Common Breastfeeding Issues

Access to good information and support leads to confidence in breastfeeding and assists mothers in overcoming any problems that arise.

This 'quick' resource for health professionals offers up-to-date information on key issues raised frequently by breastfeeding mothers such as the assessment and management of sore nipples and low milk supply.  Please follow the links below.

For evidence-based and practical information about the common conditions managed in primary care. 

> Please visit the NHS Clinical Knowledge Summaries : Breastfeeding Problems 

Mastitis

Around one in ten women who are breastfeeding may be affected by mastitis. Most of these women will develop mastitis during the first three months after giving birth.

Refer mothers to a midwife, health visitor or a breastfeeding group for information and advice. You can find the details on the local support page.

For information on the diagnosis and management of mastitis please see the related Clinical Knowledge Summary

Information for Mothers

The Breastfeeding Network has produced an excellent leaflet that can be printed off and given to mothers for background information

Download here : BfN leaflet on Mastitis

 

 

Thrush

Symptoms, causes, treatments, complications and prevention of thrush

Thrush (Candida Albicans) is a fungal infection which usually starts after a period of pain-free breastfeeding or after a course of antibiotics. Other causes of breast pain should be excluded before diagnosing thrush.

The following NHS links provide clinical and prescribing information:

The Breastfeeding Network (BfN) offers information on the differential diagnosis of breast pain and prescribing for thrush and a leaflet for mothers about managing thrush

Tongue Tie

Some babies are born with a tight piece of skin between the underside of their tongue and the floor of their mouth. This is known as tongue-tie and it can affect breastfeeding by making it hard for baby to attach effectively at the breast. More information about tongue-tie can be found on the NHS Choices website. 

Many tongue-tie cases are minor and do not need treatment. However, all babies with tongue-tie need extra breastfeeding support to prevent problems. Babies under 4 months old with breastfeeding difficulties can be treated for tongue-tie. 

Health professionals wishing to refer Greenwich mothers for tongue-tie assessment or treatment, please refer to the Greenwich Breastfeeding groups in the first instance

 

 

Breastfeeding and weight issues

Many parents present to GP's with concerns about their baby's weight loss or about a low milk supply. Usually, this can be resolved in consultation with the midwives, health visitors or referring to the breastfeeding advocates.

The UNICEF Breastfeeding assessment tool (pdf) is a useful checklist for assessing breastfeeding. 

For help with more complex clinical issues please contact the Greenwich Infant Feeding Advisors (IFA).

Review the UK Medicines information (UKMi) guide > Drugs and Inadequate Lactation (UKMi) (pdf).

 

 

Night time feeds

The links below provide information on night time feeds. 

Click here for NEW ISIS Infant Sleep Information Source website.

Click here to download UNICEF Health professionals guide to 'Caring for your baby at night' leaflet and here to download UNICEF 'Caring for your baby at night' leaflet.

Click here for research on bed sharing and breastfeeding from UNICEF.

Click here for NHS leaflet 'Reduce the risk of cot death'

Giving information to mothers about safe bed-sharing, night time feeds and how to manage them is a UNICEF BFI standard.

Night time breastfeeding should be discussed with mothers at the first and follow up contacts, firstly because of the importance of breastfeeding at night for a good milk supply and baby weight gain and also because this provides the opportunity to discuss the prevention of Sudden Infant Death.

What a mothers needs to know

While establishing breastfeeding, milk is produced by supply and demand and levels of prolactin (the milk-making hormone) are higher at night, so breastfeeding throughout the 24 hours ensures a good supply for their baby.

A baby has a small stomach and breastmilk is digested quickly, so the baby needs to be fed at intervals through the night to ensure good growth.

If the mothers breasts become too full overnight, she is at risk of blocked ducts and mastitis. Her milk supply will also reduce because of Feedback Inhibitor of Lactation (FIL). In short, if her breasts are not emptied, her body thinks she does not need so much breast milk and makes less.

It is important that breastfeeding mothers and families receive this information, as often well-meaning family members offer to bottle-feed overnight so that mum will get more rest, without understanding how this will affect breastfeeding. Many new mothers are often woken up by their full breasts anyway! Many find it difficult to sleep without their babies near to them. Many dads fall asleep with baby on a sofa or armchair.

Family can support the mother in other ways and she should rest at other times of the day if possible, for example, when the baby sleeps.

If parents have made an informed decision that they want to give their breastfed baby a bottle of formula at any time it is better for milk supply and for the mother, to give it in the evening rather than during the night.

Health professionals often advise mothers to never take their baby into bed with them because of the risks of sudden infant death syndrome (SIDS) and accidental injury; however, to simply direct mothers in this way is not considered best practice in the prevention of SIDS and in the support of breastfeeding mothers. We know from good research, and professional experience, that at times mothers will take their babies into bed and fall asleep with them and instead we should be giving them information and support to make what they are doing as safe as possible. Many breastfeeding mothers who are told not to feed their baby in bed will then fall asleep feeding in a chair or sofa – which is a very dangerous thing to do.

The safest place for a baby to sleep is still in a crib/cot next to mothers bed for the first 6 months, but we also need to talk to breastfeeding mothers about safe positions for feeding lying down and safe bed sharing. Using the UNICEF Caring for your baby at night' leaflet is the most effective way of doing this.

