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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Tuesday, March 16, 2010
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Tuesday, March 16, 2010
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- My 6 month old son bites very hard while breast feeding it is so painful I must stop feeding him. What can I do?
- If I have breast implants, can I still breast feed?
- Can a woman who has had a reduction mammoplasty breastfeed?
- I had a benign lump removed from my breast almost 13 years ago. The doctors made an incision on my areola - will I be able to breastfeed?
- What is the standard length of time that it takes to establish breastfeeding, so as to not cause confusion when you offer a bottle?
Many babies will bite at some time between 6 to 12 months when "cutting" teeth. Babies also become much more efficient breastfeeders around 6 months. If a mother doesn't realize that her baby can now get a good meal in 5 to 10 minutes (or less) at the breast, she may be surprised that the baby seems to get frustrated and bites at the end of a feeding if "forced" to continue. A baby who is getting a lot of bottles, which provide instant gratification when placed in the mouth, or getting too many solids or other liquids, may protest a "too long" wait for a let-down of milk by biting. Some babies chew or bite on bottle nipples/pacifiers and think they can do the same to Mom. Biting also may occur when a baby is suffering with the pain or congestion of an ear, nose or throat illness or condition.
Some mothers of young babies say they plan to stop breastfeeding when their babies get teeth and start to bite, but babies can't bite when actually suckling during a breastfeeding. When a baby is suckling, or actively moving milk from the breast into his mouth, the baby's tongue is over the bottom gum (and any teeth). The baby does not have to clench or bite down to hold the nipple in place or to remove milk. When a baby bites, it tends to be at the end of a feeding or, less often, at the beginning - prior to active breastfeeding.
Fortunately, it's usually fairly easy to overcome biting. However, it requires a consistent response on your part. First, try to avoid biting by going back to the basics of good positioning and latch-on techniques; it's easy to get "sloppy" about this with 6-month-olds who can latch on without help and nurse while twisting around like pretzels! Be attentive to the baby during feedings. Most older babies enjoy interacting with their mothers while breastfeeding, so make eye contact, talk to and touch your baby. When he indicates he is finished, believe him! End the feeding. He'll let you know if he wants more in a little while. If he falls asleep, remove him from the breast after breaking the suction.
If he bites, say "ouch," which usually is easy to do under the circumstances, and stop the feeding by putting your finger at the corner of his mouth between his gums. Put the baby down as you say something to the effect of, "No biting. It hurts Mommy." Say it in a firm, but calm voice. A yell or over-reaction really scares some babies and they need a lot of coaxing to breastfeed the next time. Offer a teething ring or some other biting substitute. Wait several minutes before letting baby breastfeed again if he "asks." Whether he bites again in 5 minutes, 5 hours or 5 months, repeat the same action. Stop the feeding, and tell him biting is not allowed as you put him down for a few minutes. Most babies want to breastfeed more than they want to bite, so this method usually works quickly.
Consider using breast massage and expressing milk, by hand or breast pump, for a minute or two if the baby tends to bite early in a feeding. Also, look at the breastfeeding to see if you may be offering too much solid food too fast or too many other liquids that may be causing a decrease in milk production. Call the baby's pediatric care provider and get her/his recommendations for treating the symptoms if an ear, nose or throat issue seems to be contributing to biting.
Reference:
Mohrbacher N & Stock J (1997). The breastfeeding answer book (rev. ed.). Schaumburg, IL: La Leche League International.
Breast feeding following breast augmentation mammoplasty (implanting saline-filled or silicone filled sacs under the surface of the breast) is sometimes possible. There are several things which will determine if you will be able to breastfeed your baby. You need to know the type of implant (available from the surgeon), and if there were any complications associated with the surgery or since the surgery. If you have an incision around the areola (the dark area surrounding the nipple) some of the milk ducts and nerves may have been cut which may result in a decreased amount of available milk. If your incision is under the fold of the breast or by the axillia, the implants have probably been inserted behind the milk ducts and will not affect milk production. If you have had complications, you will need to discuss this with the surgeon as well as your health care provider and the one you plan for your baby. It is important to choose your child's health care provider prior to delivery and discuss your plans to breast feed with them. The La Leche League has a page with information on nursing with breast implants.
Many women with reduction mammoplasty have breastfed. Some can fully breastfeed; others must partially breastfeed and also use some amount of supplement--how much depends on the situation. The individual woman and the extent, or type, of reduction surgery she has had determine which she is able to do. Before reduction mammoplasty, a surgeon should explain the possible effects the surgery could have on lactation/breastfeeding, so the woman can take that into consideration. If a surgeon is aware that a woman wants to optimize her ability to breastfeed in the future, it may be possible to do a procedure that leaves more gland (milk-producing) tissue in addition to keeping the nipple and areola attached to that gland tissue via a "pedicle" technique.
