If the correct technique of breast feeding is not practiced ,it might lead to failure of breast feeding.

It might be a wise idea to ask for a history of previous problems during breast feeding (Including the history of breast feeding of previous children).

 

Proper Positioning of the Baby for Breast feeding- Very Important

The mother should be seated comfortably with proper support in a relaxed position.

The baby should be held in a position so that the head is aligned to the breast and the mouth directly in front of the nipple.

The breast must be held with the mothers free hand and the nipple and areola( The dark area surrounding the nipple) offered to the baby to ensure a proper “Latch on”.

As much as possible both the nipple and areola should be inserted into the baby’s mouth.

After feeding the baby should be removed from the breast by placing a finger into the baby’s mouth between the gums.

If the baby sucks on the nipple only (improper “latch on” ) , it may lead to cracked , bleeding or sore nipples.

 

I have sore/painful cracked nipples. How is it caused and what should I do?

At the commencement of breast feeding the negative pressure in the ductules causes soreness and pain, this should gradually pass of with the establishment of lactation.The soreness can be exacerbated by improper “latch on” (See above).

Treatment is by rinsing the nipple with clean water and allowing it to air-dry. A small amount of expressed breast milk can be applied and allowed to dry, this can hasten the healing process because of the presence of natural anti-microbial factors in the breast milk.

Topical antibiotics may be applied if infection is suspected. The nipple infection could also be due to candida (fungus) in which case topical antifungal agents will be useful.

Ensure that the topical antibiotics/ antifungal is washed off with clean water before commencing feeds.

 

How long should my baby suck per feeding?

On average the baby must suck for 10 minutes on the first breast and 20 minutes on the second one. There is no hard and fast rule on how long should a baby suck.

It must be emphasized that both breasts must be suckled during a single breast feeding period. At the next feeding time the baby must be placed at the breast last suckled. This encourages emptying of both breasts.

 

How many times should I breast feed my baby?

There is no hard and fast rule .

Breast feeding should be on demand.

Most babies will feed about 8 to 12 times within 24 hours.

Timed feeding is very demanding and stresses the mother as well as the baby and should be discouraged.

Frequent sucking promotes milk production.

Should I give Prelacteal /Supplimental feeds to my baby?

Prelacteal feeds should be avoided , especially in the first 4- 6 months of age. Prelacteal/Supplemental feeds include water,infant formulae, glucose water and other fluids.

Some of the disadvantages of supplimental feeds are suppression of breast milk production, nipple confusion by the baby and infection through contamination.

There are rare situations where supplemental feeds may be necessary eg severe illness in the mother, severe maternal exhaustion. If supplimental feeds are begun ,they should be discontinued rapidly once the indication for them is resolved.

 

What is appetite spurt?

This describes periods of excessive crying and irritability of the baby despite adequate breast feeding.

This usually occurs during the second and fourth week of age and at three months of age.

During this period there is the real danger of resorting to supplimental feeds , which usually does not solve the problem.

Patience and reassurance of the mother is needed in this situation.

 

I am lactating but my breasts are engorged. What could be the problem?

Breast engorgement during lactogenesis (formation of milk) is due the the increased blood and lymph flow to the breast. This is further compounded by poor or infrequent emptying.

This can be managed by frequently emptying the breasts either manually (Manual expression of milk by hand) or sucking

 

What are plugged ducts?

This refers to focal areas of breast enlargement caused by stasis of milk. It results from inadequate emptying of the breast .

Treatment is by frequent suckling and massaging affected parts during feeding.

 

What is breast abscess /Mastitis?

This is due to bacterial infection by staphylococcus aureus or strep pyogenes. The usual presenting symptoms are breast pain, fever, swelling and erythema (Reddish appearance around the affected part).

Treatment of this condition requires oral antibiotics and a pain killer such as paracetamol. Moist heat application may also be useful.

Breast feeding should not be stopped during treatment.

In this situation feeding should be started at the unaffected breast to stimulate the milk let down reflex.

 

References:

i) Paediatrics and child health in a tropical region edited by J. C. Azubuike and K.E. O Nkanginieme-1999

ii) Park’s Textbook of Preventive and Social Medicine by K .Park 17 th edition -2002.

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