Breastfeeding: Encyclopedia II - Breastfeeding - Difficulties with breastfeeding

Breastfeeding - Difficulties with breastfeeding

It is not uncommon for a mother and child to have difficulties breastfeeding in the beginning, but most of these problems resolve in the early weeks.

A small percentage (between 2 & 3%) of women are unable to provide a full day's calories. It is not known what causes insufficient milk supply, but extended separation at birth, insufficient glandular tissue, and Polycystic Ovary Syndrome (PCOS) are all known culprits. Even among this small group, it is feasible to continue breastfeeding while supplementing with donated breastmilk or artificial baby milk. Many of these mothers breastfeed exclusively by using thin tubing taped to the breast to deliver the supplementary food. This is called a supplementary nursing system, or SNS.

While some may find it too problematic or choose not to attempt or continue breastfeeding for personal reasons, most women who have initial difficulties can go on to breastfeed successfully.

Breastfeeding - Breast refusal

Though babies have a natural sucking reflex, they still have to learn how to feed and may occasionally resist feeding from the breast. To establish breastfeeding firmly, it is important for the baby to be put to the breast soon after birth so that the baby is accustomed to feeding from the breast from the very beginning. The AAP policy on breastfeeding says: Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed.

Causes of breast refusal include:

• Formula feeding, sometimes without the knowledge of the mother.
• The use of artificial teats (nipples) or dummies leading to "nipple confusion"
• Poor feeding technique
• Over-handling after birth
• Thrush in the baby's mouth [21] [22]
• Distractions or interruptions during feeds
• Long separations from the mother
• Breathing difficulties, often caused by a common cold [23]
• Swallowing difficulties, sometimes the painful result of ear or throat infections
• Pain from surgery (most commonly circumcision), blood tests, vaccinations, and other procedures commonly done without anesthesia [24] [25]

In later stages teething could be perceived by the mother as a hindrance to breastfeeding. While it is seen by some as a good time to wean the infant, teething difficulties can usually be overcome.

Breastfeeding - Medical conditions of the infant

Reasons for the inhibition of an infant to feed include:

• Difficulties latching onto the breast
• Poor sucking reflex
• Poor stamina
• Medical conditions such as cleft palate
• Hypoglycemia or hyperglycemia
• Hypotonia, or "low-tone" infant disorder

Premature babies can have difficulties if their sucking reflex is still underdeveloped and if they tire during feeds.

For many sucking related feeding difficulties, the infant can receive proper nutrition by use of a Haberman Feeder, a special bottle with a carefully designed nipple that simulates breastfeeding.

Breastfeeding - Medical conditions of the mother

Many women with previous surgeries, abscesses and cancer can breastfeed successfully. However, damage to the breast tissue can cause problems or prevent manageable breastfeeding for women with history of breast surgery or infection. Cancer (particularly breast cancer) and chemotherapy treatments have also been shown to cause difficulties. Infectious diseases such as HIV, AIDS, or active, untreated tuberculosis can be passed onto the infant. A HIV-positive mother breastfeeding an infant can, in some countries, be investigated for child abuse – a 1998 case in the U.S. resulted in the HIV-positive mother being reported to social services for her continued breastfeeding and non-treatment of the child for HIV [26]. The presence of herpes lesions on the breast is also contraindicative to breastfeeding.

Mastitis is inflammation of the breasts caused by the blocking of the milk ducts. Mastitis cause painful areas on the breasts or nipples and may lead to a fever or flu-like symptoms. It is not necessary to wean a nursling simply because of mastitis; in fact, nursing is the most effective way to remove the blockage and alleviate the symptoms, and is not harmful to the baby. Sudden weaning can cause or exacerbate mastitis symptoms.

Breastfeeding - When breastfeeding can be harmful to the infant

Breastfeeding can be harmful to the infant if the mother:

• has HIV or active tuberculosis
• is taking certain medications that suppress the immune system
• is taking certain medications which may be passed onto the child through the milk and are found to be harmful. However, the vast majority of medications are compatible with breastfeeding.
• has had excessive exposure to heavy metals such as mercury
• uses potentially harmful substances such as cocaine, heroin and amphetamines. Substances such as caffeine, tobacco, and alcohol, while possibly harmful to the nursling if consumed in large quantities, are safe to use in moderation while breastfeeding (see below).

Most of these problems are avoidable as they relate to the nursing mother's behaviour.

Breastfeeding - Health and diet

Since the nutritional requirements of the baby must be satisfied solely by the breast milk in exclusive breastfeeding it is important for the mother to maintain a healthy lifestyle, especially her diet. If the baby is large and grows quickly, the fat stores gained by the mother during pregnancy can be quickly depleted, and she may have trouble eating well enough to keep developing sufficient milk. The diet usually involves a high calorie, high nutrition diet which follows on from that in pregnancy. The Subcommittee on Nutrition during Lactation advises approximately 1500–1800 calories per day [27]. While mothers in famine conditions can produce milk with highly nutritional content, a malnourished mother may produce milk with decreased levels of vitamins A, D, B6 and B12. She may also have a lower supply than well-fed mothers [28].

There are no foods which are absolutely contraindicated during lactation, although a baby may show a sensitivity to particular foods in the mother's diet. Some breastfeeding advisers suggest mothers avoid certain gas producing food, such as beans, if the baby starts to develop colic or gas.

Breastfeeding mothers must use caution if they smoke and therefore consume nicotine. Heavy use of cigarettes by the mother (more than 20 per day) has been shown to reduce the mother's milk supply and cause vomiting, diarrhoea, rapid heart rate, and restlessness in breastfeeding infants. Research is ongoing to determine whether the benefits of breastfeeding out-weigh the potential harm of nicotine in breast milk. Sudden Infant Death Syndrome (SIDS) is more common in babies exposed to a smoky environment [29]. Breastfeeding mothers who smoke are counselled not to do so during or immediately before feeding their child. They are encouraged to seek advice to help them reduce their nicotine intake or quit.

Heavy alcohol consumption is known to harm the infant, causing problems with the development of motor skills and decreasing the speed of weight gain. There is no consensus on how much alcohol may be consumed safely, but it is generally agreed that small amounts of alcohol may be occasionally consumed by a breastfeeding mother. However, some believe that a single daily glass of wine is enough to cause distress, with levels of alcohol in breast milk peaking 30 to 90 minutes after one drink of moderate alcoholic content. Considering the known dangers of alcohol exposure to the developing fetus, many medical professionals believe it is preferable to err on the side of caution and have breastfeeding women restrict or eliminate their alcoholic intake.

Excessive caffeine consumption by the mother can cause irritability, sleeplessness, nervousness and increased feeding in the breastfed infant. Moderate use (one to two cups per day) usually produces no effect. Breastfeeding mothers are advised to avoid or restrict caffeine intake.

Cannabis is listed by the American Association of Pediatrics as a compound that transfers into human breast milk.[30] This is based on research which demonstrated that certain compounds in marijuana have a very long half-life. Cannabis exposure via the mother's milk during the first month postpartum appears to be associated with a decrease in infant motor development at one year of age.

Adapted from the Wikipedia article "Difficulties with breastfeeding", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki