Problems of Breastfeeding

Dr Asmaa Fathy
Lecturer of Family medicine
Problems of breastfeeding
Common complain during postnatal care visits
Too much breast milk ???
Breast engorgement
Blocked milk duct
Breast abscess
Sore or cracked nipples
Breastfeeding and thrush
Baby is not latching on properly
Not enough breast milk
Breastfeeding and tongue tie
 Lecture topics
Breast milk overproduction(too much
breast milk)
Breast engorgement
Insufficient milk
Sleepy baby
Lactation and Flu
 Too much breast milk
breasts refill very quickly after feeding
baby
Breast feel lumpy and tight after
breastfeeding
leak more than usual or have an explosive
milk-ejection reflex, which makes it
difficult to feed in public
can cause difficulties for the baby at the
beginning of feeding
 Complications
Breast engorgement, blocked milk ducts
or mastitis and breast abscesses
Early weaning if overproduction is not
diagnosed and managed well
overproduction of milk can make
breastfeeding a less pleasurable
experience for mother or baby.
 Management of overproduction of breast milk

Reassuring the parents that overproduction is

a common experience, especially in the first
three months after giving birth
Block feeding
 Choose a time frame usually from 3 to 4 hours and feed
the baby from only one breast during that time then
change to the other breast for the same time period
 Continue this pattern for a few days.

 
 Management of overproduction of breast milk

Block feeding
 Might need to hand express a small amount from

 the unused breast to relieve pressure or discomfort, but not
empty it .
 The residual milk in the unused breast triggers the reduction in 
milk production.
 Management of oversupply of breast milk

Block feeding
Block feeding will also help to reduce
the amount of thinner foremilk consumed by baby. 
As baby gets to drink more of the creamy hindmilk
the baby’s stools get thicker. (good indicator)
 Breast engorgement
Breast engorgement is the development of
hard, swollen, painful breasts from too
much breast milk.
Engorged breasts can become extremely
large, tight, lumpy, and tender. The
swelling may go all the way up into
armpit, and the veins on the surface of the
breasts may become more visible
 MANGEMENT

Encourage frequent on demand breastfeeding(at least

every 1 to 3 hours throughout the day and night)
Let the baby breastfeed for as long as she wants, but
at least 20 minutes at each feeding
Application of cold compresses
Take a warm shower or apply a warm compress to
the breasts just before breastfeeding. The warmth
can help with  let-down reflex and make milk
flowing. But, she shouldn't put heat on the breasts
between feedings since it can make the swelling
worse
 Management

Don't give the baby formula or water in

between breastfeeding sessions
Gentle breast massage
Hand expression of milk may help initiate
flow
Alternate breastfeeding positions to drain
all the areas of the breasts.
 Engorgement
Evaluation for signs of mastitis or breast
infection that may need to be treated with
systemic antibiotics is important
Continuation of breastfeeding
Not enough breast milk
Not enough breast milk
Signs of sufficient milk supply
How the baby sucks at the breast
Amount of urine and stool
Weight gain
How the baby sucks at the breast
 Not enough breast milk
How the baby sucks at the breast
The baby starts feeds with a few rapid sucks followed by long,
rhythmic sucks and swallows with occasional pauses.
Mother can hear and see her baby swallowing.
The baby's cheeks stay rounded, not hollow, during sucking.
They seem calm and relaxed during feeds.
The baby comes off the breast on their own at the end of feeds.
Their mouth looks moist after feeds.
The baby appears satisfied after most feeds.
The breasts feel softer after feeds.
The nipple looks more or less the same after feeds – not
flattened, pinched or white.
The mother feel sleepy and relaxed after feeds.
 Signs of insufficient milk
 Don’t hear your baby swallow.
 Do not see the open–pause–close kind of
suck.
The baby goes to sleep after sucking for a
few minutes only.
The baby seems to be hungry all the time
 Amount of urine and stool

Number and colour of bowel movements per day by age

Number of bowel movements

Age Colour of bowel movements
per 24 hours

Day 1 and 2 Greenish-black and sticky 1 to 2

Day 3 and 4 Greenish-brown Minimum 2

Day 5 Becoming yellow Minimum 2

Day 6 to 4 weeks Yellow and may be seedy Minimum 2, may be every feed
Signs of not enough breast milk
the baby is still having dark, greenish-
black, sticky bowel movements on day 5.
The baby has less than 2 bowel
movements in 24 hours up to 4 weeks.
After 4 weeks, baby is not having a
bowel movement and seems
uncomfortable or is having less than 6 to
8 heavy wet diapers in 24 hours
 Amount of urine and stool

Amount and number of wet diapers

Baby's age in days Minimum number of wet diapers in 24 hours

1 1
2 2
3 3
4 4
5 5
6 and older 6 to 8
Signs of not enough breast milk
The baby has less than one wet diaper per
day of life in the first week (for example,
less than 2 on day 2, 3 on day 3) or less
than 6 to 8 soaked diapers in 24 hours
after the first week.
The baby has dark yellow urine.
The urine is dark yellow in colour and
decreased in amount.
 Prevention of insufficient breast milk

Exclusive breastfeeding (breast milk

only) is recommended for around the first
6 months. Introducing bottle feeds will
reduce the amount of breast milk
produced
 Miss

Breasts start to feel softer again

Baby starts to breastfeed more often than
before (growth spurts)
2 to 3 weeks, at 6 weeks, and at 2 to 3
months(Growth spurts)
Baby cluster feeds, meaning that the baby
feeds every hour for 3 to 4 hours then sleeps
for a longer period: Babies often feed like this
in the late afternoon and evening to prepare to
sleep through the night.
 Miss
Breasts leak little or no milk: This is
normal for many women.
 Baby is fussy but has been gaining
weight well.
 Nipple Discomfort

Prevention
Hand expression of milk may help initiate flow
Breast massage to maintain milk duct patency
Begin feeding on the least painful or unaffected
breast
Careful positioning of the infant close to the
mother should ensure appropriate attachment
Frequent position changes will help to prevent
tissue irritation
 Nipple discomfort
Management
The nipple should be kept clean and dry to
promote healing
Nipple should be cleansed not with soap or
alcohol
Nipple should be dried by exposure to air
Thrush may cause sore,cracked,fissured nipple
and physician should evaluate both the mother
and the infant if this condition continue
 The sleepy baby
In the first month, the baby should wake to feed 8
to 12 times in 24 hours, or every 1 1/2 to 3 hours.
 It is normal to have one longer period of
continuous sleep of 5 hours in a 24-hour period.
Breast milk digests more easily and quickly than
formula, so the baby may get hungry faster.
The baby feeds for about 15 to 45 minutes.
Feedings will gradually decrease to 6 to 8 times in
24 hours as your baby gets older
 The sleepy baby
A single 4-5 hour sleep is normal then
feed at least every 3 hours
Sleepy baby in the first few days (from
labour anesthesia and post delivery
analgesic)and babies with improper
weight gain
The sleepy baby
Management
The baby should be aroused during REM
sleep
Signs of REM sleep
Rapid eye movement under the eyelids
Arm or leg movement
Suckling or change in facial expression
 The sleepy baby
Waking technique
Dimming the light
Holding the baby upright
Talking to the baby
Rubbing the back
Changing the diaper
Wiping the forehead
Expressing milk on the lips
 Lactation during flu
It is the best for the baby to continue
breastfeeding
Because the time the mother begins to feel
sick, his baby has already been exposed to
her illness also the mother’s body produces
specific antibodies which reach the baby in
the milk
However it is very important to ensure
frequent hand washing, limit face to face
contact and better wear face mask
 Expression and storage of breast milk

Indications
To relieve or prevent breast engorgement
To supply breast milk for use while mother and
baby are separated
 When the infant is not available or not able to
breastfeed as sick and at risk infants
 The mother will not be available for the feeding
and the breast milk must be stored
To increase milk supply
Mother’s lack experience
 Expression and storage of breast milk

Container choices
The term infant: use clean ,heavy plastic or
glass bottles
 The container should be washed will in a
dishwasher with sanitizing cycle or washed by
hand in hot, soapy water and rinsed well with
hot water
Preterm/sick infant: use sterile ,heavy plastic or
glass bottle
Use of soft plastic bags is discouraged
 Expression and storage of breast milk

