatment?
• Continue to breast-feed often, at least 8-12 times a day
• Hand-express to pump the affected side if the baby doesn't thoroughly drain that breast
• Alternate nursing positions with each feeding
• Massage and gently compress the breast and hard area with your fingertips each time the baby pauses between sucks
• Apply warm compresses to affected area
• Be sure to eat a well-balanced diet, get plenty of rest and drink plenty of fluids
• Be sure to contact your physician, who may prescribe antibiotics
• Ask your physician if you can use medication such as ibuprofen as both a pain reliever and anti-inflammatory
References:
Walker, Marsha, Rn, IBCLC, La Leche League International, Lactation Consultant Series Two , Unit 2, “Mastitis in Lactating Women,” 1999.
Walker, M., Care Plan for Mastitis , La Leche League International.
Riordan, J., Auerback, K, Breastfeeding and Human Lactation , Jones & Bartlett, 2 nd edition, pp. 502-504.
Adoptive Nursing
There are really two objectives involved in nursing an adopted baby. One is getting your baby to breastfeed and the other is producing breast milk. Since there is more to breastfeeding than breast milk, many mothers are happy to be able to breastfeed without expecting to produce all the milk the baby will need. It is the special relationship, the special closeness, and the biological attachment of breastfeeding that many mothers are looking for. As one adopting mother said, “I want to breastfeed. If the baby also gets breast milk, that's great.”
Getting the baby to the breast is often related to the baby's age, that is, those under three months are more likely to go to breast with less hesitation than the baby three months or older. The older babies are simply less likely to know how to breastfeed because they've probably been bottle-fed all their lives and may also be less willing to try. Therefore, the sooner a baby is placed at the breast after he is born, the better.
Milk production begins during pregnancy and is certainly helpful in priming the breasts for its function after the baby's birth. However, pregnancy is not necessary for milk production. Regular, effective suckling stimulation is the key. Most adoptive mothers make some milk; how much depends on how often the baby goes to the breast and how effectively and vigorously the baby breastfeeds. The baby is the one who governs milk production.
In most cases, adoptive mothers need to provide extra nutrients via a supplemental nursing system (SNS) in addition to their breast milk until the baby begins solids. By then, many (but not all) adoptive mothers may be making enough milk, and supplemental fluid is no longer necessary. As their babies eat more solid foods, and drink occasional juices and water from a cup, their need for milk diminishes.
Keep in mind that success is not geared solely to milk production. Adoptive nursing helps show the baby that he is part of the family, helps him feel secure and shows him that his needs will be met in his new environment.
*Information gathered from publications by J. Newman MD and K. Auerbach Ph
