My ED consultant colleagues requested that we run a series on “feeding issues” in Paediatric Pearls as it forms a part of the ED trainees curriculum and is a common subject to come up in conversation with parents in the ED. It seems appropriate to begin the series with an article on breastfeeding problems put together by our breastfeeding counsellor, Jo Naylor, and one of the current paediatric trainees, Dr Sarah Prentice. Their full article is downloadable here and I have reproduced some nuggets in this month’s Paediatric Pearls newsletter and below.
| Breastfeeding adequately? | Inadequate milk intake? |
| feeding every 2 – 5 hours for 20 – 40 minutes | infrequent feeds |
| 3-4 wet nappies and changing stool by day 3 | continued urates and/or meconium after day 3 |
| pain free breastfeeding | painful feeds, ineffective sucking |
| weight loss < 10% | weight loss > 10% |
| baby settled between feeds | fretful, hungry baby |
Reminder: handout of local breastfeeding drop-in groups available here.
I intend to cover the following topics over the next few months (some of which have actually already been touched on in previous months): vitamin supplementation, formula milk, gastro-oesophageal reflux, starting solids, allergy, fussy eating, food refusal, dentition and use of bottles, healthy eating, obesity, eating disorders. Please do leave requests for other topics below.
A small study has been published on the efficacy of frenotomy for newborn babies with tongue tie who are having dificulty establishing breastfeeding and/or there is maternal nipple pain. http://pediatrics.aappublications.org/content/early/2011/07/13/peds.2011-0077.full.pdf+html.
My experience supporting mothers with breastfeeding when their baby has ankyloglossia is firstly get the positioning and attachment as good as it can be. If this doesn’t make a significant improvement to both the baby’s ability to suckle effectively and the mothers nipple pain, having a frenotomy done often will make a difference. I’ve also found that the longer this is left the harder it is to get babies to ‘relearn’ how to take the breast properly, especially if they’ve have been having expressed milk by bottle while trying to establish breastfeeding.
Whipps Cross guide to breastfeeding for Mums available: http://www.paediatricpearls.co.uk/wp-content/uploads/WX-Helping-your-baby-to-breastfeed2.pdf.
My daughter had tongue tie and couldn’t latch on. It was missed in the hospital (4 day admission) & I drove myself to exhaustion expressing & feeling like a failure for 5 weeks.
Hi jo Naylor my son has tongue tie and the procedure will be done at Royal London on the 3rd of November can you please get back to me if you are the same jo naylor that would be doing the procedure thanks regard Nurjahan begum
Hi Nurjahan. You will need to contact the Royal London directly. Jo kindly contributed to this website when she was working at Whipps Cross but she won’t be able to pick up messages from here. I wish you and your son well with the breastfeeding. Julia