Common Breast feeding problems may be broadly divided into three categories

I) breast and nipple problems,

II) partial or complete lactation failure, and

III) Breast feeding problems in special situations like sick mother, sick baby or working mother.

I) Breast feeding problems & nipple problems are very common and often used as an excuse to start top-feeding, despite adequate milk output. These problems are more common in primipara mothers and include —

a) Flat or inverted Nipples, which do not project easily, prevent proper attachment of baby to the breast thus leading to Breast feeding problems. Antenatal breast examination is the ideal avenue to identify these problems, which may be managed by — a) nipple-stretching exercises, b) use of a breast pump to pull the nipple out before every feed, or c) syringe method.

Syringe method is a simple suction device, prepared by cutting the nozzle end of a syringe and inverting its piston. When the smooth end of syringe is pressed against the nipple and piston is pulled gently, the inverted nipple pulls out of the breast tissue. This should be done before each breast-feed to avoid Breast feeding problems.

b) Sore Nipples are painful, tender nipples with or without cracks or bleed, caused by — a) wrong attachment of baby on the breast, b) forcible separation of baby while sucking, iii) repeated washing of breasts with soap solutions before feeds, iv) local fungal infections (thrush).

Sore nipples are managed by proper attachment of baby, starting each feed on the less- affected breast, application of hind-milk on the nipple as emollient, and d) local anti-fungal treatment, if necessary.

c) Breast engorgement indicates inadequate expression of milk despite adequate production, leading to hard, painful, warm and swollen breasts. It is usually caused by infrequent Breast feeding due to — a) delayed initiation at birth, b) maternal/neonatal sickness or c) painful breast and nipple conditions.

Most of these cases are self-limiting and can be prevented or managed by — a) frequent demand feeding, b) frequent expression of milk, if baby! Mother is sick, and c) local hot-water compresses to relieve pain.

d) Breast Abscess (mastitis) may develop due to infection of engorged breast, with cracked nipple as a portal of entry for infection causing Breast feeding problems.

These cases are treated with — a) antibiotics and surgical drainage, b) symptomatic therapy with analgesics & hot compresses (breast massage should be avoided), and c) frequent expression of BM, which may than be fed to the baby.