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86 4.1 Milk Feeding
Monitoring Breastfed Infants ●● examine the infant, noting general appearance,
including the tongue
Frequent weighing of breastfed infants is no
longer recommended as small or no discernible ●● check the infant’s weight gain and growth chart
weight gain can be distressing for parents and
cause them to give up breastfeeding. Small gains ●● take note of the number of wet nappies and stool
in weight can easily be masked by a change in frequency and colour
fluid content: an infant with a full bladder can
weigh up to 200 g more than after emptying his or ●● observe a feed and assess positioning and
her bladder. attachment, noting jaw action, swallow, length
of feed and infant’s behaviour, and listening for
A breastfed infant who is feeding adequately audible swallowing
will:
●● examine the mother
●● be alert, responsive and healthy in appearance
●● ask about family life and the mother’s
●● take a minimum of six feeds in 24 hours during responsibilities in addition to her infant.
the day and night
Sore or cracked nipples
●● have at least six wet nappies in 24 hours
Sore nipples are usually due to poor attachment
●● have at least two yellow stools daily. and the pain should decrease when attachment is
improved. However, in some instances sore
Overcoming Breastfeeding nipples may be due to thrush or Reynaud’s
Problems and Difficulties syndrome.
Many mothers need support to continue Thrush, or Candida albicans, is a fungal
breastfeeding and when discharged from the infection that often follows the use of antibiotics to
maternity unit they should be given (NICE 2008b): treat mastitis or other infections. The skin may
become sore and itchy. Both mother and baby may
●● contact details of breastfeeding counsellors they be infected and should be referred to the GP for
can contact for help and support with treatment.
breastfeeding in case they encounter problems
Some women’s nipples become blanched due
●● information on local peer support groups since to lack of blood supply, known as Reynaud’s
it has been shown that breastfeeding mothers syndrome. There is no ready cure for this but
who are in contact with other breastfeeding heat treatment and feeding in a warm room may
mothers continue breastfeeding for longer. help.
The majority of breastfeeding problems are directly Cracked nipples may follow from poor
or indirectly attributable to incorrect attachment attachment. Mothers should be encouraged to
of the infant to the breast. Even if the attachment continue breastfeeding, as with improved
appears good, it can usually be improved. attachment nipple pain should lessen considerably
after about the first 20 seconds of feeding. Nipples
To assess breastfeeding problems the healthcare will then begin to heal.
practitioner should:
Occasionally, cracked nipples may bleed and the
●● take a breastfeeding history – going back to the infant may posit or vomit bloodstained milk.
birth if necessary Ingesting blood is harmless for the infant and there
is no cause for alarm.
●● ask about a typical feed
Engorgement
●● ask about a typical day, including feed frequency,
behaviour in between feeds, including the sleep Engorgement occurs when the breast becomes full
pattern of milk and the blood and lymph flow slows and
