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Common Problems  in the first weeks of Breast Feeding

Letdown / ejection reflex. Fissures of the nipple
Too much milk (engorged). Dermatitis of the nipple
Too little milk Psychosomatically sore nipples
Baby doesn't feed Milk blister
Sucking difficulties Milk leakage
Flat nipples Periods & contraceptives
Too big nipples Bottle feeding
Sore nipples Breastfeeding schedule
Persistent sore nipples (due to thrush)


Fissures of the nipple.



A fissure also may be very slow to heal, especially if it is complicated by thrush infection. It may be necessary to stop putting the baby to the breast and to express the milk manually instead. Usually the milk volume decreases when you do this, but will increase again when the nipples have healed and the baby can suck frequently again. It is reasonable to apply an antiseptic cream as soon as you suspect a fissure, with the hope that it may reduce the chances of bacterial infection making the condition worse.

Another thing that may help is to use a nipple shield (of rubber, or glass and rubber) temporarily. This should reduce the pain and also protect the nipple.


Dermatitis of the nipple.



Dermatitis of the nipple is a condition, in which the nipple looks red and sore, and the mother feels pain all the time while the baby is at the breast, not just in the beginning (as in sore nipples). The nipple is tender even if you touch it with the back of the hand.

This may be an allergic reaction to something which the woman has applied to her nipple: an ointment, detergents used for washing her brassieres or pads that are in contact with the nipple. The treatment consists primarily of removing and avoiding the irritating substance, if you can identify it. You can apply a steroid-containing cream, for instance non-greasy hydrocortisome cream (0.5 %) for a few days (never more than a week). Make sure that you wash off the cream carefully with lukewarm water before each feed, even if you are expressing the milk manually. This is to prevent the powerful steroid hormone from reaching your baby. If the diagnosis is right, this treatment is very effective.


Psychosomatic sore nipples



These have been described as occurring when a mother consciously or unconsciously associates breasts or breast-feeding with some unhappy memory or feeling, for instance in connection with uncertainty of her own feelings about motherhood.

Typically, on inspection, usually one or both nipples turn pale and then suddenly blush and then turn pale again. The mother feels pain in the nipple when she feeds the baby and all the time that the baby is at the breast.

Treatment consists of finding the cause of the mother’s anxiety, and then discussing it with her. Sometimes, when a woman understands her own problems, her fears decrease and her nipples no longer feel sore. At other times the problem is too great to resolve quickly enough, and may prevent her from breast-feeding successfully.


Milk blister



This is an uncommon and trivial condition. Milk gets under the superficial layers of the skin of the nipple, and you see a small white blister. It usually cures itself after a few days and the skin which covers the blister lifts off. While it lasts, feeding from the nipple may hurt.

In most instances, even very sore nipples can be treated successfully. Occasionally, however, the condition is resistant to treatment, or recurs at short intervals. This most commonly happens with a nipple of very poor protractability. In these rare cases, it may be better to stop breast-feeding instead of going through many painful attempts and failures (provided that artificial feeding can be done safely).

Sore nipples always test a mother’s motivation for breast-feeding. If bottle-feeding is feasible, it is up to the mother to decide how much trouble she is willing to take to continue breast-feeding.


Milk Leakage



Sometimes I find my breasts leaking milk. Why does this happen and what do I do? Also, I feel that I am losing a lot of milk, will this make my child weak?

Specialized muscles having sphincteric action surround the ducts in the breast, which cause the milk to flow, when the baby suckles. In some mothers lack of tone of these sphincter muscles causes a continuous ‘leakage’. Using pieces of clean cloth in the brassiere is the obvious solution. These must be changed frequently. Don't worry about wasting a lot of milk. Although you are losing enough to stain and smell, the volume is very small. Comparing the amount with the total daily output may be a consolation. Since the reflex affects both breasts at the same time, while the baby is feeding at one breast, milk also flows from the other. A mother can press one finger over the unsuckled nipple, this will considerably reduce the leaking from the unsuckled breast. Leaking usually lessens as time passes.


Periods & Contraceptives



My baby is 6 months old, and I have yet to start my periods. Do we practice contraception even though I haven't started menstruating? How long may I have to wait for periods?

Some women start menstruating as early as six weeks after delivery. But in some women who breast-feed, menstruation is usually delayed longer than that – sometimes for as much as 18 months. Menstruation stops because ovulation (egg production) stops. And a woman who does not ovulate does not get pregnant.