All new parents should also have the NHS Reduce the risk of cot death leaflet (DH Publications orderline 292301) which advises:

  • Place your baby on the back to sleep, in a cot in a room with you
  • Do not smoke in pregnancy or let anyone smoke in the same room as your baby
  • Do not share a bed with your baby if you have been drinking alcohol, if you take drugs or if you are a smoker
    Never sleep with your baby on a sofa or armchair
  • Do not let your baby get too hot – keep your baby’s head uncovered – place your baby in the “feet to foot” position

 

Drugs In Breastmilk

Click here for the NHS Evidence Clinical Knowledge Summaries.

Click here for information prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals QA73-3-InadeqLactation_final_3 (1).doc

Prescribing information for health professionals and pharmacists.

Read about UK Drugs in Lactation Advisory Service.

Click here to read NICE Maternal and Child Nutrition Recommendation 15 

The Breastfeeding Network's information sheets cover a diverse range of drugs and treatments, including antibiotics, antidepressants, analgesia and dental treatment can be found below.

http://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/

Please check the Drug Information Factsheets before contacting the Breastfeeding Network’s Drugs in Breastmilk Helpline, which is available to health professionals to check the safety of drugs for breastfeeding mothers. It is staffed by Wendy Jones, BfN Breastfeeding Supporter and Community Pharmacist, and an answerphone will accept messages while Wendy is at work.

Use of drugs to initiate or augment milk supply

Due to an apparent low milk supply being one of the most common reasons for discontinuing breastfeeding, both mothers and clinicians have sought to address this problem. Galactagogues (drugs for faltering milk supply) should only be used after thorough evaluation for treatable causes such as poor attachment, and when increased frequency of breastfeeding, pumping or hand expression of milk has not been successful. In Greenwich, mothers should be referred to a breastfeeding group and/or health visitors for additional support with feeding.

Domperidone is the drug of choice because of its adverse effect profile and efficacy, and because only small amounts pass into breast milk. Further information can be found on Clinical Knowledge Summaries. 

 

Growth Charts

The new UK-WHO growth charts are now in use 

The UK-WHO 0-4 years charts came into use for all new births and new referrals from May 11th 2009 and can be found in the Personal Child Health Record books (Red Books) and on A4 for low birth weight or vulnerable infants.

As a minimum, babies should be weighed (naked) at birth and at 5 and 10 days, as part of an overall assessment of feeding and thereafter as needed (NICE: PH11; 2008). 

Only class III clinical electronic scales in metric setting should be used to weigh infants. These should be maintained and calibrated annually, in line with medical devices standards.

Some degree of weight loss is common in the first week. A weight loss of 10% or more needs careful assessment. Recovery of birth weight by 2 weeks indicates that feeding is effective and the child is well.

Once feeding is established, if parents wish, or if there is professional concern, babies can be weighed at 6-8 weeks, 12 and 16 weeks. Babies should usually be weighed at 12-13 months at the time of routine immunisations.

If there is concern, weigh more often; however, weights measured too close together are often misleading, so babies should be weighed: no more than once a month up to 6 months of age once every two months from 6 to 12 months of age once every three months over the age of 1 year. However most children do not need to be weighed this often.

Click here for Greenwich parents information.

When should babies & children have their length or height measured?

Length or height should be measured whenever there are any worries about a child’s weight gain, growth or general health.

How do I assess weight loss after birth?

Most babies lose some weight after birth but 80% will have regained this by 2 weeks of age. Fewer than 5% of babies lose more than 10% of their weight at any stage; only 1 in 50 are 10% or more lighter than birth weight at 2 weeks.

The Royal College of Paediatrics and Child Health (RCPH) website has comprehensive information on the new growth charts

Click here for the RCPCH.

In a hurry?

RCPCH Information for healthcare professionals about the use and interpretation of growth charts:

Using Dummies

UNICEF UK Baby Friendly Initiative statement on dummy use

Research has shown that the mechanism used to suck on a dummy differs from how a baby feeds on the breast. Sucking on a dummy can therefore interfere with a baby’s ability to breastfeed effectively during the crucial early weeks when breastfeeding is being established

Dummy use can also interfere with demand feeding if mothers misinterpret feeding cues and use a dummy to settle or pacify their baby rather than offering a breastfeed.

The Baby Friendly Initiative has received a number of queries from health professionals about information leaflets which suggest that parents settle their baby to sleep with a dummy in order to reduce the risk of sudden infant death. The following information has been produced to clarify the position of the Initiative with regard to this issue.

> UNICEF UK BFI Dummy statement 2008 (PDF)

Infant Feeding Advisors

Infant Feeding Advisors are available to professionals for information and clinical guidance on infant feeding issues, local services for breastfeeding families and UNICEF Baby Friendly

For maternity, please contact:

Mel Phillips
Infant Feeding Lead Midwife
Queen Elizabeth Hospital 
Lewisham and Greenwich NHS Trust

tel: 0208 836 6903

email: melanie.phillips1@nhs.net

For health visiting, please contact: 

Liz Ginty 
Liz Ginty (Infant Feeding Advisor: Specialist Health Visitor)

Universal Children's Services Greenwich
Oxleas NHS Foundation Trust

tel: 020 8331 7125

email: e.ginty@nhs.net