37-41 IS IT NORMAL FOR AN INFANT TO LOSE WEIGHT AFTER BIRTH?
Yes. Most breast fed infants will lose weight for the first few days after birth due to the small volume of breast milk being produced. Colostrum, however, will meet the infant's nutritional needs. Once the milk "comes in", between days 3 and 5, the infant will start to gain weight. Most breast fed infants regain their birth weight by day 7. This weight loss is normal and does not cause the infant any harm. The normal infant does not usually lose more than 10% of the birth weight. Marked weight loss suggests that the infant is ill or not getting enough milk.
37-42 IS IT NECESSARY TO WEIGH A NORMAL INFANT EVERY DAY?
No. The normal infant should be weighed at delivery and again on days 3 and 5 if still in hospital. Weight at discharge must be recorded. At every clinic visit the infant's weight should be measured and recorded. Ill infants should be weighed every day until well.
37-43 HOW CAN YOU IMPROVE A MOTHER'S MILK SUPPLY?
- Reassurance, support and encouragement that she will be able to breast feed. Also ensure that she is getting enough sleep and is not under too much stress, as anxiety is a major cause of poor milk production. Anxiety also inhibits the let down reflex. Many mothers are more relaxed in their own homes.
- Make sure that she is fixing the infant correctly to the breast and that the infant is sucking correctly.
- Put the infant to the breast frequently during the day until a good milk supply is established. If the infant is not demand feeding 3 to 4 hourly, it should be woken for feeds. The best stimulus to milk production is the infant sucking frequently and for prolonged periods.
- The mother should rest for a while in the afternoon and drink adequate fluids.
- Stop any bottle feeds.
| THE BEST STIMULUS FOR MILK PRODUCTION IS FREQUENT FEEDING |
37-44 SHOULD INFANTS BE ROUTINELY TEST WEIGHED?
No, there is no need to test weigh all infants. The amount of milk an infant takes varies widely between feeds. A small feed, which is common in the afternoon or when the mother is tired, may cause maternal anxiety. Test weighing may be useful to assess a mother's milk production if the infant does not gain weight.
37-45 SHOULD THE INFANT ALWAYS FEED ON BOTH BREASTS?
It is best to empty one breast first before putting the infant to the opposite breast. This ensures that the infant gets the rich hind milk. Start each feed on alternate breasts. However, for the first few days it is useful to allow the infant to feed on both breasts to stimulate the milk production.
37-46 WHAT SHOULD YOU DO IF AN INFANT REFUSES THE BREAST?
Some infants may reject the breast and refuse to fix on the nipple and suck. Common causes are a sore mouth due to thrush, the infant being ill or upset, or the milk flow being too fast. These problems should be looked for and treated.
Do not hold the infant's head too tightly or push the face towards the breast, as the infant will turn towards your hand instead of the nipple. It may help to squeeze a little breast milk onto the nipple before placing it in the infant's mouth.
37-47 WHAT MAY CAUSES AN INFANT TO CHOKE WHILE FEEDING?
During the first few weeks the mother may have a lot of milk and the milk may flow too fast causing the infant to choke or gag when feeding. As a result the infant may refuse to feed or overfeed and become restless. It may help for the mother to lie back at the start of the feed with the infant across her chest so that the milk has to flow upwards against gravity. The mother may have to express a bit before starting the feed, or feed the infant more frequently. Too much milk and milk that flows too quickly settles with time.
37-48 HOW SHOULD YOU MANAGE SWOLLEN OR PAINFUL BREASTS?
A normal, full breast feels tense and heavy, but is not painful and any discomfort is relieved by feeding. Breasts that are swollen, tender, hard, lumpy and painful are caused by either engorgement or mastitis. Both engorgement and mastitis result from an obstruction in milk flow:
- ENGORGED BREASTS
Both breasts are swollen, hard and painful but the mother does not feel ill. The milk does not flow freely. Engorged breasts usually occur between days 3 and 5 when the mother's milk suddenly "comes in". Engorged breasts are common if the infant does not room-in and if the mother does not demand feed.
Treatment consists of emptying the breast by expressing or allowing the infant to suck. The infant should be fed on the most painful breast first. Sponging the breasts with warm water or standing under a warm shower relieves the discomfort, while a mild analgesic like paracetamol (Panado) is helpful. Often the infant is not able to fix correctly if the breast is engorged as the nipples become flattened by the swelling. If some milk is first expressed from the breast, the infant will usually fix well. Breast engorgement should be prevented by frequent feeds.
- MASTITIS (milk fever)
Mastitis is an inflammation of the breast due to infection in blocked milk ducts. It causes a swollen, painful, red area of one breast. The mother feels ill and may have a temperature.
Treat with rest, warm compresses and a mild analgesic. It is most important that the infant continues to suck frequently on the affected breast, as this will help the milk to flow. Altering the feeding position often helps to drain the affected area. Mastitis is not dangerous for the infant. If the signs and symptoms do not improve within 24 hours an antibiotic (penicillin or cloxacillin) should be prescribed for 5 days. If a fluctuant mass develops then a breast abscess has formed. This should be surgically drained. Due to the pain of a breast abscess, feeding may have to be stopped on that breast for a few days. If possible, feeding can be continued however.
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