Breastfeeding difficulties

While breastfeeding difficulties are not uncommon, putting the baby to the breast as soon as possible after birth helps to avoid many problems. The policy of the American Academy of Pediatrics on breastfeeding instructs to, "delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed."{{cite journal | vauthors = Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, Eidelman AI | title = Breastfeeding and the use of human milk | journal = Pediatrics | volume = 115 | issue = 2 | pages = 496–506 | date = February 2005 | pmid = 15687461 | doi = 10.1542/peds.2004-2491 | doi-access = free }} Many breastfeeding difficulties can be resolved with research based hospital procedures, properly trained nurses and hospital staff, speech pathologists and lactation consultants.{{cite book | author = Newman J | author-link = Jack Newman (doctor) | author2 = Pitman T | title = Dr. Jack Newman's guide to breastfeeding | publisher = HarperCollins Publishers | year = 2000 | isbn = 978-0-00-638568-4 | url-access = registration | url = https://archive.org/details/drjacknewmansgui0000newm }} Another source of information is the volunteer-based breastfeeding promotion organization, La Leche League.

A variety of factors and conditions can interfere with successful breastfeeding:

• Ankyloglossia (tongue tie){{cite journal | vauthors = Genna CW | title = Tongue-tie and breastfeeding | journal = LEAVEN | year = 2002 | volume = 38 | issue = 2 | pages = 27–29 | url = http://www.lalecheleague.org/llleaderweb/LV/LVAprMay02p27.html | access-date = 2007-08-27 | archive-url = https://web.archive.org/web/20170826132618/http://www.lalecheleague.org/llleaderweb/lv/lvaprmay02p27.html | archive-date = 2017-08-26 | url-status = dead }}{{cite journal | vauthors = Ballard JL, Auer CE, Khoury JC | title = Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad | journal = Pediatrics | volume = 110 | issue = 5 | pages = e63 | date = November 2002 | pmid = 12415069 | doi = 10.1542/peds.110.5.e63 | doi-access = }}
• Formula feeding
• Distractions or interruptions during feeds
• Long separations from the mother
• Tachypnea (rapid breathing) such as in transient tachypnea of the newborn, surfactant deficiency, respiratory distress syndrome or other infant medical conditions
• Presence of an actual physical barrier between mother and infant
• Swallowing difficulties such as with prematurity and coordination of sucking, swallowing and breathing, or gastro-intestinal tract abnormalities like tracheo-oesophageal fistula.
• Pain resulting from surgical procedures like circumcision, blood tests, or vaccinations.{{cite journal | vauthors = Hagan J Jr | title = The assessment and management of acute pain in infants, children, and adolescents | journal = Pediatrics | volume = 108 | issue = 3 | pages = 793–797 | date = September 2001 | pmid = 11533354 | doi = 10.1542/peds.108.3.793 | doi-access = }}{{Failed verification|date=January 2009}}
• Latching onto the breast{{Cite web|title=How do I breastfeed?|url=https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/how-is-it-done|access-date=2020-10-29|website=nichd.nih.gov/|language=en}}
• Hypoplastic breasts/insufficient glandular tissue
• Galactorrhea
• Lactation failure
• Polycystic ovarian syndrome
• Diabetes
• Maternal stress{{Cite web|title=Will stress during pregnancy affect my baby?|url=https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/stress|access-date=2020-10-29|website=nichd.nih.gov/|language=en}}
• Insufficient rest/support of the mother during the first 6 weeks post-partum
• Early return to work due to lack of financial support/maternity leave of mother{{Cite web|date=2018-07-12|title=Supporting Nursing Moms at Work|url=https://www.womenshealth.gov/supporting-nursing-moms-work|access-date=2020-10-29|website=womenshealth.gov|language=en}}
• Cleft palate
• Thrush{{cite journal | vauthors = Brent NB | title = Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment | journal = Clinical Pediatrics | volume = 40 | issue = 9 | pages = 503–506 | date = September 2001 | pmid = 11583049 | doi = 10.1177/000992280104000905 | s2cid = 12091215 }}
• Hypoglycemia or hyperglycemia{{cite journal | vauthors = Bentley-Lewis R, Goldfine AB, Green DE, Seely EW | title = Lactation after normal pregnancy is not associated with blood glucose fluctuations | journal = Diabetes Care | volume = 30 | issue = 11 | pages = 2792–2793 | date = November 2007 | pmid = 17698611 | pmc = 4428539 | doi = 10.2337/dc07-1243 }}
• Hypotonia, or "low-tone" infant disorder{{cite journal | vauthors = Genna CW | title = Tactile Defensiveness and Other Sensory Modulation Difficulties | journal = LEAVEN | year = 2002 | volume = 37 | issue = 3 | pages = 51–53 | url = http://www.lalecheleague.org/llleaderweb/LV/LVJunJul01p51.html | access-date = 2007-08-27 | archive-url = https://web.archive.org/web/20170806003707/http://www.lalecheleague.org/llleaderweb/lv/lvjunjul01p51.html | archive-date = 2017-08-06 | url-status = dead }}
• Hyperlactation syndrome{{cite journal | vauthors = Livingstone V | title = Too much of a good thing. Maternal and infant hyperlactation syndromes | journal = Canadian Family Physician | volume = 42 | pages = 89–99 | date = January 1996 | pmid = 8924818 | pmc = 2146202 }}
• Overactive let-down{{cite book | vauthors = Mohrbacher N, Stock J | title = The Breastfeeding Answer Book | edition = 3rd (revised) | publisher = La Leche League International | year = 2003 | isbn = 978-0-912500-92-8 }}
• Premature babies can have difficulties coordinating their sucking reflex with breathing. They may need to be fed more frequently because their stomachs tend to be smaller, and they may get sleepier during feedings.{{Cite web|url=https://www.womenshealth.gov/breastfeeding/breastfeeding-challenges/breastfeeding-baby-health-problem/#3|title=Breastfeeding a baby with a health problem {{!}} womenshealth.gov|website=womenshealth.gov|language=en|access-date=2018-11-07|date=February 2017}} Premature infants unable to take enough calories by mouth may need enteral or gavage feeding - inserting a feeding tube into the stomach to provide enough breast milk or a substitute. This is often done together with Kangaroo care (prolonged skin-to-skin contact with the mother) which makes later breastfeeding easier. For some suckling difficulties, such as may happen with cleft lip/palate, the baby can be fed with a Haberman Feeder.
• Dysphoric milk ejection reflex (D-MER) is a newly recognized condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions that occur just before milk release and continuing not more than a few minutes. Preliminary testing tells us that D-MER is treatable and preliminary research tells us that inappropriate dopamine activity at the time of the milk ejection reflex is the cause of D-MER.{{cite web|url=http://d-mer.org|access-date=2010-09-10|publisher=d-mer.org|title=d-mer.org}}

