LACTATION FAILURE

LACTATION FAILURE 

Definition

Lactation failure is failure in the part of the breasts to produce adequate quantity of milk which manifests as failure to sustain growth in a normal infant within2 standard deviations of the standard for the infant in the first 6 months of age. Complete LF means total absence of milk flow or secretion of only a few drops of milk following regular suckling for a period of at least 7 day. Partial LF means insufficient milk flow by the mother who is otherwise regularly breastfeeding her baby so that the infant needs supplementation by artificial feeding for sustaining growth.

Etiology

LF is usually not the cause, but a consequence of a number of factors which are responsible for introduction of top milk under the following notion of “not enough milk”, or because of maternal-child separation, working mothers, sore/ cracked nipples, etc.

Etiology of lactation failure

Maternal factors: Psychosocial lack of motivation/confidence/will, dislike of BF because of wrong notions, stress and anxiety, rejection of baby, previous unpleasant experience, undue concern for figure, aping the west, influence of advertisements favoring breast milk substitutes.

Physical: Breast conditions, e.g. nipples that are retracted, cracked or sore, painful conditions, e.g. mastitis, engorgement or abscess, malnutrition, sickness, pregnancy, contraceptive pill, alcoholism, smoking, working mother.

Infant factors

Sick infant, prematurity, suckling problem, e.g. cleft palate, nasal block, oral thrush

Feeding factors: Prelacteal feeds, delayed initiation, poor technique, introduction of bottle

Prevention

The most important preventive measures are through antenatal check-up of the breasts, antenatal preparation of the mother for breastfeeding, feeding as early as possible after delivery, remedial measures or anatomical defects in the breast and complete emptying of the breasts. If necessary, even manual expression of milk following feeds may by done. Most of lactation failure can be prevented if the pediatrician forms a part of the team for the antenatal care, and the breasts of every expectant mother are carefully examined.

Treatment

Metoclopramide and chloropromazine may help certain mother with lactation failure to revert to normal milk production through their galactagogue effect. Nevertheless, remember, the best galactagogue is indeed the frequent suckling.

Relactation in partial lactation failure

Satisfactory relactation in these mothers is attained by motivation and encouragement. They need to be educated in the supremacy of breast milk and actively involved in achieving success with “commitment for the cause”. As the days ass by, the amount of top feed needs to be reduced in increments until the infant is entirely of mother’s milk.

Relactation in complete lactation failure

This is rather more difficult situation. In addition to motivation, encouragement and moral support, the following actions are warranted

1. Nipple stimulation exercises by nipple stroking, massaging the breast and rolling the nipple between thumb and the index finger.
2. Frequent suckling , at least 8 to 10 times a day, each session lasting 10 to 15 minute for each breast.
3. Drop and drip method may be employed if the infant fails to suckle for 8 to 10 minutes.
4. Method consists in expressing some breast milk or topmilk in a cup and gradually pouring it over as drops over the breast. As the drops slide over the nipple down into infant’s mouth, he is stimulated to suckle at the breast.
5. Nursing supplement may be used to induce suckling in the infant. This gadet consists of a fine infant feeding tube. The tube is employed as a drawing straw. It is made to pass from milk in a cup to the infant’s mouth. Its end is placed along with mother’s nipple so that the baby suckles at both the nipple and the tube is simultaneously. As he suckles when milk passes in to his mouth, the nipple gets stimulated, thereby enhancing the prolactin reflex which increases the milk production.

Evidence of successful relactation

1. Appearance of first milk secretion in 2 to 10 days.
2. Partial restoration of breastfeeding with reduction of top feed to half of the initial
3. Complete restoration of breastfeeding with total withdrawal of top feed
4. Satisfactory weight gain by the infant.