Breast Feeding and its associated

complications

Dr. Varsha Atul Shah

Senior ConsultantDept Of Neonatal

and Developmental Medicine

Why Breastfeed?Literature is replete with scientific evidence on the benefit of

the most natural process of a mother- breast feeding her baby Exclusive breast feeding in the first six months of life can cut

down under-five child mortality by

13-15%

There could not be more compelling reasons for breastfeeding the baby.

Advantages

Baby Mother Family

Advantages to the baby

Decreased incidence of infections- diarrhea, RTI, otitis media, NE, late onset sepsis in pre termReduction of both Type I and II diabetes, leukemias, lymphomas, asthma and obesity.Enhances performance on cognitive development

Advantages to the mother

Involution of uterus and haemorrhagePostnatal amenorrhoeaDecrease risk of breast and ovarian malignancyDecreased risk of hip fracture after menopause

Advantages to the family

Readily availableHygienicEconomicalKeeps children healthy

How is milk produced?

Preparation of breast for milk productionProduction of milkLet down Reflex

The first few steps…..

Proper antenatal counseling A well informed, supportive husband Relative or nurse in the labour room

How Soon?

At The EarliestIn the healthy neonate suckling reflex is at its

peak- 30 to 40 mins after birthEarly feeds stimulate production of prolactin and

increases the mean duration of breast feeding

The first few steps…..

Placed prone on the mother’s abdomenFeed in the 1st hr of delivery

on the labour table itself

Breast Feeding In Operative Delivery

Maintain skin to skin contactBreast feeding within 1 hr when LSCS under spinal anesthesia; otherwise when the effect of GA weans off. Women should not have pain, as it decreases production of milkPosition of baby is important

SIDE LYING

FOOTBALL(CLUTCH HOLD)

CROSS CRADLE HOLD

CARDLE HOLD

POSITIONSOF

BABY

Latching – The Right Technique

Latching on is the creation of a tight seal around nipple and most of the areola through baby‘s mouth.Ideally, baby’s lower lip should be covering more of the areola than the upper lip and nipple should not hurt after few min

Frequency And Length Of Breast Feeding

Exclusive breast feeding for 6 monthsOn an average 650 to 850 ml milk is produced per day.2 to 3 hourly or 8 feeds per day or feed on demandDuration time is 25 to 30 min- both breasts should be fed each time

The Right Technique

Baby’s head should be always at a higher levelCorrect latching onProper sucking and swallowingPost feed care of baby is important

Indicators Of Adequate Feed

No. of feeds each day (8 or on demand)If baby sleeps well for 2 to 3 hours after feed Urine output- 6 to 8 diapers per dayNo. of stools- 4 to 5 times per dayWeight gain- 30 gm per day

Care Of Mother

Calorie intake- 300 to 500 extra calories ( 2200 to 3000 kcal per day)

Balance diet and no weight reductionFluid intake : 22% from well balanced diet; increase fluid intake is essential but excessive consumption can result in reduction of production of milk( Dusdiekor in 1994)Iron and Calcium Supplementation

Contra Indications For Breast Feeding

Maternal: Acute febrile conditions and critically ill patientsBreast abscessHIV +ve motherOpen cases of pulmonary TBAnti thyroid drugsAnti cancer drugsHepatitis AFollowing radio pharmaceuticals

Contra Indications For Breast Feeding (Contd….)For baby:

Breast milk jaundice Cleft lip or palate Oromotor dysfunctionPre-maturityUnder weight

GALACTOGOGUES

There is no ideal galactogogueChlorpromazine and metoclopromide- 10 mg 3 times daily for 7 daysGarlic, ginger, coconut, jaggery, ghee, panjeeri, saunth, khas-khas, bajra, pepper etc

Self confidence, freedom from anxiety, soothing environment with vigorously sucking by an active

baby are the most effective pre-requisites for successful establishment of lactation.

SUPPRESSION

EstrogenBromocriptinCabgolinThiazidePyridoxineOCPTestosterone

Lactation Complaints

Insufficient Milk SyndromeRetracted nipplesSore nipplesBreast engorgementMastitis Breast abscessChoice of contraceptionProblem of working women

RETRACTED NIPPLE

Antenatal examination and counseling for cleaning of nipples and their aversion is important20 cc syringe may also be used for correcting retractionNipple shieldUse of breast pump

SORE NIPPLE

Commonest Cause improper latchingSymptoms: pain Signs: nipple is red, cracked, bruised, blistered and tenderTreatment: linolin/ emolient cream; air drying and applying own milk, nipple shield for time being, EBM

ENGORGEMENT

Swollen breast due to increased milk production

Maybe early or lateEarly engorgement resolves with baby suckingPainful, swollen, warm, hard or rigid breasts needs treatmentTreatment: gentle massages, warm compresses, milk expression, breast support, oxytocics, NSAID

Mastitis And Breast Abscess

Pain, fullness, fever with or without chills, swollen, red, tender breasts Treatment: broad spectrum antibiotics,

anti-inflammatory drugs, breast support, feeding to continue, Untreated or under-treated neglected cases may lead to antibioma / abscess formation

Mastitis And Breast Abscess (cont.)

Breast AbscessHigh fever with chillsLocalized, swollen, red, warm, tender, indurated mass with fluctuationTreatment is I&D and supportive therapy same as mastitisBreast feeding to be resumed as early as possible

Milk Expression

Manual or hand expressionVia pump: hand held pumps, mechanical, cylindrical, battery operated and semi operated pumpsMechanical, cylindrical pump is safe and easy to use and can be sterilized, cost effectiveSuction generated by battery operated pump can be regulated to suit the userEBM stays in good condition in room temp for 8 hrs; refrigerator 24 hrs or in the freezer at -20 degree cent for 3 months.

CYLINDER BREAST PUMP

ELECTRICAL BREAST PUMP

Electrical Breast Pump

Electrical pumping is more effective in raising maternal prolactin levels and volumes of milk8 times expression in 24 hrs ( twice at night and 1 in early morning) is required to keep up the milk productionPumping both breasts simultaneously produces more milk

Pacifier/ Dummies/ Soothers

These should not be used within 4 weeks of age or until breastfeeding technique is fully established.It should not used to delay feeding

WEANING

Aim is to introduce- iron, calcium, vitamins and calories to baby in adequate quantity through

liquid and semisolid diet from 4 to 6 months of ageIt should be done gradually

“The nature has designed the provision that infants be fed upon their mother’s milk. They find their food and mother at the same time.

It’s a complete nourishment for them both for their body and soul”

- Rabindranath Tagore

Breast Feeding and its associated complications

“The nature has designed the provision that infants be fed upon their mother’s milk. They find their food and mother at the same time.

It’s a complete nourishment for them both for their body and soul”- Rabindranath Tagore