Difficulties in Breast

Feeding in healthy
term neonate
 INTRODUCTION
 WHO & UNICEF recommended that breastfeeding should be initiated in the first hour after birth, continued
exclusively for the first 6 months of life and continued, with safe and adequate complementary foods, up to 2
years.

 In India, only 44.6% of mothers initiate breastfeeding within one hour of birth despite the fact that about
78.7% of mothers deliver in institutions. (RSOC, 2014).

 •Further, 64.9% of babies are exclusively breastfed during the first six months and only 50.5% of babies
between 6-8 months are given complementary foods (RSOC, 2014).

 •Therefore, it is important to encourage optimal breastfeeding practices (early initiation of breastfeeding

within one hour, exclusive breastfeeding for first six months and can be continued for two years).
Lactation support focuses on three critical determinants

 Sufficient milk production

 Effective attachment
 Maternal confidence

Any issues in above-mentioned factor accounting for the drop off in breastfeeding
Issues related to maternal confidence
Mothers with C-Section
 At higher risk for producing insufficient milk due Peripartum events which includes anesthesia,
pain and infant-mother separation
 Delayed initiation of suckling also contribute to the risks

Suggested Measures

 Start breastfeeding as early as possible and preferably within 1 hour of birth.

 Provide skin-to-skin contact, as much as possible, especially during the first day
 Help mother to find a comfortable position to breastfeed
 She may feed in her supine position (on first day), side-lying position (on second day), or sitting
position (day three onwards).
 Mothers with twin pregnancy
 Having physical and emotional difficulties while caring more than one infant
 lack of professional support from Hospital staff
 Need of Additional calories, proteins and micronutrients to produce enough milk

Suggested Measures
 Mother must receive tremendous support , encouragement and assistance initially from health
care worker and later from family member
 Needs greater assistance with positioning and attachment
 By Providing parents with a chart and teach them how to keep a daily record of milk intake
 Mother can offer alternate breast for feeding to each baby
 Recommend back-to-back feedings
 Additional calories, proteins and micronutrients must be provided to mother to produce enough
milk
Working Mother
 Evidence shows that breastfeeding rates drop significantly when they return to work

Suggested Measures

 supportive breastfeeding environment should be ensured for all working mothers - including
those in the informal sector or on temporary contracts - by having access to regular breastfeeding
breaks and dedicated time with space to breastfeed

 Mother can express her milk in clean container which can be stored at room temperature for up
to 4–6 hours, in the refrigerator for 24 hrs
Problems With Attachment And Insufficient
Milk Production

Breast Engorgement
 Breasts become swollen, hard, areola gets overstretched and nipple become non-protectile
 Engorgement may occur early (24- 72 hours postpartum) or late in the postpartum period.•
 Early engorgement results from a combination of edema, tissue swelling and milk production
 whereas engorgement that occurs later is usually strictly due to accumulated milk
Suggested Measures
 Enhancement of milk flow is key to both preventing and treating engorgement
 Ensure good attachment, and encourage unrestricted breastfeeding
 Empty the breasts frequently and completely by breastfeeding.
 Expression of milk by hand or breast pump in between feedings to soften the areola and
allow the baby to latch on more easily
 Massaging gently before feeding can improve milk flow and soften the breast.
 Hot Fomentation can provide relief
B) Sore Nipples –
 Due to Incorrect positioning and attachment of baby, nipple sucking, frequent use of soap
and water on breast, and fungal infection of nipple.

Suggested Measures
 Continue breastfeeding with correct position and attachment.
 Donot offer complementary feed from bottle as it lead to nipple confusion
 Expose the nipple to air between feeds and apply hind milk to the nipple after breastfeeding.
 If fungal infection occurs, apply medicine on the nipple and inside the baby’s mouth.
Signs of good attachment

 Signs of good attachment

 The baby's mouth is wide open
 Most of the nipple and areola in the mouth, only upper areola
visible, not the lower one
 The baby's chin touches the breast
 The baby's lower lip is everted
Inverted/Flat Nipples
 Flat or short nipples which well (become protract prominent or pull out easily) do not
cause difficulty in breast feeding .Only inverted or retracted nipples make attachment to
the breast difficult

Suggested Measures

 Build mother’s confidence

 Help mother to position baby early, trying different positions. Provide skin-to-skin
contact.
 Nipple should be manually stretched and rolled out several times a day
 For retracted nipple syringing method should be used