Trouble Shooting Chart

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Trouble Shooting Chart

Breastfeeding
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Trouble Shooting Chart
Trouble Shooting Chart
htmTroubleshooting
Learn the basics about potential health problems related to breastfeeding.
345629
InteliHealth
2011-09-06
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InteliHealth Medical Content
2013-03-11

Reviewed by the Faculty of Harvard Medical School

Troubleshooting Chart
Problem
Symptoms
Causes
Prevention
Treatment
Nipple Troubles
Soreness; blisters; bruising; cracks; bleeding
Poor latching on and positioning of the infant on the breast; weak seal made by baby's lips, rather than strong seal; overeager infant; improper removal of infant from breast; infant chewing his way onto the breast; teething by infant; tongue-tie of infant; improper tongue movement by infant related to pacifier/rubber nipple use; tonic bite of infant

Use of soaps, powders and creams on areola; improper use of nipple shield; wet nipples; poor letdown; nipple sticking to bra or bra pad; soap residue on clothing/bra; pregnancy or menstruation; thrush and yeast; inverted nipples; improper use of pump; skin problem such as eczema, impetigo

Learn the correct position of the nipple in the baby's mouth. If your baby has poor muscle tone that is responsible for a weak seal of the baby's lips on the breast, support the baby's chin while nursing.

Monitor the infant's position during the entire feeding to prevent the infant from slipping down onto just the nipple. The infant should have a strong seal on the areola to remove the milk.

Do not use soaps, powders and creams on the areola.

Use nipple shields but only if under the direction of your health-care provider or lactation specialist. Misuse of shields can cause a drop in the milk supply and infant weight loss.

Remove the infant from your breast by gently breaking suction with your finger.

Follow pump operation instructions carefully.

Avoid using rubber nipples and pacifiers, especially during the first three to four weeks.

Wipe your breast milk on the nipple after a feeding, as the milk acts as an antibacterial liquid.

A modified ultrapure hospital-grade lanolin product may be wiped on the sore nipple.

Moist healing. Wipe milk and a small amount of a modified ultrapure hospital-grade lanolin product on the nipple. Then place a nipple shell over the sore nipple but under the bra. This allows the nipple to heal without forming a scab.

Consult your health care provider for a referral to a lactation consultant or other health-care provider who specializes in lactation.

You can try gel pad products. Contact a professional consultant for the correct one to use, as some of the gel pads available over the counter can leave a residue on the breast that is not good for the baby.

Problem
Symptoms
Causes
Prevention
Treatment
Leaking of Milk
Milk leaking from breasts (This is common during the first few weeks as your body adjusts to the increasing demands of nursing the baby.)
Let-down; over-full breasts; stimulation during lovemaking; frequent milk expression; overuse of breast shells; irritation of the nipple by rough clothing
Nurse the infant before lovemaking.

Wear absorbent pads and change them frequently.

Wear a larger sized bra.

Express milk if you are unable to nurse the infant for a feeding.

Determine if any medications or herbs are causing an increase in supply.

For a quick fix, press the heel of your hand against the areola to stop the leaking, or cross your arms across your chest and hug yourself.

If you have leaking of milk six months or longer after weaning, there may be a health-related problem that should be assessed by your health care provider.

Problem
Symptoms
Causes
Prevention
Treatment
Engorgement
Tenderness in the breast, warmth, throbbing, and the skin may become tight and shiny. There also may be a low-grade fever. One or both breasts may be involved.

If engorgement is allowed to progress, the mother is at risk of severe pain; mastitis (infection); damage to milk-making cells, which results in reduced ability to make a full milk supply; sore nipples; and feeding problems related to infant's inability to latch on, putting the infant at greater risk of poor weight gain.

Infrequent breastfeeding that causes the breasts to become blocked with milk; blood and lymph fluid; poor latching on; infant unable to drain breast because the areola is very firm and the baby is unable to draw the nipple into his mouth.
Nurse your baby frequently and with no restrictions, such as scheduled feedings, to reduce your risk.
Increase feedings to 10 to 12 times in 24 hours.

Apply cold compresses to your breasts and under your arms between feedings to reduce swelling. (DO NOT use hot compresses, which can cause increased swelling.)