{{main|Low milk supply}}

• Primary lactation failure: occurs when the mother has a condition incompatible with full milk production, for example breast hypoplasia, breast reduction surgery, or bilateral mastectomy.
• Secondary lactation failure: milk production that is low due to preventable factors, such as formula supplementation, poor milk transfer by the baby, or unrelieved breast engorgement.{{cite journal | vauthors = Hurst NM | title = Recognizing and treating delayed or failed lactogenesis II | journal = Journal of Midwifery & Women's Health | volume = 52 | issue = 6 | pages = 588–594 | year = 2007 | pmid = 17983996 | doi = 10.1016/j.jmwh.2007.05.005 }}
• Chronic low milk supply is estimated to be experienced by 10-15% of women.{{cite journal | vauthors = Lee S, Kelleher SL | title = Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology | journal = American Journal of Physiology. Endocrinology and Metabolism | volume = 311 | issue = 2 | pages = E405–E422 | date = August 2016 | pmid = 27354238 | pmc = 5005964 | doi = 10.1152/ajpendo.00495.2015 }}

Pain often interferes with successful breastfeeding. It is cited as the second most common cause for the abandonment of exclusive breastfeeding after perceived low milk supply.{{cite journal | vauthors = Woolridge MW | title = Aetiology of sore nipples | journal = Midwifery | volume = 2 | issue = 4 | pages = 172–176 | date = December 1986 | pmid = 3643398 | doi = 10.1016/S0266-6138(86)80042-0 }}

Inverted or retracted nipples sometimes make attachment to the breast difficult.{{cite web |title=Challenge: Inverted, flat, or very large nipples |url=https://www.womenshealth.gov/breastfeeding/breastfeeding-challenges/common-breastfeeding-challenges |website=Common breastfeeding challenges |publisher=U.S. Department of Health & Human Services. Office on Women's Health |access-date=7 November 2018|date=February 2017 }} These mothers need additional support to feed their babies. Treatment is started after the birth of the baby. The nipple is manually stretched out several times a day. A pump or a plastic syringe is used to draw out the nipple and the baby is then put to the breast.

Breast engorgement is the sense of breast fullness experienced by most women within 36 hours of delivery. Normally, this is a painless sensation of "heaviness". Breastfeeding on demand is the primary way of preventing painful engorgement.