So, breast-feeding, because it delays ovulation, helps to space children. But this effect wears off, and menstruation often starts again, long before you stop breast-feeding. Once menstruation starts after the delivery, you are as fertile as before. But the first ovulation occurs two weeks before the periods start – so you can conceive before menstruation reappears. So breast-feeding is not a reliable way for you to prevent pregnancy – even if you haven't started menstruating. There is no way of knowing exactly when you will begin to ovulate again – whether it will be two, six, twelve, or eighteen months. You should therefore use some form of contraception unless you want another child in a year’s time.


Bottle Feeding



I have been exclusively breastfeeding my 4-month-old son, and want to commence bottle-feeding. My mother- in-law says, if I bottle-feed him, he will refuse to breast feed again. Is this true?

What is easier for the baby, to bottle-feed or breast-feed?

An infant who is used to sucking from a bottle may have difficulty sucking from a breast. Both the sucking techniques employed in fact are quite different. It is explained thus: ‘The bottle receiving mouth technique consists of rounding the lips, expecting the food to come from straight in front, and holding the tongue high and close to the palate. It is as if the baby were guarding against having something thrust too far into his mouth, whereas the baby taking the breast needs to use a small indrawing action to pull the nipple into a widely opened mouth. Once the baby’s technique has been adjusted to taking a bottle, it becomes much harder to get him to take the breast, but competition from the bottle does not matter, the baby becomes skilled with both.’

Thus, since you have been breastfeeding him regularly till now, the baby should have no problem adjusting to both.


Breastfeeding Schedules



Should I train my child on demand feed schedule? Or should I feed him looking at the clock, irrespective of his need? Also tell me, should I feed him more during the day or at night?

There is no set rule that a child should be fed only on demand, or only when the clock indicates feeding time. As such, a child demands milk when he is hungry and should be fed then. . Generally, a clock schedule should be prepared as a guideline for feeding the child and not just to be followed to the tee. The clock schedule can work as an indicator as to whether the baby’s daily needs are met. But, if your baby has 6 wet diapers a day and you’re not giving extra water, he is getting enough. If you’re nursing as needed, 7-11 times in 24 hours, your baby is getting enough. If the mother feels that the child does not demand milk often enough during the day, she can feed him more according to the clock.

Does the infant have the ‘right’ to demand feed at night? Discussion on the topic seems endless. If an infant is hungry, however, he has, we think, the right to be fed. This is a rule with some exceptions.

For the first weeks and months of life, the infant certainly needs ‘round the clock’ service. But as he becomes older, he has to learn that in spite of what it may have been led to believe it is not the center of the world. It must wait its turn, at times. The mother may, astonishingly enough, have other things to do as well as look after it. The infant must accept a compromise between its own, overwhelming demands, and what is possible for the mother – this is part of the socialization process.

For mothers who sleep with their infants at night, feeding may not even be a problem at all. In fact, the number of night feeds for the first three months has been shown to be almost equal to the number of feeds given through the day. But if the mother does find it a problem, she may try to persuade her infant to forget about it, by pretending not to hear the cries of hunger for a couple of nights. Some mothers can bear to leave their babies to cry, others cannot bear it! Some infants are particularly hungry or particularly persistent – and some mothers are softer than others are.

All that can be said is that a compromise between mother and child has to be made – as in the case of many other of these questions. No one has yet shown that any lasting harm (or benefit) results whoever ends up dominating the compromise! But from a purely nutritional point of view, a normal child, fed on demand during the day, does not need to be fed during an 8-hour night interval – at least not after the first three months.

After the age of 3 months, if the baby wakes up at odd hours at night after being fed satisfactorily according to the schedule during the day, warm water (20 – 30 ml) with � teaspoon sugar can be fed to the baby in a sterilized bottle so that he sleeps off. In this way, the baby will slowly adjust to no milk feeds at night. Also, the baby will slowly get used to bottle feeding. But, cow’s milk should not be introduced through bottlefeeding at least till 4 months of age.

Some children ’turn the clock’ – i.e. they feed in the morning, then they may sleep for 6-7 hours in the middle of the day. During the night they are fresh and happy and want their parents to be the same. In this case you have to try to turn the clock back. The mother should wake the child several times during the day, and she may be able to teach it that the consensus of the rest of the humanity is to sleep at night and wake by day. 

Hence, as time goes on, each mother sees for herself that breast-feeding is possible and that it is not a fragile and haphazard process but a simple function, which she herself can control. This increases her self-confidence, which makes uncomplicated breast-feeding even easier. As time passes, breast-feeding becomes more of an everyday routine.

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