Breastfeeding is usually possible, even if some ducts were cut during the surgery. To fully breastfeed, there must be enough gland tissue still connected to open ducts so that milk can be made and then transported to the baby during breastfeeding. Fortunately, most breasts are capable of producing a lot more milk than they are "asked" to produce for a single baby, so many women are able to produce quite a bit of milk as long as there is a reasonable amount of gland tissue and attached ducts.
If many milk ducts were cut, or an important nerve was cut, or a lot of glandular tissue was removed during surgery, the ability to produce milk will be affected to some degree. Usually a new mother must "wait and see" to discover just how much breastfeeding is affected. Often a woman doesn't know if enough gland and duct tissue remain until she's breastfed her new baby for several days to a week.
It is very important that a woman be honest and let the baby's pediatric care provider, the postpartum nurses and the IBCLC (International Board Certified Lactation Consultant) know if she's had a reduction mammoplasty. Then health care providers can then watch her more carefully during breastfeeding for signs that the baby is "removing" milk from her breasts and they can watch the baby for signs that she/he is getting enough breast milk. If it becomes obvious that full breastfeeding is not possible, a mother may supplement during breastfeedings by using a feeding tube system taped to the breast. An IBCLC or other breastfeeding support leader would be able to help a mother with this. I would suggest consulting with an IBCLC or a very knowledgeable and experienced breastfeeding support leader, such as a La Leche League leader before a baby's birth.
It is possible for milk to become "trapped" in areas of gland tissue if this tissue is behind ducts that have been cut and so the area cannot "drain" during breastfeeding. In this situation, uncomfortable but localized engorgement can temporarily result. The use of ice/cold packs applied to those areas between breastfeedings or pumping sessions usually helps. Engorgement generally does not remain a problem, as the milk-producing cells in those areas soon "dry up" if ducts are not available to transport milk to the nipple. This does not affect the milk-producing cells in gland tissue that do have ducts available to transport milk to the nipple; those areas can keep producing milk just fine.
References:
Lawrence, RA & Lawrence, RM (1999) Breastfeeding: A guide for the medical profession (5th ed.). St. Louis, MO: Mosby.
Riordan, J & Auerbach, KG (1999). Breastfeeding and human lactation (2nd ed.). Sudbury, MA: Jones & Bartlett.
You should be able to breastfeed, although there is a possibility that some milk ducts or milk-producing tissue were damaged during the breast surgery. If damage occurred, it is unlikely that all tissue or ducts in that breast were affected. That breast may produce less milk, but lactation still could be established in all undamaged milk-producing tissue attached to undamaged milk ducts. Also, milk production in your other breast is unaffected.
When you become pregnant, pay attention to the development and changes in each breast. Let your health care provider know if there is much difference in development or if there is little change in the affected breast. You also may want to contact a certified lactation consultant (IBCLC) and a mother support group, such as the La Leche League group in your area, before your baby is born. They will have information that will help you know whether you are making enough milk for your baby and be able to provide ideas that may help you optimize your breasts' milk-making ability.
References:
Neifert MR (1999). Clinical aspects of lactation: Promoting breastfeeding success. Clinics in Perinatology, 26(2), 281-306.
Riordan J & Auerbach KG (Eds.) (1999). Breastfeeding and human lactation (2nd ed.). Boston: Jones & Bartlett.
Wilson-Clay B & Hoover K (1999). The breastfeeding atlas. Austin, TX: LactNews Press.
It is a good idea to avoid introducing a bottle until a baby has demonstrated that she/he can consistently latch-on and suckle effectively at the breast and milk production is well established. It usually takes about 2-3 weeks for a baby to learn to consistently breastfeed effectively and for a mother to establish appropriate milk production. So, wait at least three weeks if you can. By then most babies have developed good breastfeeding patterns and are unlikely to become confused when occasionally offered something other than the breast. It may take a little longer if a baby has a slow breastfeeding start after birth.
If you introduce a bottle at some point, a slow-flow nipple/teat on any bottle may be a better choice for breastfed babies. These teats usually state "slow flow" on the packaging. Many mothers recommend the Avent bottle system - a "slow flow" variety is available and a baby "latches" onto this teat in a way that is more similar to the breast than with many other bottle teats. However, other slow-flow brands also work. To test a teat for slow flow, put water in a bottle and tip it at the angle used for feeding. Between drips from the teat, you should be able to slowly count to at least "three."
To avoid confusing an infant, optimize the benefits of breast milk and maintain adequate milk production, keep supplementary bottles to a minimum. Be sure to breastfeed (and/or pump with a hospital-grade, electric breast pump) at least 8 times in 24 hours for your baby's first several months. Research indicates that introducing too many bottles too soon is associated with early weaning from the breast and inadequate breast milk production.
Last Reviewed: Jun 17, 2002
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Tina Weitkamp, RNC, MSN Associate Professor of Clinical Nursing College of Nursing University of Cincinnati |
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Karen Kerkhoff Gromada, MSN, RN, IBCLC Adjunct Clinical Instructor Parent Child-Health Nursing Department College of Nursing University of Cincinnati |
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