00:01
So there are many breastfeeding problems that occur to parents,
especially new mothers who don't know what they're doing.
00:07
The first is sore nipples. That's common, very common.
00:13
The first thing we want to do is make sure the latch is good.
00:16
Make sure that baby's mouth is wide open when it accepts the breast.
00:20
So inspect that latch and make sure it's good.
00:23
Make sure the tongue is positioned appropriately.
00:26
We should provide therapy for sore nipples as well.
00:29
So for example, what we will often do is do cold packs after breastfeeding
and may be even warm packs before breastfeeding to help engorge the breast.
00:39
So breast engorgement when it's too full is often a result of inadequate frequency of breastfeeding.
00:47
The mother should be encouraged to feed more often.
00:50
Also, it can be from ineffective feeding.
00:54
That's also a problem.
00:55
Sometimes it's because mothers are always starting on one side but not the other.
01:00
So we should encourage mothers to alternate which side they start the baby on.
01:05
Remember that baby's going to eat for may be 5-10 minutes
and then switch breast to the other side.
01:09
The second breast, the baby is may be a little bit less vigorous
and breasts only make as much milk as they are demanded off.
01:15
So if they always start on one side, gradually one breast will grow bigger than the other.
01:21
The other one is plugged ducts.
01:22
So if you warm it before and cold it after, that will help.
01:26
Also varied positions help and it's important to know what are the breastfeeding positions,
so you can teach that to the parent.
01:33
Here is the cross-cradle position or they could use the supine position.
01:38
Or they can use the football hold position.
01:41
Any of these are fine, in terms of allowing the baby to breastfeed.
01:45
And sometimes, varying positions allow the baby to suck at the breast from different angles
which allows those ducts to empty out.
01:52
Next is mastitis. This can sometimes come up.
01:57
Any pregnant or breastfeeding mother should know that after she has been breastfeeding for a while,
if she develops fever and has no other symptoms, she should be seen for potential mastitis.
02:07
After a while, after that fever is out,
often they'll get redness over the breast and rarely there can be an abscess.
02:14
So the redness may be delayed, but you should continue to feed
through a breast that is infected because that will actually make her get better faster.
02:23
It will help unplug those ducts. And we will provide antibiotics,
but those are antibiotics that are safe for the baby to get in a breast milk.
02:31
Another complication is jaundice. There are two types of jaundice.
02:36
This is a common test question. The first is breastfeeding jaundice.
02:41
That's when a baby is not eating enough.
02:44
We call it breastfeeding jaundice because of that colostrum.
02:47
They are not generating enough stools.
02:50
Remember, stool is how we get the jaundice out of the baby through the biliary tract.
02:55
Another type of jaundice that's specific to breastfeeding is breast milk jaundice.
03:01
This typically happens around the age of 10-14 days
and it is a transient phenomenon and you should feed through it.
03:10
In very extreme cases, you might bottle feed for a day and let mom pump,
and then go back to breastfeeding.
03:16
But you should not stop breast expression because of breast milk jaundice.
03:20
What's happening is there some undefined factor in breast milk
that actually reduces the conversion of bilirubin in the liver
and extrusion of bilirubin out into the biliary tree.
03:32
Nobody knows why it happens, but it's well-described.
03:35
It does not happen with formula, but it's transient and benign.
03:39
Okay. Formula feeding.
03:41
Let's say I'm on the side she doesn't want to breastfeed
or she hasn't breastfed before or for whatever reason, she's chosen to use formula.
03:49
That's fine. There are generally many different type of formula
which she can choose from and formula companies will market themselves to parents.
03:59
We should avoid letting mothers get confused by this marketing.
04:04
A lot of the marketing is flat out wrong.
04:07
So, what should she choose? Well, the first line agent is usually a milk-based formula.
04:14
She may say something like, "I was allergic to milk-based formula,
when I was a kid so I want to start soy."
It's probably not worth getting in an argument about
if somebody feels very passionately to start soymilk but it's probably not necessary.
04:29
Remember, propensity for allergy is inherited, but what that allergy is, is not inherited.
04:35
So that baby most likely will tolerate cow's milk-based formula just fine,
but if they don't want that, they can certainly choose a soy-based formula.
04:45
There is no real benefit here, this is really personal choice.
04:49
However, there are special formulas for patients who have true milk protein allergy.
04:55
If your baby has blood in the stool or gets very sick with blood in the stool,
your baby may have a milk protein allergy.
05:03
Very rarely, it can be from fussiness, but most infantile fussiness is not a formula issue,
it's an issue with colic.
05:12
That aside, we have this special hydrolyzed formulas for this purpose like Nutramigen or Alimentum.
05:18
It's important that if a child is on milk-based formula
and they have a true allergic response, they should not be placed on soy formula.
05:27
Let me say that again, they should not be placed on soy formula.
05:31
They should go straight to an alimental formula.
05:34
The reason for that is there's a lot of cross-allergy between these two formulas,
so infants on milk who have allergy may still have the allergy on the soy formula
and some of those kids can get quite sick.