Lactation Physiology and Management. Alison Stuebe, MD, MSc email@example.com. Objectives. Review public health impact of breastfeeding Understand physiology of lactation Identify the differential diagnosis and treatment for common breastfeeding problems Low milk supply Mastitis
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Identify the differential diagnosis and treatment for common breastfeeding problems
Low milk supply
Health Impact of Not Breastfeeding
Formula-feeding vs. breast-feeding: risk of adverse outcomes.
Breastfeeding and Maternal and Infant Health Outcomes inDeveloped Countries. AHRQ Evidence Report Number 153. April 2007.
Exclusive breastfeeding for the first six months of life
Continued breastfeeding for at least one year, ‘As long as is mutually desired by mother and child’
American Academy of Pediatrics (2005). "Breastfeeding and the Use of Human Milk." Pediatrics 115(2): 496-506.
HTLV-1 and HTLV-2
HSV with lesion on the breast
Medications that contraindicate breastfeeding
Newborn with galactosemia
US: not recommended
UNICEF: When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding is recommended; otherwise, exclusive breastfeeding is recommended during the first months of life.
How Does Lactation Happen?
Where does milk come from?
Let Down: Ejection, not suction, moves milk to the areola.
Moves milk from lobules to sinuses, so baby can eat
Inhibited by stress, pain, anxiety
Triggered by sound, smell, sight of infant
Stress and Milk Volume
J. Pediatr 1948; 33:698-704.
Latch: The baby’s tongue moves milk from areola to nipple.
Infant grasps most of the areola in his mouth
Tongue “milks” milk to the back of the mouth prior to swallowing.
Moving Milk:Demand drives supply.
Milk in lobules contains whey protein called Feedback Inhibitor of Lactation (FIL)
If milk is not removed, and lumen is full, production will decrease
Goal: 10-12 feeds in 24 hours, until baby is done.
Start out right: establish normal physiology
Evidence-based early care
Low Milk Supply
Primary lactation failure
Disruption of normal physiology
Infrequent or inadequate milk removal
First line therapy:
Mechanical expression after breastfeeding
Supplement after breastfeeding as indicated
Continue pumping during supplementation
Definition: tender, swollen, wedge-shaped area of breast, usually unilateral, with fever, malaise, chills, and systemic symptoms
Incidence: 3 to 20%
Antibiotics – Dicloxicllin 500mg QID x 10-14d
Empty the breast
Continue frequent breast feeding
Milk is not harmful to healthy, term infant
Abrupt weaning slows maternal recovery
Poor response requires further evaluation
Academy of Breastfeeding Medicine. ABM Clinical Protocol #4: Mastitis. Breastfeeding Medicine 3(3); 2008.
3% of women with mastitis
Hard, red, tender mass after appropriate treatment
Needle aspiration for culture / treatment
Surgical drainage for large or multiple abscesses
For more information
American Academy of Pediatrics (2005). Breastfeeding and the Use of Human Milk. Pediatrics 115(2): 496-506.
American Academy of Family Physicians. (2001, 2/26/2007). Breastfeeding (Position Paper).
American College of Obstetrics and Gynecology (2007). Breastfeeding: Maternal and Infant Aspects. Special Report from ACOG. ACOG Clinical Review 12(1 (supplement)): 1S-16S.