So there are many breastfeeding
problems that occur to parents,
especially new mothers who
don’t know what they’re doing.
The first is sore nipples.
That’s common, very common.
The first thing want to do is
make sure the latch is good.
Make sure that baby’s mouth is wide
open when it accepts the breast.
So inspect that latch and
make sure it’s good.
Make sure the tongue is
We should provide therapy
for sore nipples as well.
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.
So breast engorgement
when it’s too full
is often a result of inadequate
frequency of breastfeeding.
The mother should be
encouraged to feed more often.
Also, it can be from ineffective feeding.
That’s also a problem.
Sometimes it’s because mothers are always
starting on one side but not the other.
So we should encourage mothers to alternate
which side they start the baby on.
Remember that baby’s going to
eat for may be 5-10 minutes
and then switch breast
to the other side.
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.
So if they always start on one side,
gradually one breast will
grow bigger than the other.
The other one is plugged ducts.
So if you warm it before and
cold it after, that will help.
Also varied positions help
and it’s important to know what
are the breastfeeding positions,
so you can teach
that to the parent.
Here is the
or they could use the
Or they can use the
football hold position.
Any of these are fine, in terms of
allowing the baby to breastfeed
And sometimes, varying positions
allow the baby to suck at the
breast from different angles
which allows those
ducts to empty out.
Next is mastitis.
This can sometimes come up.
Any 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
After a while, after that fever is out,
often they'll get redness over the breast
and rarely that
can be an abscess.
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.
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.
Another complication is jaundice.
There are two types of jaundice.
This is a common test question.
The first is breastfeeding jaundice.
That’s when a baby is not eating enough.
We call it breastfeeding jaundice
because of that colostrum.
They are not generating enough stools.
Remember, stool is how we get the jaundice
out of the baby through the biliary tract.
Another type of jaundice that’s specific
to breastfeeding is breast milk jaundice.
This typically happens
around the age of 10-14 days
and it is a transient phenomenon
and you should feed through it.
In very extreme cases, you might bottle
feed for a day and let mom pump,
and then go back
But you should not stop breast expression
because of breast milk jaundice.
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.
Nobody knows why it happens,
but it’s well-described.
It does not happen with formula,
but it’s transient and benign.
Let’s say I’m on the side she
doesn’t want to breastfeed
or she has breastfed before or for whatever
reason, she has chosen to use formula.
There are generally many different type
of formula which she can choose from
and formula companies will
market themselves to parents.
We should avoid letting mothers
get confused by this marketing.
A lot of the marketing is flat out wrong.
For example, they might say that adding
DHEA will improve your baby’s intelligence.
That is a complete falsehood.
So, what should she choose?
Well, the first line agent is
usually a milk-based formula.
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.
Remember, propensity for
allergy is inherited,
but what that allergy
is, is not inherited.
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.
There is no real benefit here,
this is really personal choice.
However, there are
for patients who have true
milk protein allergy.
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.
Very rarely, it can
be from fussiness,
but most infantile fussiness
is not a formula issue,
it’s an issue with colic.
That aside, we have this
special hydrolyzed formulas
for this purpose like
Nutramigen or Alimentum.
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.
Let me say that again, they should
not be placed on soy formula.
They should go straight
to an alimental formula.
The reason for that is there’s a lot of
cross-allergy between these two formula,
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.