When the breast overfills with milk it becomes painful. Engorgement comes from not getting enough milk from the breast. It happens about 3 to 7 days after delivery and occurs more often in first time mothers. The increased blood supply, the accumulated milk and the swelling all contribute to the painful engorgement.{{cite journal | vauthors = Hill PD, Humenick SS | title = The occurrence of breast engorgement | journal = Journal of Human Lactation | volume = 10 | issue = 2 | pages = 79–86 | date = June 1994 | pmid = 7619260 | doi = 10.1177/089033449401000212 | s2cid = 25908855 }} Engorgement may affect the areola, the periphery of the breast or the entire breast, and may interfere with breastfeeding both from the pain and also from the distortion of the normal shape of the areola/nipple. This makes it harder for the baby to latch on properly for feeding. Latching may occur over only part of the areola. This can irritate the nipple more, and may lead to ineffective drainage of breast milk and more pain. Reverse pressure softening (RPS) is a technique that can soften the areola enabling deeper latching and more milk transfer; RPS involves gentle positive pressure in the direction of the chest wall from the fingertips around the areola.{{Cite journal |date=2021-04-02 |title=Effectiveness of Reverse Pressure Softening of Areola in Women with Postpartum Breast Engorgement |url=http://medicopublication.com/index.php/ijpot/article/view/14513 |journal=Indian Journal of Physiotherapy and Occupational Therapy |volume=15 |issue=2 |pages=50–58 |doi=10.37506/ijpot.v15i2.14513|last1=Pednekar |first1=Priyanka Sandeep |s2cid=241146508 |doi-access=free }} Engorgement may begin as a result of several factors such as nipple pain, improper feeding technique, infrequent feeding or infant-mother separation.

To prevent or treat engorgement, remove the milk from the breast, by breastfeeding, expressing or pumping. Gentle massage can help start the milk flow and so reduce the pressure. The reduced pressure softens the areola, perhaps even allowing the infant to feed. Warm water or warm compresses and expressing some milk before feeding can also help make breastfeeding more effective. Some researchers have suggested that after breastfeeding, mothers should pump and/or apply cold compresses to reduce swelling pain and vascularity even more.{{Cite web|title=Overcoming breastfeeding problems: MedlinePlus Medical Encyclopedia|url=https://medlineplus.gov/ency/article/002452.htm|access-date=2020-10-29|website=medlineplus.gov|language=en}} One published study suggested the use of "chilled cabbage leaves" applied to the breasts. Attempts to reproduce this technique met with mixed results.{{cite journal | vauthors = Nikodem VC, Danziger D, Gebka N, Gulmezoglu AM, Hofmeyr GJ | title = Do cabbage leaves prevent breast engorgement? A randomized, controlled study | journal = Birth | volume = 20 | issue = 2 | pages = 61–64 | date = June 1993 | pmid = 8240608 | doi = 10.1111/j.1523-536X.1993.tb00418.x }} Nonsteroidal anti-inflammatory drugs or paracetamol (acetaminophen) may relieve the pain. A warm shower and using cold compresses to help ease the discomfort.

Sore nipples (nipple pain, or thelalgia) are probably the most common complaint after the birth. They are generally reported by the second day after delivery but improve within 5 days.{{cite journal | vauthors = Ziemer MM, Paone JP, Schupay J, Cole E | title = Methods to prevent and manage nipple pain in breastfeeding women | journal = Western Journal of Nursing Research | volume = 12 | issue = 6 | pages = 732–43; discussion 743–44 | date = December 1990 | pmid = 2275191 | doi = 10.1177/019394599001200603 | s2cid = 9921276 }} Pain beyond the first week, severe pain, cracking, fissures or localized swelling is not normal. The mother should see a doctor for further evaluation. Sore nipples, a common cause of pain, often come from the baby not latching on properly. Factors include too much pressure on the nipple when not enough of the areola is latched onto and an improper release of suction at the end of the feeding. Improper use of breast pumps or topical remedies can also contribute.{{cite journal | vauthors = Cable B, Stewart M, Davis J | title = Nipple wound care: a new approach to an old problem | journal = Journal of Human Lactation | volume = 13 | issue = 4 | pages = 313–318 | date = December 1997 | pmid = 9429367 | doi = 10.1177/089033449701300417 | s2cid = 22804136 }} Nipple pain can also be a sign of infection.{{cite journal | vauthors = Amir LH, Garland SM, Dennerstein L, Farish SJ | title = Candida albicans: is it associated with nipple pain in lactating women? | journal = Gynecologic and Obstetric Investigation | volume = 41 | issue = 1 | pages = 30–34 | year = 1996 | pmid = 8821881 | doi = 10.1159/000292031 | publisher = Karger }}

Symptoms of candidiasis of the breast include pain, itching, burning and redness, or a shiny or white patchy appearance.{{cite journal | vauthors = Wiener S | title = Diagnosis and management of Candida of the nipple and breast | journal = Journal of Midwifery & Women's Health | volume = 51 | issue = 2 | pages = 125–128 | date = March–April 2006 | pmid = 16504910 | doi = 10.1016/j.jmwh.2005.11.001 }} The baby could have a white tongue that does not wipe clean. Candidiasis is common and may be associated with infant thrush.