Hand expression of breast milk

Wash hand well with soap and water
before handling breast milk
If possible, locate a quiet ,restful
environment
 Imagine being in a pleasant place
 Think nice thoughts about the baby
 The ability to relax well contribute to a
better milk ejection reflex
Expression and storage of breast milk

Hand expression of breast milk

Apply moist heat to the breast for 3-5 minutes
before expressing
Massage breast in a circular pattern, followed
by light stroking of the breast from the outer
edge toward the nipple
Gently stimulate the nipples by drawing them
out or rolling them between the fingers
Shake the breast while leaning forward so the
gravity will help the milk eject
 Expression and storage of breast milk

Hand expression of breast milk

Express and discard the first 2-3 squirts of milk
obtained from each breast
Express milk into a clean container(hard plastic or
glass)
Place thumb on the top of the breast at the areola
edge and four fingers underneath the breast at the
areola edge
Press the breast toward the ribcage and then gently
press the thumb and fingers together just behind the
areola
 Expression and storage of breast milk

Hand expression of breast milk

Repeat in a rhythmical pattern, rotating the position
of fingers around the breast to empty all areas
Alternate the breast every 5 minutes or when the
milk flow slows,remebering to repeat the
massage,stroke,express cycle several times at each
breast
The amount of milk obtained at each expression
may vary
When complete ,apply a few drops of breast milk
onto each nipple and allow to air dry
 Expression and storage of breast milk

Hand expression of breast milk

The appearance of milk will change while
expressing
 The first few drops will appear clear but after a milk
ejection the milk will be creamy white.
 Some medications,foods,and vitamins may also
slightly alter the color of breast milk. The milk fat
will rise to the top when the milk is stored
Immediately after expressing ,seal the container.it is
then ready to store in the coldest part of refrigerator
or freezer. Don't keep in the door area
 Expression and storage of breast milk

Mechanical expression of breast milk

Breast pumps can be manual, battery
operated, or electric.
Choose the right pump for each individual
situation. Use of pump empties the breast
effectively and stimulates milk production
Prior to pumping ,apply moist heat to the
breast, massage the breast and stimulate
the nipples like in hand expression
Mechanical expression of breast milk
The mother should follow the main guidelines of
hand expression
Follow the general instructions that came with the
breast pump
The flow of milk will vary during the first few
minutes it may drip out slowly and then squirt
forcefully after there is a milk ejection. This pattern
will repeat several times while expressing each breast
The amount of milk obtained at each expression may
vary. This is not unusual
 Storage of expressed breast milk
Store in amount equal to what your baby will take
at one feeding
Label each container with name,date,time and
amount
Refrigerate or freeze immediately after expressing
Be certain to leave room in the container for
expansion of milk
Preterm or sick infants: extra caution with milk
collection and storage is recommended.it is safest
to refrigerate milk immediately and not leave it at
room temperature
 Storage of expressed breast milk
Room temperature:
 Storage time:4-6 hours
Refrigerator:
 Storage time:24 hours (not in the door)
Always use the oldest milk first
The longer milk is stored the more it loses in
nutrient and immunological content
Keep in mind that the milk may change after
milk has been stored ,since the different
components of milk often separate
 Storage of expressed breast milk
Re-freezing: it is not recommended to
refreeze the milk that has been thawed or
partially thawed. Keep this in mind when
transporting milk to the hospital or from
work. For this reason it is usually best to
wait to freeze the milk once it has reached
its final destination
Don’t re use milk left over in bottle as
baby saliva may contaminate the milk
 Storage of expressed breast milk
Thawing milk:
 Thaw frozen milk “slow defrost "overnight in
refrigerator
 Swirl the milk in a bowl of tepid water to warm
excessive heat modifies or destroys enzymes and
proteins
 Defrost the total amount as butterfat separates during
the freezing process
 Never use a microwave oven to defrost or warm milk
 Once thawed breast milk should be used within 24
hours
 Storage of expressed breast milk
Expressing milk can be given to the infant
by
 finger feeding
 Cup
 Spoon
 Tube feeding
Bottle feeding should be avoided to
prevent nipple confusion.