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Special Situations and Breastfeeding - Illustrated Article

Some babies have conditions that may interfere with or make breastfeeding more difficult. But, in all of the following cases, breastfeeding is still best for a baby's health.

Jaundice
Jaundice is a condition that is common in many newborns. It appears as a yellowing of the skin and eyes and is caused by an excess of bilirubin, a yellow pigment that is a product in the blood. All babies are born with extra red blood cells that undergo a process of being broken down and eliminated from the body. Bilirubin levels in the blood can be high because of higher production of it in a newborn,an increased ability of the newborn intestine to absorb it, and a limited ability of the newborn liver to handle large amounts of it. Many cases of jaundice do not need to be treated, - your baby's doctor will carefully monitor your baby's bilirubin levels. Sometimes infants have to be temporarily separated from their mothers to receive special treatment with phototherapy. In these cases, breastfeeding may be discouraged and supplements or other fluids may be given to the baby. But, the American Academy of Pediatrics discourages against stopping breastfeeding in jaundiced babies and suggests continuing frequent breastfeeding, even during treatment. If your baby is jaundiced or develops jaundice, it is important to discuss with your baby's doctor all possible treatment options and share that you do not want to interrupt nursing if this is at all possible.

Reflux
It is not unusual for babies to spit up after nursing. Usually, babies can spit up and show no other signs of illness, and the spitting up disappears as the baby's digestive system matures. As long as the baby has six to eight wet diapers and at least two bowel movements in a 24 hour period (under six weeks of age), and your baby is gaining weight (at least 4 ounces a week) you can be assured your baby is getting enough milk.

However, some babies have a condition called gastroesophageal reflux (GER), which occurs when the muscle at the opening of the stomach opens at the wrong times, allowing milk and food to come back up into the esophagus (the tube in the throat). Symptoms of GER can include:

  • severe spitting up, or spitting up after every feeding, or hours after eating
  • projectile vomiting, where the milk shoots out of the mouth
  • inconsolable crying as if in discomfort
  • arching of the back as if in severe pain
  • refusal to eat or pulling away from the breast during feeding
  • waking up frequently at night
  • slow weight gain
  • problems swallowing
  • gagging or choking
  • frequent red or sore throat
  • frequent hiccupping or burping
  • signs of asthma, bronchitis, wheezing, problems breathing, pneumonia, or apnea

Many healthy babies might have some of these symptoms and do not have GER. But there are babies who might only have a few of these symptoms and have a severe case of GER. Not all babies with GER spit up or vomit.

Some babies with GER do not have a serious medical problem, but caring for them can be hard since they tend to be very fussy and wake up frequently at night. More severe cases of GER may need to be treated with medication if the baby, in addition to spitting up, also refuses to nurse, gains weight poorly or is losing weight, or has periods of gagging or choking.

If your baby spits up after every feeding and has any of the other symptoms mentioned above, it is best to see his or her doctor for a correct diagnosis. Other than GER, your baby could have another condition that needs treatment. If there are no other signs of illness, he/she could just be sensitive to a food in your diet or a medication he/she's receiving. If your baby has GER, it is important to try to continue to breastfeed since breast milk still is more easily digested than formula. Try smaller, more frequent feedings, thorough burping, and putting the baby in an upright position during and after feedings.

Cleft Palate and Cleft Lip
Cleft palate and cleft lip are some of the most common birth defects that happen as a baby is developing in the womb. A cleft, or opening, in either the palate or lip can happen together or separately and both can be corrected through surgery. Both conditions can prevent babies from breastfeeding because a baby cannot form a good seal around the nipple and areola with his or her mouth, or get milk out the breast well.

Cleft palate can happen on one or both sides of a baby's mouth and be partial or complete. Right after birth, a mother whose baby has a cleft palate can try to breastfeed her baby, and she can start expressing her milk right away to keep up her supply. Even if her baby can't latch on well to her breast, the baby can be fed breast milk by cup. In some hospitals, babies with cleft palate are fitted with a mouthpiece called an obturator that fits into the cleft and seals it for easier feeding. The baby should be able to exclusively breastfeed after surgery.

Cleft lip can happen on one or both sides of a baby's lip, but a mother can try different breastfeeding positions and use her thumb or breast to help fill in the opening left by the lip to form a seal around the breast. With cleft lip repair, breastfeeding may only have to be stopped for a few hours.

If your baby is born with a cleft palate or cleft lip, talk with a lactation consultant in the hospital for assistance as soon as possible. Human milk and early breastfeeding is still best for your baby's health.

Twins or Multiples
Mothers of twins or multiples might feel overwhelmed with the idea of breastfeeding more than one baby at a time. The benefits of human milk to both these mothers and babies are the same as for all mothers and babies. But mothers of multiples get even more benefits from breastfeeding:

  • Their uterus contracts, which is helpful because it has stretched even more to hold more than one baby.
  • Hormones are released that relax the mother, which is helpful with the added stress of caring for more than one baby.
  • Eight to ten hours per week are saved because there is no need to prepare formula or bottles and the mother's milk is available right away.
  • It is estimated that breastfeeding saves a mother of twins $2000 or more during the babies' first year on feeding costs alone (La Leche League, 2003).

Breastfeeding early and often for a mother of multiples is important to keep up her milk supply. A good latch-on for each baby is important to avoid sore nipples. Many mother find that it is easier to nurse the babies together rather than separately, and that it gets easier as the babies get older. There are many breastfeeding holds that make it easier to nurse more than one baby at a time. If you are having multiples, talk with a lactation consultant about more ways you can successfully breastfeed your babies.

Breastfeeding During Pregnancy
While most mothers who are nursing a toddler stop breastfeeding if they find out they are pregnant, it is an individual choice to decide whether to keep breastfeeding during the pregnancy. It is not unsafe for the unborn child if you continue to breastfeed an older child during this time. But, if you are having some problems in your pregnancy such as uterine pain or bleeding, a history of preterm labor or problems gaining weight during pregnancy, your doctor may advise you to wean. Your child also may decide to wean on his or her own because pregnancy changes the amount and flavor of your milk. Some women also choose to wean at this time because they have nipple soreness caused by pregnancy hormones, are nauseous, or find that their growing stomachs make breastfeeding uncomfortable.

Breastfeeding after Breast Surgery
If you have had had breast surgery, including breast implants, you might be worried about whether you will be able to breastfeed. The most important things that affect whether you can produce enough milk for your baby are how your surgery was done and where your incisions are, and the reasons for your surgery. For example, women who have had incisions in the fold under the breasts are less likely to have problems producing milk than women who have had incisions around or across the areola. Incisions around the areola can cut into milk ducts and nerves, where milk is produced and travels. And women who have had breast surgery to augment breasts that never fully developed may not have enough glands to produce a full milk supply.

If you had breast surgery and are worried about how it will affect breastfeeding, talk with a lactation consultant. If you are planning breast surgery and worried about how it will affect breastfeeding, talk with your surgeon about ways he or she can preserve as much of the breast tissue and milk ducts as possible.

Source: The National Women's Health Information Center
U.S. Department of Health and Human Services
Office on Women's Health



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