Both mother and baby must be treated to get rid of this infection. First-line therapies include nystatin, ketaconazole or miconazole applied to the nipple and given by mouth to the baby. Strict cleaning of clothing and breast pumps is also required to eradicate the infection.{{cite journal | vauthors = Tanguay KE, McBean MR, Jain E | title = Nipple candidiasis among breastfeeding mothers. Case-control study of predisposing factors | journal = Canadian Family Physician | volume = 40 | pages = 1407–1413 | date = August 1994 | pmid = 8081120 | pmc = 2380126 }}

Another non-prescription treatment of candidia is gentian violet. It usually works, and relief is rapid. It is messy, and will stain clothing. The baby's lips will turn purple, but the purple will disappear after a few days.

Milk stasis is when the milk ducts are blocked and cannot drain properly, usually due to swelling and insufficient breast emptying during the engorgement phase. This may affect only a part of the breast and is not associated with any infection. It can be treated by varying the baby's feeding position and applying heat before feeding. If it happens more than once, further evaluation is needed. Milk stasis is an urgent matter for mothers who wish to breastfeed, as failure to remove milk from the breasts causes milk production to decrease and eventually stop.

{{Main|Puerperal mastitis}}

Mastitis is an inflammation of the breast. It causes local pain (dolor), redness (rubor), swelling (tumor), and warmth (calor). Later stages of mastitis cause symptoms of systemic infection like fever and nausea. It mostly occurs 2–3 weeks after delivery but can happen at any time.{{cite journal | vauthors = Evans ME, Heads J | title = Incidence of mastitis in breastfeeding women during the six months after delivery: a prospective cohort study | journal = The Medical Journal of Australia | volume = 170 | issue = 4 | pages = 192 | date = February 1999 | pmid = 10078195 | doi = 10.5694/j.1326-5377.1999.tb127735.x | s2cid = 31019946 }} Typically results from milk stasis with primary or secondary local, later systemic infection. Infectious organisms include Staphylococcus sp., Streptococcus sp. and E. coli. Continued breastfeeding, plenty of rest and adequate fluid supply is the best treatment for light cases.

{{main|Overactive let-down}}

Overactive let-down (OALD) is the forceful ejection of milk from the breast during breastfeeding. The forceful spray of milk can cause the baby to consume too much milk too quickly as well as to swallow air during the period of rapid swallowing following the let-down.

File:Nipple-blanching.jpg

Nipple pain can be caused by vasospasm of the nipple. In essence, blood does not flow properly to the nipple which causes the nipple to blanch. This can be caused by trauma to the nipple through early breastfeeding or candidal infection of the nipple. The pain is intense during the latch stage and in between breastfeeding sessions there is a throbbing pain when the nipple is blanched. The nipple can be massaged to help blood flow return to reduce pain, as well as avoiding cold. In some instances, heart medication, nifedipine, is used to help the blood flow return to the nipple.{{cite web|vauthors = Kernerman E |title=Vasospasm and Raynaud's Phenomenon|url=http://www.breastfeedinginc.ca/content.php?pagename=doc-V-RP|work=Centre for Breastfeeding Education|access-date=2012-10-18|archive-url=https://web.archive.org/web/20120318172036/http://www.breastfeedinginc.ca/content.php?pagename=doc-V-RP|archive-date=2012-03-18|url-status=dead}}

Infants with classic galactosemia cannot digest lactose and therefore cannot benefit from breast milk. Breastfeeding might harm the baby also if the mother has untreated pulmonary tuberculosis, is taking certain medications that suppress the immune system. has HIV,{{cite web | title = When should a mother avoid breastfeeding? | publisher = Centers for Disease Control and Prevention | date = 2006-08-26 | url = https://www.cdc.gov/breastfeeding/disease/contraindicators.htm | archive-url = https://web.archive.org/web/20060824220444/http://www.cdc.gov/breastfeeding/disease/contraindicators.htm | url-status = dead | archive-date = August 24, 2006 | access-date = 2007-03-04 }}{{cite web | title = HIV and Infant Feeding | publisher = Unicef | url = http://www.unicef.org/programme/breastfeeding/hiv.htm | access-date = 2006-08-19 | archive-date = 2018-05-11 | archive-url = https://web.archive.org/web/20180511013024/https://www.unicef.org/programme/breastfeeding/hiv.htm | url-status = dead }} or uses potentially harmful substances such as cocaine, heroin, and amphetamines. Other than cases of acute poisoning, no environmental contaminant has been found to cause more harm to infants than lack of breastfeeding. Although heavy metals such as mercury are dispersed throughout the environment and are of concern to the nursing infant, the neurodevelopmental benefits of human milk tend to override the potential adverse effects of neurotoxicants.

