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Dx Breast feeding and Difficulties/ Treatments:

Breastfeeding and Difficulties

The Merck Manual Home Edition
"A normal newborn has active rooting and sucking reflexes and can start feeding right away, so doctors recommend placing the newborn at the mother's breast immediately after birth. If this is not done, feedings are begun at least within 4 hours after birth.

Most babies swallow air along with the milk. Babies usually cannot burp on their own, so a parent needs to help. Babies should be held upright, leaning against the parent's chest, with their head against the parent's shoulder, while the parent pats them gently on their back. The combination of patting and pressure against the shoulder usually leads to an audible burp, often accompanied by spitting up of a small amount of milk.

Although babies may be fed breast milk or formula, doctors recommend exclusive breastfeeding for at least the first 6 months. However, breastfeeding is not always possible (for example, if the mother is taking certain drugs), and many healthy babies have been raised on formula feedings.

Benefits of Breastfeeding:
Breast milk is the ideal food for newborns. Besides providing the necessary nutrients in the most easily digestible and absorbable form, breast milk contains antibodies and white blood cells that protect the baby against infection. Breast milk favorably changes the pH of the stool and intestinal flora, thus protecting the baby against bacterial diarrhea. Because of the protective qualities of breast milk, many types of infections occur less often in babies who are breastfed rather than bottle-fed. Breastfeeding also seems to protect against the development of certain chronic problems, such as allergies, diabetes, celiac sprue, and Crohn's disease.

Breastfeeding offers many advantages to the mother as well. For example, it helps her to bond and feel close to her baby in a way that bottle-feeding cannot. Mothers who breastfeed have a quicker recovery time after delivery and have some long-term health benefits, such as decreased risk of obesity, osteoporosis, breast cancer, and ovarian cancer. About 60% of mothers in the United States breastfeed their babies, and this proportion is steadily increasing. Mothers who work may breastfeed while at home and have the baby bottle-feed pumped breast milk or formula during the hours they are away. Most doctors recommend giving daily vitamin D supplements to breastfed infants after 2 months of age.

A thin yellow fluid, called colostrum, flows from the nipple before breast milk is produced. Colostrum is rich in calories, protein, and antibodies. The antibodies are absorbed directly into the body from the stomach, protecting the baby against many infections.

The mother should take the baby, especially a first baby, to the doctor 3 to 5 days after delivery so that the doctor can find out how breastfeeding is going, weigh the baby, and answer any questions. A doctor may need to see the baby earlier if the baby was discharged within 24 hours, is not feeding well, or if the parents have a particular concern. Because mothers cannot tell exactly how much milk a baby takes, doctors use frequency of feeding and weight gain to tell whether milk production is adequate. Babies that are hungry and feed every hour or two but fail to gain weight appropriately for their age and size are probably not getting enough milk."

Medications/ Treatments Used in Treatment:
1. Syntocinon: While use of oxytocin during the last stage of labor is associated with more babies withdrawing from breast feeding at 3 months, the long-established used of synthetic oxytocin nasal spray to encourage breast feeding has been found of no value.
2. Nipple stimulation with an increased central release of oxytocin. A research case study showed that the nipples are conduits to the hypothalamus release of oxytocin. Further data will be forthcoming.

*[Editor] It is recognized that the sucking process of nipple stimulation by the infant stimulates a reflex release of oxytocin from the brain. The oxytocin stimulates the breast to release milk.

But for some, the process of lactation is not successful. Research by the Editor has found that there is a chemical that can be applied to the nipple that amplifies the release of oxytocin in the brain and can 'jump start' lactation. While only a third of African-American and Hispanic mothers are nursing their infants at 3 months, the number is almost twice greater in the Caucasian population. While this appears to be cultural, an effort to improve the bonding of mother and infant through nursing should be pursued.

*[Editor] Retrophin signs US licensing agreement to bring Syntocinon back in 2014.

*[Editor] The Cochrane database reported in 2000 that sublingual and buccal oxytocin was somewhat effective.

*[Editor] Our recent research has suggested that a topical nipple preparation may be able to induce the spinothalamic neurons to stimulate the hypothalamic release of oxytocin and increase milk letdown. The application may be needed for just a few days and discontinued once effective nursing has been established. Physicians investigators interested in a clinical trial should contact Edward Lichten, M.D.

Editor]: Reference Article Domperidone for Lactation: What Health Care Providers Need to Know. Ob Gyn 2017 Jun; 129(6): 1054-5.
"domperidone is not approved in any country for lactation enhancement. Domperidone is associated with serious cardiac arrhythmias. The U.S. Food and Drug Administration (FDA issued an import alert in 2004, updated in 2012, explaining that the importation of domperidone is illegal with limited exceptions." Copyright® 2014