Tuesday, August 4, 2020

Pathology related to Breastfeeding

Breastfeeding has been playing an important role for the development of infant since ages. According to WHO and AAP, Breastfeeding is the normal way of providing young infants with nutrients they need for healthy growth or development. Scaling up breastfeeding could save lives of more than 8,20,000 -children under the age of 5. It could lower the rates of allergies, Ear -Lung Infection , Obesity , Sudden Infant Death ,Necrotizing Enterocolitis And associated sepsis .Not only it could be beneficial for the infant but also for the mother because it could reduce the chances of uterine bleeding , burn calories , reduce the risk of breast / ovarian / uterine cancer , osteoporosis , Arthritis , Type II Diabetes mellitus and Heart Disease. Initially the breast releases colostrum which has high content of immune cells and antibodies, a much lower fat content and also acts as a laxative to pass out the first stool meconium. But there could be several problems associated with breastfeeding. I would like to list down a few of them-

1. DIFFICULTIES FROM LATCHING INTO THE BREAST – A good latch promotes high milk flow and minimizes nipple discomfort for the mother whereas a poor latch results in poor milk transfer to the baby and can quickly lead to sore and cracked nipples.

2. CRACKED NIPPLES- A shallow latch or Thrush (Candiasis) or Dry skin around The Areola could be the general causes. Cracked nipples could be a little frightening and uncomfortable at the beginning and could be associated with some bloody discharge. Treatments for this could be application of Soothing Gel pads, nursing ointments or painkillers like Acetaminophen (Tylenol).

3. ENGORGEMENTS OF BREAST- A sense of breast fullness or heaviness within 36 hrs. of delivery. The increased blood supply, accumulated milk and swelling all contribute to painful engorgement. Engorgement may affect the areola, the periphery of the breast or the entire breast and may interfere with breastfeeding both from the pain and also from the distortion of the normal shape of the areola / nipple. This makes latching a daunting task for the baby.  The possible treatments could express or pumping. Gentle massage or pressure could soften the areola. Application of cold compresses to reduce the swelling pain and vascularity even more. One published study suggested that the use of Chilled Cabbage leaves could produce mixed results. Acetaminophen could relieve the pain too.

4. MILK STASIS- When alveolar and lactiferous ducts are blocked and cannot drained properly. This can be treated by varying the baby’s feeding position and applying heat before feeding.

5. MASTITIS- Inflammation of Breast in Association with dolor, rubor, tumor and calor. This could be due to Primary causes as in milk stasis or secondarily with infectitious organisms such as Staphylococcus sp., Streptococcus sp., and E-Coli. Continued Breast feeding, plenty of rest and fluid intake could possibly cure such conditions.

6. Dysphoric Milk Ejection Reflex (D – MER)- A newly recognized condition affecting lactating women that is characterized by abrupt dysphoria or negative emotions that occurs before milk release. The possible cause may be due to inappropriate dopamine activity at the time of milk ejection reflex.

7. INVERTED NIPPLES- A condition where the nipple instead of pointing outwards, is retracted back into the breast. The etiology to these conditions might be due to 
• Fat necrosis
o Breast Carcinoma 
o Inflammatory Breast Cancer 
o Paget’s Disease
o Mammary Duct Ectasia 
o Breast Abscess
o Mastitis
o Weaver Syndrome
o Kennerknecht – Sorgo – Oberhoffer Syndrome

8. RAYNAUDS OF THE NIPPLE/ NIPPLE BLANCHING- Can be caused by vasospasm of the nipple. Blood does not flow properly to the nipple which causes the nipple to blanch. This could be due to early breastfeeding or candidal infection of the nipple. There could be associated throbbing pain in between the breastfeeding sessions when the nipple is blanched.  In some instances, heart medication nifedipine is used to help flow of blood to the nipples.

9. TONGUE TIE/ANKYLOGLOSSIA- This condition is present at birth that restricts the range of motion of the tongue. With tongue tie an unusually short, thick and tight band of tissue (lingual frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth so it may interfere with breast feeding. It could also affect the way a child eats, speaks and swallows.

10. POSTNATAL DEPRESSISON- Many women feel a bit down, tearful or anxious in the first week after giving birth. Symptoms might include insomnia, a persistent feeling of sadness and low mood, loss of appetite, intense irritability and difficulty of bonding with the baby.


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