Artificial teats (nipples) or dummies (pacifiers) can suppress the sucking reflex in infants. In addition, when a baby is put to the breast for shorter periods of time, milk production decreases. The time spent sucking by the infant on the pacifier or artificial teat reduces the time on the breast.{{cite journal | vauthors = Marmet C, Shell E, Aldana S | title = Assessing infant suck dysfunction: case management | journal = Journal of Human Lactation | volume = 16 | issue = 4 | pages = 332–336 | date = November 2000 | pmid = 11188682 | doi = 10.1177/089033440001600409 | s2cid = 208505043 }}{{cite journal | vauthors = Jaafar SH, Ho JJ, Jahanfar S, Angolkar M | title = Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD007202 | date = August 2016 | volume = 2016 | pmid = 27572944 | doi = 10.1002/14651858.CD007202.pub4 | pmc = 8520760 }} The CDC also currently (2022) reports that early use of pacifiers can have a negative outcome on the success of breastfeeding and they suggest that it should be delayed until breastfeeding is firmly established.{{cite web |title=Infant Safety in Maternity Care Practices that Support Breastfeeding in US Birth Facilities |url=https://www.cdc.gov/breastfeeding/recommendations/safety-in-maternity-care.html |website=CDC |date=28 January 2021 |access-date=January 14, 2022}}

It is not safe for mothers with active, untreated tuberculosis to breastfeed until they are no longer contagious. According to the American Academy of Pediatrics 2006 Redbook: {{cquote|Women with tuberculosis who have been treated appropriately for 2 or more weeks and who are not considered contagious may breastfeed. Women with tuberculosis disease suspected of being contagious should refrain from breastfeeding or any other close contact with the infant because of potential transmission through respiratory tract droplets (see Tuberculosis, p 678). Mycobacterium tuberculosis rarely causes mastitis or a breast abscess, but if a breast abscess caused by M. tuberculosis is present, breastfeeding should be discontinued until the mother no longer is contagious.}}

In areas where BCG vaccination is the standard of care, the WHO provides treatment recommendations and advises mothers to continue breastfeeding.[https://www.who.int/child-adolescent-health/New_Publications/NUTRITION/Breastfeeding_Tub.pdf The WHO] {{webarchive |url=https://web.archive.org/web/20061107232833/http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/Breastfeeding_Tub.pdf |date=November 7, 2006 }} on Breastfeeding and maternal tuberculosis; acquired 2006-08-19 TBC may be congenital, or perinatally acquired through airborne droplet spread.{{cite journal | vauthors = Nemir RL, O'Hare D | title = Congenital tuberculosis. Review and diagnostic guidelines | journal = American Journal of Diseases of Children | volume = 139 | issue = 3 | pages = 284–287 | date = March 1985 | pmid = 3976610 | pmc = 5209150 | doi = 10.1001/archpedi.1985.02140050078028 }}

