Breast-fed infants are usually seen by their baby's doctor at 2-weeks
of age or earlier to determine how well they are breast-feeding. Common questions
regarding breast-feeding are routinely answered at this visit. The following
are some of the most common problems encountered by nursing mothers.
Engorgement
Breast engorgement begins in the hospital after delivery of the newborn
but may not become severe until after hospital discharge. The breasts become
full, hard, and tender, and the mother may have a fever and flu-like symptoms.
If the areola becomes distended, the infant may have difficulty nursing,
which may contribute to nipple damage.
Treatment of engorgement requires completely emptying the breast of
milk. If the baby is unable to do this, a warm shower taken by the mother
before nursing while she attempts to express her milk may soften the areola
enough to prevent nipple maceration when the baby nurses. A nipple shield
can be used temporarily until the nipple is pliable enough for the infant
to nurse. If the infant does not empty the breast completely, the mother
should express her milk only one time until her breasts are soft. This can
be done by hand or with a breast pump. An electric breast is often the most
efficient and least painful way to empty the breasts.
Cracked Nipples
Cracked and painful nipples are common in the first months after delivery.
The causes of cracked nipples include the following: the infant not having
enough of the areola in his or her mouth while nursing; the mother not breaking
the suction properly when disengaging the infant from the breast; the infant
nursing for prolonged periods; milk leaking between feedings, resulting in
a continuously moist nipple; or the mother pulling a stuck pad away from
the breast without moistening it first. Cracked nipples may bleed, causing
flecks of blood to be present in the baby's spit-up.
Treatment for cracked nipples depends on the cause. For example, limit
the baby's nursing to 20 minutes each breast. The mother should air her nipples
after each feeding. This can be done by leaving the flaps of the nursing
bra open for five to ten minutes. The nursing mother with painful nipples
should avoid the use of soaps or other drying agents. A lanolin-based nipple
cream can be used, and it does not have to be washed off before nursing if
the mother rubs it completely into the skin.
A nursing mother may find it helpful to change the infant s position
at the breast by holding him or her under the arm like a football while she
is sitting or by lying down and nursing the infant from the least painful
breast first. A mother also may try using a nipple shield temporarily or
may take acetaminophen 30 minutes before nursing.
Leaking
The sound of a mother s baby crying often will elicit the let-down
reflex, which causes the leakage of milk. If this occurs, a nursing mother
can apply pressure on the nipple with the heel of her hand for about a minute.
She should place pads, preferably without a plastic liner, against the nipple
to prevent the
Mastitis
Mastitis is inflammation of the breast tissue, producing local tenderness,
redness, and heat, with fever and general malaise. Management includes rest,
fluids, antibiotics, analgesics, and hot or cold packs applied to the breast
for comfort. Nursing does not have to be interrupted if there is no purulent
discharge from the breast. If a discharge is present, only a temporary
interruption is necessary, usually for no more than 24 hours and only for
the affected breast. The mother will need to express her breast milk if nursing
is interrupted, since engorgement will worsen the symptoms. Undiagnosed and
untreated mastitis may lead to a breast abscess, which usually requires
hospitalization.
Diet
It is obvious that nursing mothers should eat a well-balanced diet.
Fluid intake will be increased because of a greater thirst during lactation.
Some babies seem to be more sensitive to what their mothers eat than others.
If an infant has gas and/or an upset stomach that is suspected to be related
to a food that the mother has eaten, then the mother should avoid that food.
She may try the suspected food again in a few weeks, starting with small
amounts of that food alone, to confirm her suspicion.
