Low Milk Production and Infant Weight Flashcards
Major reason given worldwide given for discontinuation of breastfeeding?
Poor infant growth due to poor milk production
Fully breastfed term infants lose about _____% of their birthweight in the first 72 hours
6-7%
Weight loss > _____% in the first 3-5 days is considered excessive
10%
Does mode of delivery influence weight loss?
Yes. Babies born by c section tend to lose more weight than babies born vaginally.
Stools that are not yellow by DOL 5 indicate what?
Baby is not taking enough milk, do further investigation
List some infant conditions that put the baby at risk for poor growth
- cardiac defects
- respiratory and metabolic disorders
- babies with down syndrome
- impaired suck for any reason
Important to rule out when parent reports low milk supply
unsubtantiated low milk production aka parents misjudge but actually have robust supply
Some secondary causes for insufficient milk production (full ability to produce milk, but external interference with establishment)
- delays in breastfeeding initiation
- suboptimal hospital practices
- sending baby to nursery at night
- delay feedings because of too many visitors
- formula supplementation for any reason
- baby with poor suck
- prolonged and unrelieved engorgement
- scheduled feedings
- working parent not expressing often enough
- nipple anomalies may impact baby ability to drain breast
- unsupervised use of nipple shields
- some medications can decrease supply
- Cigarette smoking
- nutritional factors (low b12, zinc, iodine, iron, protein)
Primary lactation insufficiency
- Alterations in lactation hormones or their receptors
- alterations in nutrient transporters
- combination of environment, genetics, diet
some risk factors for delayed lactation
- Primiparous mothers
- Increasing maternal age
- Gestation diabetes
- Excessive weight gain in pregnancy
- birth stress
- preterm birth
- SSRI usage in pregnancy
- retained placental tissue
- hemorrhage
primary physical causes of insufficient milk production
- Breast anatomy variations
- breast surgery
- Glandular hypoplasia
- Mastitis (usually reverses)
- spinal cord injuries
- preterm delivery
Primary physiologic causes of insufficient milk production
- Hypertension
- obesity
- insulin dysregulation
- thyroid dysfunction
- issues with prolactin secretion
- history of infertility/PCOS
Oxytocin and MER problems –> low milk supply
- any time the MER is chronically impaired, poor milk removal can lead to downregulation of milk production
- can be central (hypothalamic) or peripheral (breast)
typical daily weight gain first 2 months
20-40g/day (15-30g/day first two weeks) according to WHO weight velocity table
How much to supplement in the first 4 days of life if baby not feeding effectively
0-24hrs: 2-10ml
24-48 hrs: 5-15ml
48-72 hrs: 15-30ml
72-96 hrs:30-60ml