{{main|Breastfeeding by HIV infected mothers}}

Research published in the Lancet{{cite journal | vauthors = Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML | title = Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study | journal = Lancet | volume = 369 | issue = 9567 | pages = 1107–1116 | date = March 2007 | pmid = 17398310 | doi = 10.1016/S0140-6736(07)60283-9 | s2cid = 6183061 }}[http://news.bbc.co.uk/1/hi/health/6507309.stm Breastfeeding alone cuts HIV risk] has highlighted a lower risk of HIV transmission with exclusive breastfeeding by HIV positive mothers (4% risk), compared to mixed feeding (10-40% risk). Research on the timing of HIV transmission in 2000 revealed that a "substantial transmission occurs early during breastfeeding," concluding that 75% of all breast milk transmission had occurred within the first 6 months during a randomized control trial in Kenya.{{cite journal | vauthors = Nduati R, John G, Mbori-Ngacha D, Richardson B, Overbaugh J, Mwatha A, Ndinya-Achola J, Bwayo J, Onyango FE, Hughes J, Kreiss J | display-authors = 6 | title = Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial | journal = JAMA | volume = 283 | issue = 9 | pages = 1167–1174 | date = March 2000 | pmid = 10703779 | doi = 10.1001/jama.283.9.1167 | doi-access = }} This research is of particular importance in developing countries where infant formula is not widely available or safe to prepare. In fact, the World Health Organization recommended breastfeeding in 1987 and 1992 for seropositive and seronegative women in areas where malnutrition and infectious diseases are the major cause of infant mortality.World Health Organization. Statement from the Consultation on Breast-feeding/Breast Milk and Human Immunodeficiency Virus (HIV). Geneva, Switzerland: WHO; 1987.{{cite journal | author = Global Programme on AIDS | title = Consensus statement from the WHO/UNICEF consultation on HIV transmission and breast-feeding. | journal = Weekly Epidemiol Record | date = 1992 | volume = 67 | pages = 177–179 }} In 1996 UNAIDS issued a recommendation that women in developing countries consider the risks and benefits of each feeding practice on an individual level; they recommended women make an informed choice about infant feeding.{{cite journal | author = Joint United Nations Program on HIV/AIDS. | title = HIV and infant feeding. | journal = Weekly Epidemiological Record | date = 1996 | volume = 71 | pages = 289–291 }} In the days before the AIDS epidemic was clearly understood, some researchers pointed to the need to increase breastfeeding rates and pointed to the risks of formula feeding, citing increased rates of marasmus and diarrhea.{{cite journal | vauthors = Jelliffe DB, Jelliffe EF | title = Feeding young infants in developing countries: comments on the current situation and future needs | journal = Studies in Family Planning | volume = 9 | issue = 8 | pages = 227–9 | date = August 1978 | pmid = 715834 | doi = 10.2307/1965868| jstor = 1965868 | url = }} D Jelliffe and E Jelliffe also criticized the marketing of infant formulas by US companies to resource-poor countries, something they termed "comerciogenic malnutrition." A more recent article from 1992 describes how the health of an infant can be compromised by water, which in many resource-poor countries holds the risk of environmental pathogens that are not present in breastmilk.{{cite journal | doi = 10.1146/annurev.an.21.100192.001131 |author1=Dettwyler K |author2=Fishman C | year = 1992 | title = Infant Feeding Practices and Growth | journal = Annual Review of Anthropology | volume = 21 | pages = 171–204 }}

{{Main|Breastfeeding and medications}}

{{also|Alcohol and pregnancy}}

Moderate alcohol consumption by breastfeeding mothers can significantly affect infants. Even one or two drinks, including beer, may reduce milk intake by 20 to 23%, leading to increased agitation and poor sleep patterns. Regular heavy drinking (more than two drinks daily) can shorten breastfeeding duration and cause issues in infants, such as excessive sedation, fluid retention, and hormonal imbalances. Additionally, higher alcohol consumption may negatively impact children's academic achievement.{{cite journal |title=Alcohol. |date=2006 |pmid=30000529}}

"Alcohol passes to the baby in small amounts in breast milk. The milk will smell different to the baby and may affect their feeding, sleeping or digestion. The best advice is to avoid drinking shortly before a baby's feed."{{Cite web |url=http://www.bestbreastpumpadvisor.com/breastfeeding/breast-milk-and-alcohol-are-babies-in-danger-if-breastfeeding-mothers-drink |title=Alcohol and pregnancy |access-date=12 November 2014 |archive-date=12 November 2014 |archive-url=https://web.archive.org/web/20141112153457/http://www.bestbreastpumpadvisor.com/breastfeeding/breast-milk-and-alcohol-are-babies-in-danger-if-breastfeeding-mothers-drink/ |url-status=live }} "Alcohol inhibits a mother's let-down (the release of milk to the nipple). Studies have shown that babies take around 20% less milk if there's alcohol present, so they'll need to feed more often – although infants have been known to go on 'nursing strike', probably because of the altered taste of the milk."{{Cite web |url=http://kaldascenter.com/alcohol-and-breastfeeding.html |title=Alcohol and breastfeeding (2009) - Retrieved 23 May 2014 |access-date=23 April 2014 |archive-date=12 November 2014 |archive-url=https://web.archive.org/web/20141112124245/http://kaldascenter.com/alcohol-and-breastfeeding.html |url-status=dead }} "There is little research evidence available about the effect that [alcohol in breast milk] has on the baby, although practitioners report that, even at relatively low levels of drinking, it may reduce the amount of milk available and cause irritability, poor feeding and sleep disturbance in the infant. Given these concerns, a prudent approach is advised."{{cite book |title=Australian Alcohol Guidelines: Health Risks and Benefits |date=2001 |publisher=National Health and Medical Research Council |location=Canberra |isbn=1864961600 |page=16 |url=https://www.aph.gov.au/~/media/wopapub/senate/committee/clac_ctte/completed_inquiries/2008_10/alcohol_reduction/submissions/sub58a_pdf.ashx}}

Cannabis is listed by the American Association of Pediatrics as a compound that transfers into human breast milk. Research demonstrated that certain compounds in marijuana have a very long half-life.[http://www.aap.org/policy/0063.html American Association of Pediatrics] {{webarchive |url=https://web.archive.org/web/20070927192603/http://www.aap.org/policy/0063.html |date=September 27, 2007 }} on cannabis (see table 2); acquired 2006-08-19

