COMMON PROBLEMS DURING BREASTFEEDING

 

13-04-2008 

 

 

 

Although breastfeeding is the recommended method of feeding infants, it is not without complications or occasional discomforts for the mother. By being aware of these common problems, the health care professional can offer advice to mothers to help alleviate potential difficulties. As a general rule, breastfeeding should be continued through most illnesses, including periods of diarrhea. Some of the most common problems are listed below.

 

 

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Sore Nipples: Most women experience sore nipples at some period during their breastfeeding course, especially during the first 2 weeks postpartum.13 Frequent, short nursings, repositioning the infant at the breast, applying cold packs or heat to breasts, avoiding irritating soaps or lotions on nipples, air-drying nipples after nursing, exposing nipples to direct sunlight or 60 watt bulb for 15-20 minutes three or four times per day, applying vitamin E squeezed from capsules or ointment such as vitamin A & D, pure lanolin or Masse¢ cream to nipples, and avoiding the use of nipple shields may help ease the pain of sore nipples.13, Occasionally, sore nipples are caused by a Candida albicans. The breasts may not appear to have a fungal infection, but cultures of nipple surfaces will be positive for Candida albicans11 Women often report shooting pains at the end of a nursing when sore nipples are caused by a fungal infection. 11

 

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Engorgement: The first engorgement caused by increased blood flow and filling of the breasts will occur on the third or fourth day postpartum, usually without discomfort.11 However, some women experience rapid filling of the breasts causing increased engorgement and discomfort. Blocked mammary ducts may also be a cause of pain. Frequent nursings, breast massages once or twice a day or before feedings, hot or cold packs, wearing a firm bra for support and avoiding the use of nipple shields can help alleviate some of the discomforts of engorgement. 27 The best way to prevent engorgement is to begin breastfeeding as soon as possible after birth followed by subsequent frequent nursings. 27

 

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Mastitis: Mastitis is a breast infection causing chills, fever, flu-like symptoms, redness and breast sensitivity. It may be a complication of a clogged mammary duct or caused by an infection carried from the baby. 11, 27 The primary goal in treating mastitis is emptying the infected breast. Healthy infants are not at risk for developing illnesses by nursing during mastitis and frequent nursing is actually encouraged.11, 27 If a mother develops symptoms of mastitis her physician should be notified. Antibiotics or pain relievers that are safe during breastfeeding are often prescribed. If mastitis goes untreated, an abscess could develop. Applying heat (not cold) to the breast, drinking plenty of fluids and adequate rest are advocated to aid in the healing process.11

 

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Jaundice: The onset of breastmilk jaundice is typically at 1-2 weeks of life and occurs in about 1% of the population of breastfeeding newborns.12 It is apparently caused by the presence of a substance in the breastmilk that enhances red cell hemolysis or alters liver function.27 It is rarely necessary to stop breastfeeding. Mothers should be encouraged to breastfeed 10-12 times per day as frequent nursings are inversely correlated with serum bilirubin levels. 11, 12

 

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Poor Milk Supply: Poor milk supply can be a cause of failure to thrive in breastfeeding infants. Maternal causes of poor milk supply are hypothyroidism, excessive antihistamine use, oral contraceptive use, excessive caffeine intake, illness, poor diet, decreased fluid intake, infrequent nursings or fatigue.12Correction of any of these causes may improve milk supply. 

 

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Nipple Confusion: Infants who are breastfeed may refuse to take a bottle as the weaning of breastfeeding occurs. The same musculature is necessary to suck from either a breast or bottle, however, the spatial arrangement of the tongue and nipple differs from the two modes of feeding.11 If the mother plans to feed formula from a bottle at anytime during the first year of life, advise her to offer a bottle during the first 2-4 weeks of life and then offer one bottle per week thereafter to decrease the incidence of nipple confusion. The bottle feedings can be given using expressed breastmilk.11, 12

 

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