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When to Call the Doctor


Robyn's Nest Related Topics:
Common Problems - Breast Feeding
Home Remedies - Engorgement Relief

The following breast-feeding situations and conditions need extra assistance, counseling and sometimes medication to remedy. The sooner one gets professional assistance, the better. The reason is that they often can be treated immediately to avoid further complications. If you have any doubts about the methods suggested here, or by your doctor, please call a Certified Lactation Consultant. They can also assist with medication questions.

Poor Sucking, Disorganized, Not Interested
Pain, Plugged Ducts and Mastitis
Breast Abscess
Infant Vomiting/Diarrhea
Infant Weight Loss
Post-Partum Depression
Fussiness and Colic
Breast Lesions, Lumps and Blisters
Nipple Variations
Elongated or very large nipples

Baby is a poor sucker. Often this does not extend past 24 hours after birth but if it does, the doctor or lactation consultant needs to look under the baby's tongue for a shortened frenulum. If it is normal, baby needs to be taught to suck and a lactation consultant should be contacted. If mom is uptight and anxious this can affect the comfort level of the baby. It is important to relax, provide lots of skin to skin contact, rocking and even singing. Sometimes it takes 2 to 3 days for baby to wake up and really get interested in the world. Of course, there are other medical or physiological conditions in both the mother and the baby, which could affect the suck reflex. These are very rare but would need to be diagnosed by a doctor.

There is also the older baby who goes on a nursing strike but that would be very unlikely during the first three months of life.

Pain, plugged ducts and mastitis are painful and unnecessary. Breast pain can come from a baby who sucks like a strong vacuum cleaner. It can also happen if mastitisbaby misses a feeding and the breasts are very full. Shooting pain just after nursing is thought to be related to the breasts filling again. This will disappear. Pain that doesn't go away while nursing an older baby, could be thrush, a yeast infection that needs to be seen by a doctor. This is more common with nursing mothers who have diabetes. Look inside baby's mouth for white spots on the tongue or cheeks. If they are present, call for a doctor's appointment.

Plugged ducts usually begin as a sore area on the breast and/or nipple and may be accompanied by fatigue and the beginning of flu-like symptoms. Diabetic nursing moms are also prone to this problem and need to always be on the alert for the plugged duct symptoms. Moms with high milk production such as mothers of twins, moms who have skipped feedings, are stressed, fatigued and/or dehydrated are also at a higher risk of plugged ducts. Remember that the plug needs to be removed and your baby is your best pump to do the job.


           -   Take off your bra if is constricting or tight fitting

           -   Go to bed with baby to rest without delay

           -   Nurse primarily on affected side, baby's chin toward lump if necessary

           -   Use warm compresses on the affected side.

           -   Drink a cup of water or more per hour

           -   Pay the baby-sitters double if you have to. It will be well worth it. (I speak from experience.)


Mastitis is a breast infection that can result from not doing the above, or it may be from the introduction of a bacteria into the breast from the nipple. Far too many mothers suffer from this simply because they do not know preventative measures such as avoiding the above causes, not changing breast pads, are severely anemic or stop nursing suddenly. Add to the above symptoms nausea and vomiting and a red swollen breast that is painful to even look at, let alone touch.


           -   Do all of the above for a plugged duct

           -   Take extra vitamin C if you wish, up to 1000 mg 4Xday

           -   If there is no improvement in 24 to 48 hours, go to your doctor without delay

           -   Do not stop breast-feeding or pumping. The tissues are infected, not the milk.

A breast abscess could develop if mastitis is not mastitistreated properly. This is rare but has been treated without cessation of breast-feeding. The abscess is a lump that remains after mastitis and after nursing. It may be hard or soft and needs to be drained surgically. Antibiotics will be prescribed and mother may have to pump on the affected side while it heals. Then resume nursing both sides. Remember to watch for signs of yeast infections with antibiotic use. Eating yogurt while taking antibiotics may prevent yeast infections.

Vomiting and diarrhea are always concerns because baby may be getting dehydrated. Is baby losing weight, irritable, colicky or lethargic, wanting to sleep more than usual? Look at the top of baby's head for the soft spot to see if it is sunken in a little. Count wet diapers. If there are less than 6 wet ones and there are greenish bowel movements running out of the diaper, then call the pediatrician as soon as possible. Vomiting may be a sign of just having taken in too much milk if there are no other symptoms and baby is eliminating well. If it continues, however, either baby is allergic to something in mom's diet or he may have reflux which tends to resolve itself after a few weeks, or pyloric stenosis, a reversible condition that develops at about two to four weeks. A pediatrician needs to diagnose and treat this as soon as possible before baby gets very sick. These are much more common in bottle fed infants. (See Vomiting and Diarrhea)

Baby will need all the good nutrition from mom's breast milk during and after this time for proper recovery. Even partial breast-feeding reduces the severity and duration of the illnesses. Because it is so quickly digested, baby will benefit from nursing even if the milk stays down only 10 to 20 minutes. Nurse small amounts often.