The vast majority of over the counter and prescription medicines are compatible with breastfeeding, but there are some that might be passed onto the child through the milk.{{cite journal | author = American Academy of Pediatrics Committee on Drugs | title = Transfer of drugs and other chemicals into human milk | journal = Pediatrics | volume = 108 | issue = 3 | pages = 776–789 | date = September 2001 | pmid = 11533352 | doi = 10.1542/peds.108.3.776 | doi-access = free }}

{{See also|Women and smoking#Unique gender differences and health effects for Females}}

If one does continue tobacco smoking after giving birth, however, it is still more beneficial to breastfeed than to completely avoid this practice altogether. There is evidence that breastfeeding offers protection against many infectious diseases, especially diarrhea. Even in babies exposed to the harmful effects of nicotine through breast milk, the likelihood of acute respiratory illness is significantly diminished when compared to infants whose mothers smoked but were formula fed.{{cite journal | vauthors = Mennella JA, Yourshaw LM, Morgan LK | title = Breastfeeding and smoking: short-term effects on infant feeding and sleep | journal = Pediatrics | volume = 120 | issue = 3 | pages = 497–502 | date = September 2007 | pmid = 17766521 | pmc = 2277470 | doi = 10.1542/peds.2007-0488 }} Regardless, the benefits of breastfeeding outweigh the risks of nicotine exposure.

The main concern about smoking and breastfeeding is that infants may have smoking-induced reductions to the milk iodine content. Smoking can adversely affect the lactation process by decreasing milk production and altering the milk composition. Smoking reduces daily milk output by roughly 250–300 mL. Not only will this be problematic on a daily basis for not producing enough milk, it will also cause the mother to wean her baby early.Najdawi, F and Faouri, M 1999. Maternal smoking and breastfeeding. Eastern

Mediterranean Health Journal. 5(3): 450-456 The altered milk composition also caused infants to exhibit daily behaviors such as colic and crying which can promote early weaning, again something that is not beneficial to the infant.

Also, the nicotine obtained from smoking travels through a woman into her breast milk, thus giving nicotine to her child.The [http://www.surgeongeneral.gov/news/speeches/06272006a.html U.S. Surgeon General's Report] {{Webarchive|url=https://web.archive.org/web/20110806133133/http://www.surgeongeneral.gov/news/speeches/06272006a.html |date=2011-08-06 }} ([http://www.surgeongeneral.gov/library/secondhandsmoke/report/chapter5.pdf Chapter 5]; pp. 180–194).

Heavy use of cigarettes by the mother (more than 20 per day) has been shown to reduce the mother's milk supply and cause vomiting, diarrhoea, rapid heart rate, and restlessness in breastfed infants. Sudden Infant Death Syndrome (SIDS) is more common in babies exposed to a smoky environment.{{cite journal | vauthors = Gunn AJ, Gunn TR, Mitchell EA | title = Is changing the sleep environment enough? Current recommendations for SIDS | journal = Sleep Medicine Reviews | volume = 4 | issue = 5 | pages = 453–469 | date = October 2000 | pmid = 17210277 | doi = 10.1053/smrv.2000.0119 }} Breastfeeding mothers who smoke are counseled not to do so during or immediately before feeding their child, and are encouraged to seek advice to help them reduce their nicotine intake or quit.{{cite journal | vauthors = Villamunga D | title = Smoking and Breastfeeding | journal = LEAVEN | year = 2004 | volume = 40 | issue = 4 | pages = 75–78 | url = http://www.llli.org/llleaderweb/LV/LVAugSep04p75.html | access-date = 2007-08-27 | archive-url = https://web.archive.org/web/20180127143233/http://www.llli.org/llleaderweb/lv/lvaugsep04p75.html | archive-date = 2018-01-27 | url-status = dead }}

With respect to alcohol, the American Academy of Pediatrics states that when breastfeeding, "moderation is definitely advised" and recommends waiting for 2 hours after drinking before nursing or pumping.{{cite web |url=https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Frequently-Asked-Questions.aspx#ques24| title = Fetal Alcohol Spectrum Disorders Toolkit Frequently Asked Questions | author = American Academy of Pediatrics |access-date = 15 Nov 2017 }} A 2014 review found that "even in a theoretical case of binge drinking, the children would not be subjected to clinically relevant amounts of alcohol [through breastmilk]", and would have no adverse effects on children as long as drinking is "occasional".{{cite journal | vauthors = Haastrup MB, Pottegård A, Damkier P | title = Alcohol and breastfeeding | journal = Basic & Clinical Pharmacology & Toxicology | volume = 114 | issue = 2 | pages = 168–173 | date = February 2014 | pmid = 24118767 | doi = 10.1111/bcpt.12149 | doi-access = }}

