Breastfeeding Problems

00:01 So there are many breastfeeding problems that occur to parents, especially new mothers who don't know what they're doing.

00:07 The first is sore nipples. That's common, very common.

00:13 The first thing we want to do is make sure the latch is good.

00:16 Make sure that baby's mouth is wide open when it accepts the breast.

00:20 So inspect that latch and make sure it's good.

00:23 Make sure the tongue is positioned appropriately.

00:26 We should provide therapy for sore nipples as well.

00:29 So for example, what we will often do is do cold packs after breastfeeding and may be even warm packs before breastfeeding to help engorge the breast.

00:39 So breast engorgement when it's too full is often a result of inadequate frequency of breastfeeding.

00:47 The mother should be encouraged to feed more often.

00:50 Also, it can be from ineffective feeding.

00:54 That's also a problem.

00:55 Sometimes it's because mothers are always starting on one side but not the other.

01:00 So we should encourage mothers to alternate which side they start the baby on.

01:05 Remember that baby's going to eat for may be 5-10 minutes and then switch breast to the other side.

01:09 The second breast, the baby is may be a little bit less vigorous and breasts only make as much milk as they are demanded off.

01:15 So if they always start on one side, gradually one breast will grow bigger than the other.

01:21 The other one is plugged ducts.

01:22 So if you warm it before and cold it after, that will help.

01:26 Also varied positions help and it's important to know what are the breastfeeding positions, so you can teach that to the parent.

01:33 Here is the cross-cradle position or they could use the supine position.

01:38 Or they can use the football hold position.

01:41 Any of these are fine, in terms of allowing the baby to breastfeed.

01:45 And sometimes, varying positions allow the baby to suck at the breast from different angles which allows those ducts to empty out.

01:52 Next is mastitis. This can sometimes come up.

01:57 Any pregnant or breastfeeding mother should know that after she has been breastfeeding for a while, if she develops fever and has no other symptoms, she should be seen for potential mastitis.

02:07 After a while, after that fever is out, often they'll get redness over the breast and rarely there can be an abscess.

02:14 So the redness may be delayed, but you should continue to feed through a breast that is infected because that will actually make her get better faster.

02:23 It will help unplug those ducts. And we will provide antibiotics, but those are antibiotics that are safe for the baby to get in a breast milk.

02:31 Another complication is jaundice. There are two types of jaundice.

02:36 This is a common test question. The first is breastfeeding jaundice.

02:41 That's when a baby is not eating enough.

02:44 We call it breastfeeding jaundice because of that colostrum.

02:47 They are not generating enough stools.

02:50 Remember, stool is how we get the jaundice out of the baby through the biliary tract.

02:55 Another type of jaundice that's specific to breastfeeding is breast milk jaundice.

03:01 This typically happens around the age of 10-14 days and it is a transient phenomenon and you should feed through it.

03:10 In very extreme cases, you might bottle feed for a day and let mom pump, and then go back to breastfeeding.

03:16 But you should not stop breast expression because of breast milk jaundice.

03:20 What's happening is there some undefined factor in breast milk that actually reduces the conversion of bilirubin in the liver and extrusion of bilirubin out into the biliary tree.

03:32 Nobody knows why it happens, but it's well-described.

03:35 It does not happen with formula, but it's transient and benign.

03:39 Okay. Formula feeding.

03:41 Let's say I'm on the side she doesn't want to breastfeed or she hasn't breastfed before or for whatever reason, she's chosen to use formula.

03:49 That's fine. There are generally many different type of formula which she can choose from and formula companies will market themselves to parents.

03:59 We should avoid letting mothers get confused by this marketing.

04:04 A lot of the marketing is flat out wrong.

04:07 So, what should she choose? Well, the first line agent is usually a milk-based formula.

04:14 She may say something like, "I was allergic to milk-based formula, when I was a kid so I want to start soy." It's probably not worth getting in an argument about if somebody feels very passionately to start soymilk but it's probably not necessary.

04:29 Remember, propensity for allergy is inherited, but what that allergy is, is not inherited.

04:35 So that baby most likely will tolerate cow's milk-based formula just fine, but if they don't want that, they can certainly choose a soy-based formula.

04:45 There is no real benefit here, this is really personal choice.

04:49 However, there are special formulas for patients who have true milk protein allergy.

04:55 If your baby has blood in the stool or gets very sick with blood in the stool, your baby may have a milk protein allergy.

05:03 Very rarely, it can be from fussiness, but most infantile fussiness is not a formula issue, it's an issue with colic.

05:12 That aside, we have this special hydrolyzed formulas for this purpose like Nutramigen or Alimentum.

05:18 It's important that if a child is on milk-based formula and they have a true allergic response, they should not be placed on soy formula.

05:27 Let me say that again, they should not be placed on soy formula.

05:31 They should go straight to an alimental formula.

05:34 The reason for that is there's a lot of cross-allergy between these two formulas, so infants on milk who have allergy may still have the allergy on the soy formula and some of those kids can get quite sick.