If the infant is unable to drain the breast thoroughly, pump the milk until your breasts are soft. Pumping is recommended for only 24 to 72 hours to relieve the breasts. Only the affected breast needs to be pumped.

Cold cabbage leaves can be used to relieve discomfort and swelling. Refer to a lactation specialist on use of this technique.

Wearing breast shells before nursing may soften the areola, which makes it easier for the infant to latch on. Do not decrease fluids.

Problem
Symptoms
Causes
Prevention
Treatment
Plugged Duct
Soreness; swelling; lumpiness or slight pain; flulike symptoms or fever, in rare cases
Poor positioning; missed feedings; irregular nursing patterns; engorgement; poor milk drainage from breast; external pressure on the breast (e.g., underwire bra, tight bra, clothing)
Remove milk completely. You can use massage during the feeding to enhance the draining of the breast. Simply place four fingers under the breast and the thumb on the side. As the baby sucks, gently squeeze the breast.
Plugged ducts need to be treated to keep from developing an infection.

Nurse at least 10 to 12 times in 24 hours, rotating positions at the breast.

Position the baby on the breast so that his chin is pointing toward the plug. This allows the strong sucking motion of the baby's tongue to help clear the lump.

Apply moist heat to the affected area before nursing or soak breast in warm basin, then pump the breast gently with your fingers to move the plug through the duct.

Use hand compression and massage to enhance milk flow from the area of the plug.

Problem
Symptoms
Causes
Prevention
Treatment
Mastitis
Breast pain; flulike symptoms; aches; chills; fever; headache; firm, reddened, hot, tender area located on the inner or outer side of breast, usually in the shape of a piece of pie; decrease in the milk supply from that side.

The infant may not nurse well because of the change in taste of the milk.

If mastitis is not treated effectively, it can turn into a more serious, deeper infection (abscess).

Nipple cracks; engorgement; plugged ducts; infrequent feedings; poor breast drainage; untreated fungal infections; stress; anemia (low iron); fatigue; anatomical problems that affect the drainage of the breast due to surgery, cysts, tumors
Maintain good drainage of the breast through feeding the baby or pumping.

Focus on correct positioning to prevent cracks on the nipple.

Ask for help with meals, housework and other children to prevent the terrible fatigue that can lead to mastitis.

Most mothers are slightly anemic after delivery, so eat plenty of iron-rich foods and check with your health-care provider to see if you need additional iron supplementation.

To treat the problem, it is important to maintain effective milk removal from the breast, get plenty of rest and treat the underlying cause.

Stay in bed for at least 48 hours. If that is not realistic, reduce your workload and try to rest as much as possible. Rest is very important to prevent recurrence of the infection.

Apply warm, moist compresses to the inflamed area before and during a feeding. It is important to remove the milk from the breasts at least 10 to 12 times in 24 hours or more, preferably by the baby or through pumping.

Contact your health-care provider to determine the need for antibiotics and pain relievers.

Use breast compression and massage to allow for better drainage of the milk reservoirs.

Problem
Symptoms
Causes
Prevention
Treatment
Thrush
Severe burning, knifelike pain that lasts throughout the nursing, even with good positioning. The nipple may or may not show flaky, shiny, rashlike blisters, and may be bright pink. There may be intense itching.

The baby may have bright diaper rash, creamy white patches on the tongue, inside the mouth and inside the cheeks and may be very gassy and fussier than usual.

You are at risk of getting thrush if you have had any of the following: recent antibiotic treatment; nipple damage; eating and drinking large amounts of dairy products or sweets; diabetes; long-term steroid use; contraceptive pills containing estrogen.
Educate yourself about yeast and its symptoms so you will be able to recognize the symptoms for prompt treatment.

If you have a history of yeast infections, consider taking acidophilus (a nutritional supplement) daily to maintain normal flora of the gut.

Be alert to all medications given to you during delivery — antibiotics can put you at risk of yeast infection.

Correct positioning of the infant prevents cracking of the nipple, which can make you vulnerable to yeast. If you have diabetes, be aware that you have an increased risk of yeast.

If your health-care provider determines that you have thrush, then both you and your baby will be treated with antifungal medications and creams that are safe for breast-feeding.

 

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infant,areola,breast-feeding,yeast,antibiotics,diabetes,fatigue,health care,iron,yeast.
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Last updated September 06, 2011


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