In this last week of August, National Breastfeeding Month, we are going to review breastfeeding challenges and our role addressing these as pediatricians in clinic. Among the many reasons to promote breastfeeding, the emerging data on how breastfeeding affects the microbiome for infants is pretty cool. These data may help us better understand why breastfed babies get fewer infections and have other health benefits.
- Case and discussion by Dr. Nancy Danoff, local breastfeeding medicine expert
- AAP module on Maintaining Breastfeeding after the 1st week and the AAP breastfeeding resources page
- Huffington Post has a nice compile for National breastfeeding month including Dad's supporting breastfeeding-really amazing photos. For breastfeeding humor, check out the compile of comics here
- Local resources include: lactation specialists at UW, Open Arms perinatal support for low-income women
Take-home points on breastfeeding challenges:
- Indicators of successful lactation to assess at first well visits: Mother: milk is in, she is not engorged, has minimal nipple soreness with latch that dissipates after the first few sucks; starting to adjust to her newborn and has social support; Baby: feeding on both breasts 8-12 x in 24 hours, satisfied after 30-40 minutes of nursing; gaining 25-30 grams a day.
- While nearly all mothers try breastfeeding, almost half quit after a few weeks usually due to a few main problems: poor latch, pain, and perceived low milk supply. The vast majority of these challenges are treatable with support from us, lactation specialists, and family/social support. Only about 5% of moms actually have physiologic problems that lead to inadequate supply.
- To help with these challenges, we need to know a few basics: observe feeds so we can help with latch in different positions, assess nipple pain (should improve over time, but think of fungal and bacterial infections and vasospasm as causes if not), and help with milk supply – reassurance if gaining wt. If milk supply is an issue, recommended strategies include rest, hydration, breast compression, and increased stimulation through feeding and pumping, and galactogues including Reglan, fenugreek and oxytocin nasal spray.
- Late preterm infants are at special risk for difficulty establishing breastfeeding. Some appear large (6-7 pounds) but can be breastfeeding "imposters"; appear to be feeding well but are not transferring enough milk and not gaining weight well. They need extra attention, clear feeding plan, and benefit from early and ongoing lactation support to help them get there.
- How do we decide if a mom's medication is compatible with breastfeeding? Look it up on LactMed, the NIH sponsored website to provide information about drugs and other chemicals while breastfeeding.