1ST CITY CLINICAL HOSPITAL

ATTACHMENT TO THE CHEST

• Turn the baby towards you, bring his nose closer to the nipple.
• Gently tilt the baby's head back a little; It is important to keep your mouth wide open.
• If your mouth doesn't open wide enough or doesn't open at all, you can touch your nipple to your lips to trigger a reflex reaction.
• Place your baby's lips firmly on the nipple, trying to get as much of the areola into the mouth as possible.
• Check to see if your baby sucks and swallows milk easily. 

Application problems:

If you have problems putting your baby to the breast, you can:

• Lightly tickle the baby's lips to cause the mouth to open wide.
• Bring the baby's head as close to the chest as possible (until it touches the chin and lower jaw).
• Place the baby's lower lip as far as possible from the base of the nipple so that the baby covers a larger area of ​​the areola.

SIGNS OF CORRECT APPLICATION

• Does not cause discomfort or pain.
• The baby's chest lies calmly on the mother's chest; the child does not have to toss and turn.
• The areola of the nipple is practically invisible.
• The baby's tongue is under the nipple.
• You can see/hear the baby's swallowing movements.
• The baby's chin touches the breast of a nursing woman.
• The child's mouth is wide open, his lips are pulled back.
• The nipple is deep in the baby's mouth, with the tip at the very back of the mouth.
• The lips and gums are pressed against the area around the nipple (areola).
• The lower lip is placed further from the base of the nipple than the upper lip.

SIGNS OF IMPROPER ATTACHMENT TO THE BREAST

• The baby sucks or “chews” only the nipple.
• The tongue “works” on the tip of the nipple.
• The lips and gums press on the nipple instead of the areola.
• The child’s lips are “sucked” inward.

With this type of attachment, the baby does not receive enough milk, breast emptying is also incomplete, which can lead to negative consequences.

CONSEQUENCES OF IMPROPER ATTACHMENT TO THE BREAST

• Pain

It is important to ensure that the baby grasps not only the nipple, but also the areola.

• Weak sucking movements of the baby

Most often associated with improper latching of the nipple and areola.

• Poor feeding

A possible cause of difficulties with feeding is a short frenulum of the tongue, which requires examination of the child by a pediatrician.

PAINFUL NIPPLES

REASONS AND SOLUTIONS

• Normal appearance of the nipple after feeding.
• The nipple is “flattened” after feeding: shallow latching of the breast or short frenulum of the tongue.
• Hyperemia of the nipple: candidiasis.
• Change in nipple color (pallor, cyanosis): vasospasm or Raynaud's phenomenon.

RECOMMENDATIONS:

• First of all, check the quality of breastfeeding.
• Change positions at each feeding.
• After feeding, express a few drops of milk and gently rub into the nipples.
• Wear natural cotton underwear.
• Avoid tight synthetic underwear.
• Wear special bra pads to ensure nipple hygiene.
• When washing your breasts, avoid using potentially irritating detergents.
• Feed your baby more frequently to prevent breast engorgement and excessive sucking.
• Stimulate the milk production reflex before putting the baby to the breast.
• Before feeding, apply ice to the nipple.
• Nipples should be dry and not covered with clothing for as long as possible, at least at night.
• It is imperative to exclude inflammatory phenomena and infections, in particular candidiasis.
• You can use wound healing creams/ointments.
• Contact your doctor.

INSUFFICIENT QUANTITY OF MILK

RECOMMENDATIONS:

• First of all, check the quality of breastfeeding.
• Feed on demand and if the breast is not completely emptied, express the rest of the milk.
• Offer your baby both breasts during one feeding.
• Introduce nutritional formulas only after consulting a doctor if there is a confirmed deficiency in the child’s body weight gain.
• Limit your child's use of pacifiers and other breast substitutes.
• Rule out hormonal disorders.

EXCESS MILK

• Use only one breast at a time; Offer one breast to your baby until it is completely emptied for at least two hours before the next feeding.
• Use only one breast at a time; Offer one breast to your baby until it is completely emptied for at least two hours before the next feeding.
• Cool compresses can be used to reduce swelling.
• Feed your baby before he shows signs of extreme hunger to reduce the risk of aggressive and painful nipple latching.
• Contact your doctor.

 EXCESSIVE MILK EJUSTMENT REFLEX

• Often combined with excess milk production; is an excessively strong reaction to the secretion of oxytocin when applied to the breast.
• It is recommended to gently grasp the nipple between your thumb and middle finger and squeeze lightly to control the flow of milk.
• If during feeding the milk flow is too fast or abundant and causes discomfort in the baby, you should interrupt feeding and express the excess milk.
• Feed strictly according to the child’s request; do not take long intervals between feedings.

