Challenges to Breastfeeding

Although there are many challenges to breastfeeding most of them can be managed with adequate preparation, education and support.

If a mother is HIV positive or is suffering from ongoing drug or alcohol use then breastfeeding is contraindicated. Rare infants with Galactosemia, Tyrosinemia and certain forms of PKU should also receive special formula and not breastmilk.

Mothers should avoid the use of medications, supplements and herbal preparations while breastfeeding unless they are clinically necessary. The vast majority of medications a mother would be prescribed while breastfeeding are safe to use. If a mother is experiencing depression subsequent to the delivery of her infant, it is much safer for the mother to be treated with an anti-depressant medication than for the mother not to be treated. Most anti-depressant medications can be safely used by breastfeeding mothers.

The risk of exposure to a maternal medication during the first few days of breastfeeding is lowest since the volume of maternal milk is lowest at this time. The book titled Medications and Mother’s Milk by Dr. Thomas Hale is a good reference.  Drugs should be chosen for breastfeeding mothers that have a short half-life, high protein binding and low oral bioavailability. Most of the time it is safer and healthier for an infant to continue to breastfeed rather than changing to formula. In some situations discontinuing breastfeeding for a short period of time while continuing to pump and discard breastmilk is necessary. This is seen when a mother is required to receive a radioactive compound to treat her own medical condition.

Jaundice is a common problem seen in infants who breastfeed or formula feed. In the past when an infant who was breastfeeding developed jaundice the breastfeeding was stopped due to concerns breastmilk would increase the jaundice. This is no longer the case. Breastfeeding should continue and if there is not effective milk transfer due to the infant being sleepy or if there is excess weight loss supplemental breastfeeding with expressed breastmilk should be initiated. The level of jaundice should be followed closely especially for premature infants.  Other options include donor human milk or formula. Advice from a Lactation Consultant in these situations is very helpful.

Breast engorgement is a common issue. It can be prevented by frequent breastfeeding and hand or pump expression of milk if engorgement is an issue. Warm compresses before nursing and cold compresses after nursing can also be helpful. On occasion anti-inflammatory medication like ibuprofen can be used.

Mothers are often concerned about inadequate milk supply. This is usually a false perception. It is important this issue is addressed directly and accurate answers given.  Parents must document adequate urine and stool output while monitoring weight gain in the infant. These are the best indicators for adequate milk supply and milk transfer from mother to the infant.

Although smoking is strongly discouraged smoking is not a contraindication to breastfeeding. Breastfeeding reduces the risk of respiratory illness in infants even if the mother is still smoking. A mother should not, however, smoke around her child. Homes, cars and child care locations should all be smoke free.

Some babies who breastfeed can be very fussy. This is usually due to your infant’s temperament and not due to breastfeeding. Providing skin to skin contact, increasing carry time either in your arms or in an infant body carrier and increasing the frequency of breastfeeding can often help. Walking with your infant is helpful as are swaddling, swaying and making soft white noise shushing sounds.  Avoid excessive stimulation due to sights, smells and sounds and do not overly stimulate with motion. A final option is to encourage sucking on your finger or a pacifier if your infant is over age 1 month.

Another challenge to the new breastfeeding mother is sore nipples. Time and patience are essential. Soreness can frequently be avoided by improving your infant’s position and latch during feeding. Superficial fungal or bacterial infections can also occur but these are uncommon. Talk to your doctor and medication can be prescribed if required. If there are signs of a fungal infection (yeast) then treatment of both infant and mother is necessary. Antifungal ointment can be applied to your nipples after each feeding and continued until you are symptom free for 3-4 days. Your infant should be treated with oral mycostatin (nystatin) drops which can be prescribed by the doctor. These can also be applied to your nipples after nursing. Your infant may show white plaques in the mouth and on the tongue. This is called thrush. All pacifiers should be washed well in hot soapy water and nystatin can be applied to the pacifier. Other treatments that can be considered for your infant include oral 0.5% Gentian Violet that is applied to your infant’s mouth one time each day for three days. This can cause staining of clothes and skin. Always check to see if your infant has signs of a yeast diaper rash that is common when your child has thrush. If this is present then treatment with an OTC medication such as clotrimazole 2-3 times per day is needed.

Mastitis is common when your breast is not emptied after nursing. This can lead to pain, redness and swelling of the breast. Weaning is not recommended. The best treatment is frequent breastfeeding to “empty the breast.” Continuous warm compresses are helpful as is soft breast massage prior to nursing. Pumping can be used if breastfeeding is too painful. Anti-inflammatory medication such as ibuprofen can be helpful and antibiotics are prescribed for you if there is pain and fever over 12 hours in duration.