If the mother consumes too much caffeine, it can cause irritability, sleeplessness, nervousness and increased feeding in the breastfed infant. Moderate use (one to two cups per day of coffee, tea, or cola) usually produces no effect.{{Cite web|url=https://www.womenshealth.gov/files/documents/your-guide-to-breastfeeding.pdf|title=Your Guide to Breastfeeding| work = Office of Women's Health.| publisher =U.S. Department of Health and Human Services |access-date=November 7, 2018|archive-date=October 17, 2020|archive-url= https://web.archive.org/web/20201017113931/https://www.womenshealth.gov/files/documents/your-guide-to-breastfeeding.pdf |url-status=dead}} Breastfeeding mothers are advised to restrict or avoid caffeine if her baby reacts negatively to it.{{Cite web|url=https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Things-to-Avoid-When-Breastfeeding.aspx|title=Things to Avoid When Breastfeeding|website=HealthyChildren.org|access-date=2018-11-07}}

Cigarette smoking is thought to increase the effects of caffeine in the baby.{{cite book | vauthors = Lawrence RA, Lawrence RM | title = Breastfeeding: A Guide for the Medical Profession | page = [https://archive.org/details/breastfeedinggui0000lawr/page/369 369] | edition = 5th | publisher = C.V. Mosby | year = 1999 | isbn = 978-0-8151-2615-7 | url = https://archive.org/details/breastfeedinggui0000lawr/page/369 }}

An exclusively breastfed baby depends on breast milk completely so it is important for the mother to maintain a healthy lifestyle, and especially a good diet.{{cite book | vauthors = Tamborlane WV, Weiswasser JZ |title=The Yale guide to children's nutrition |date=1997 |publisher=Yale University Press |location=New Haven |isbn=978-0-300-07169-6 | page = 33 }} Consumption of 1500–1800 calories per day could coincide with a weight loss of 450 grams (one pound) per week.{{cite web| title = How can I lose weight safely while breastfeeding?| publisher = La Leche League International| url = http://www.lalecheleague.org/FAQ/diet.html| date = 2006-08-29| access-date = 2007-02-12| archive-url = https://web.archive.org/web/20070220081636/http://www.lalecheleague.org/FAQ/diet.html| archive-date = 2007-02-20| url-status = dead}} While mothers in famine conditions can produce milk with highly nutritional content, a malnourished mother may produce milk with decreased levels of several micronutrients such as iron, zinc, and vitamin B₁₂.{{cite journal | vauthors = Mead MN | title = Contaminants in human milk: weighing the risks against the benefits of breastfeeding | journal = Environmental Health Perspectives | volume = 116 | issue = 10 | pages = A427–A434 | date = October 2008 | pmid = 18941560 | pmc = 2569122 | doi = 10.1289/ehp.116-a426 | url = http://www.ehponline.org/members/2008/116-10/focus.html | access-date = 2008-10-23 | url-status = dead | archive-url = https://web.archive.org/web/20081106182431/http://www.ehponline.org/members/2008/116-10/focus.html | archive-date = 2008-11-06 }} She may also have a lower supply than well-fed mothers.

There are no foods that are absolutely contraindicated during breastfeeding, but a baby may show sensitivity to particular foods that the mother eats.

Many mothers have to return to work soon after their babies have been born. If their employers and fellow employees do not support mothers in breastfeeding (for example, providing a private breastfeeding room containing a fridge where mothers can express and safely store breast milk), mothers might stop breastfeeding. This is not ideal for their infants. A Cochrane review assessed the effects of workplace interventions to support and promote breastfeeding among mothers returning to work after the birth of their babies.{{cite journal | vauthors = Abdulwadud OA, Snow ME | title = Interventions in the workplace to support breastfeeding for women in employment | journal = The Cochrane Database of Systematic Reviews | volume = 10 | pages = CD006177 | date = October 2012 | issue = 10 | pmid = 23076920 | pmc = 7388861 | doi = 10.1002/14651858.CD006177.pub3 }} The review authors comprehensively searched in 2012 for studies addressing this question but found no eligible studies. "The return to work can impact the amount of breastmilk that your body produces due to the stress and changes of leaving your baby."

{{Reflist}}

{{Medical resources

| DiseasesDB =

| ICD10 = {{ICD10|O|92||o|85}}

| ICD9 = {{ICD9|676}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj =

| eMedicineTopic =

| MeshID =

}}

{{Diseases of the breast}}

{{Pathology of pregnancy, childbirth and the puerperium}}

{{Diseases of maternal transmission}}

{{DEFAULTSORT:Breastfeeding Difficulties}}

Category:Breastfeeding

Category:Pathology of pregnancy, childbirth and the puerperium