ENGRASSION OF THE MAMMY GLANDS

• Enlargement of the mammary glands and increased sensitivity are the norm during lactation.
• Consolidation and tenderness of the mammary glands is a pathological engorgement, which may be associated with lactostasis and mastitis.
• It most often occurs on days 3-5 of the postpartum period, but can be observed at any other time, especially during long breaks in feeding.
• Breast engorgement is an indication for consulting a doctor in order to exclude lactostasis and mastitis, as well as for recommendations on further tactics.

RECOMMENDATIONS:

• Feeding should be frequent and for a long time, at the request of the child.
• Be sure to monitor the quality of breastfeeding.
• Be sure to completely empty your breasts either during feeding or during additional pumping.
• Avoid using pacifiers or feeding bottles.
• Before feeding, you can manually or using a breast pump express your breasts a little to soften the nipple and areola.
• Do not allow more than 4 hours between feedings or pumping.
• Cooling compresses can be used to reduce swelling and pain.
• Be sure to maintain adequate drinking regimen.
• Be sure to choose supportive underwear that is not tight or synthetic.

CLOGGED DUCTS

• When the ducts of the mammary gland are blocked, a painful/sensitive lump in the chest is observed, not accompanied by symptoms of general intoxication; without hyperthermia.
• Most often one-sided, asymmetrical.
• Caused by local lactostasis.
• May lead to an inflammatory reaction and mastitis.
• Requires a visit to a doctor.
• Feed or pump on the side of the blocked duct at least every 2 hours to ensure emptying.
• Try to regulate breastfeeding in such a way that the baby puts effort precisely on the area of ​​the chest in which there is stagnation.
• Gently circular massage movements from the base of the breast to the nipple
• Apply a warm compress to the area of ​​congestion (with caution if infection is possible) .
• Avoid tight, constricting underwear.

MASTITIS

• Diffuse or local inflammation of breast tissue: pain, swelling, hyperemia.
• Signs of general intoxication, increased body temperature.
• Nausea, vomiting.
• Pathological discharge from the nipples (purulent, mixed with blood).
• REQUIRES MANDATORY IMMEDIATE APPLICATION TO A DOCTOR; INDEPENDENT TREATMENT IS NOT ACCEPTABLE.
• If the elevated temperature persists for more than a day, this should be regarded as an infectious process and antibacterial therapy should be prescribed.
• If, despite AB therapy, complaints persist, new foci of hyperemia and pain appear in the mammary glands, and also if fever with a sharp increase in temperature is observed, the formation of a mammary abscess should be excluded.
• If there is an admixture of pus in breast milk, feeding should be temporarily stopped; Breasts must be expressed frequently and with care.

PROBLEMS RELATED TO THE SHAPE OF NIPPLES

In addition to the normal/standard shape of the nipples, there are also

• Retracted
• Flat
• Too big

Any of these variations can lead to a deterioration in the baby's nipple latching and, accordingly, cause feeding complications.

• For flat/inverted nipples, special shields should be used to make it easier for the baby to attach to the breast.
• The pads must be processed (sterilized) after each feeding.
• With excessively large nipples, attachment improves over time, as the baby is able to better latch on to them as he grows and develops.

Can be recommended before starting feeding

• express some milk
• Apply ice to the nipple for a short time.

BREAST REFUSAL

CAUSES:

• Illness, pain, or use of sedatives:
  • Infections
  • TBI; consequences after intravenous extraction or application of forceps
  • Stuffy nose in a child
  • Inflammation in the mouth (candidiasis, teething)
• Difficulties with breastfeeding technique:
  • Bottle feeding, using pacifiers
  • Poor attachment, breast engorgement
  • Compression of the baby's head from behind during feeding
  • Mother makes breast movements while feeding
  • Too much milk
  • Difficulty coordinating sucking
• Changes that upset the child (typical for ages 3-12 months):
  • Separation from mother
  • Lots of caregivers
  • Diseases in the mother; resumption of the mother's menstruation
  • Changes in the psychological state of the mother
• “Apparent” failure:
  • In a newborn – “aiming”, the formation of a skill
  • At 4-8 months – “distraction”, unstable attention
  • Over 1 year – physiological “weaning” from the breast

RECOMMENDATIONS

• Seeking qualified medical help
• Treatment of infection
• Expressing milk and feeding your baby by cup or tube until he can breastfeed on his own
• For thrush - specific therapy
• During teething, it is important to convince the mother to be patient and continue feeding
• If a child has a stuffy nose - treatment
• It is recommended to feed the baby less time, but more often
• The mother should spend as much time as possible with the child
• Skin-to-skin contact is important, including outside feeding and during sleep.
• Be sure to breastfeed whenever the baby asks for it (including when the baby is sleepy or after cup feeding), and whenever the milk release reflex occurs.
• Avoid using pacifiers, bottles, pacifiers
• Avoid using perfumed hygiene products