Infant Weight loss is normal only in the first week. If there is no steady weight gain after that, and baby is not waking well to feed, then parents need to intervene. Try the suggestions below for 24 to 48 hours.

           -   Wake the child every two hours to nurse.

           -   Note how long baby feeds on each side. Less than 10 minutes is not enough. Keep baby awake to increase the time and nurse on both sides.

           -   Count wet diapers. Is there less than 6 to 8 in 24 hrs?

           -   Is baby positioned correctly, tummy to tummy, nipple going straight in?

           -   Is a mom comfortable using pillows to position and support?

           -   Is mom eating properly and drinking enough fluids?

           -   Try massaging the breast, gently moving milk toward the nipple while baby is nursing. Massage mom's back between the shoulder blades.

           -   If baby is still a disorganized nurser, in spite of all the right corrections, it is time to get special help from a lactation consultant who can visit and do a full assessment and recommend the next step.

           -   If a doctor is needed, the LC can refer baby for a more comprehensive assessment.

Depression with tears and temporary sadness seems to be more common on the third day after giving birth than at any other time. These are the "baby blues" and soon disappear. The second type called post-partum depressiondepression affects about 20% of new mothers for no particular reason and can be mild to moderate in severity. It is fatigue, lack of sleep and mood changes more than hormonal changes. This is thought to be associated more with the lack of maternal support, high levels of stress and lack of support of a partner than anything physically wrong. Fatigue may also play a big role.

The third kind is 1 in 1000 and is a psychotic depression or psychosis, beginning about 2 to 14 days after delivery and peaking about 6 weeks. It is extremely hard on the whole family, compounded by the medications prescribed that may contraindicate breast-feeding. This adds to the mother's feelings of failure and depression. Mom needs a support system and the family should utilize counseling services as soon as possible to prevent more problems.

See: The Baby Blues for more information.

Fussiness and Colic are some of the most frustrating situations a parent has to face. Young infants don't distinguish their "wants" from their "needs". Every time baby cries there is a real need and someone has to respond to that need for the baby to learn to trust that someone loves him or her enough to come and help. This is essential. A young baby cannot be "spoiled" with this kind of attention. Colic is a condition that occurs for a number of reasons and sometimes for absolutely no discernible reason at all. Baby screams with a high pitched cry, in pain. It occurs once or twice a day, usually about the same time each day. With some, it happens after feedings and gradually goes away after 3 or 4 months. If baby is breast-fed you can try the following.

           -   Eliminate dairy products from mom's diet for a week, reintroduce slowly over the next month or two

           -   Don't eat large amounts of any one food, drink or spice

           -   Feed more often, every 2 to 3 hours, emptying the breasts

           -   Don't let baby cry until it is time to nurse

           -   Check the nursing position at the breast to eliminate the swallowing of air

           -   Burp more often

           -   Stop smoking

           -   Swaddle baby

           -   Take baby for a car ride

           -   Sit in infant seat on spinning washing machine or dryer (never leave a baby unattended)

           -   Give baby a warm bath

           -   Try giving a pacifier

           -   Put baby on the abdomen on a warm "hot" water bottle

           -   Relax yourself, get out, pamper yourself, exercise, call someone

For more information see Colic and Crying.

Lesions, lumps and blisters are usually a sign that it is time to see a doctor. These are probably treatable and totally curable, but should be assessed by the doctor. There is usually no reason to stop nursing during this time.

Nipple variations do not eliminate breast-feeding in most cases. For instance, the flat or inverted nipple may protrude beautifully when in the baby's mouth. It may be more difficult to get baby started, however, and a lactation consult may be needed. One or more of the following may be tried:

           -   Wearing breast shields or shells

           -   Exercise the nipple/areola area to stretch the adhesions behind the surface

           -   Apply something cold to the nipple just before nursing

           -   Use a breast pump to stretch and pull out the nipple just before putting the baby on to nurse

Elongated or very large nipples may cause more of a problem, especially if the infant is small. When the tip is too long, baby may continue to slide off, trying not to gag, and thus cause sore nipples. If it really is a problem, mom could fall back to pumping often bottle-feeding until baby is older and more capable of handling the size of the nipples. Then re-introduce the breast-feeding.

Robyn's Nest Related Topics:
Common Problems - Breast Feeding
Home Remedies - Engorgement Relief


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Breast Feeding When to Call the Doctor


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