One of the first crises I see is within the first week, where weight is lost, but not regained. Acceptable weight loss is up to 10% of the baby’s initial birth weight. So for example if a baby weighs in at 3000 gm, we will accept 300 gm weight loss in the first week. Weight loss beyond 10% can lead to the large problem of the mother feeling guilty because she is having problems breastfeeding. The baby is having difficulty latching on; a lactation consultant is called in.

So many other nurses are involved in the mother’s initial care that she is bombarded with suggestions for different techniques and different approaches. And all consistently guilting her into feeling that she is compelled to breastfeed. Breast nipple confusion is of great concern, and so a lactation consultant will often ensure that the only other substitute to breast- feeding is by a dropper or a sipping cup or both.

My approach is a little bit less conservative. I have yet to see a confused baby when it comes to breastfeeding versus bottle-feeding. My approach is very simple. If the baby is failing to thrive and the mother is unable to produce enough milk, or the baby is unable to latch on to facilitate enough colostrum and breast milk in the first week, I have adopted something which I refer to as the 10-10-10 rule.

This allows the mother an alternative to both pumping and breastfeeding and essentially exhausting herself in that first week. This exhaustion often sets her up for instant failure. The 10-10-10 rule is simple in that the baby will feed 10 minutes on one breast, 10 minutes on the other breast and will be topped up with 10 minutes on a bottle with formula. This is hardly harmful for the baby and, as I have said, I have never seen any confusion occur. This ensures that the baby does gain weight and also allows the mother enough sleep time that her breast milk will come in. She will then be able to increase the amount of time the baby is on each breast and reduce the amount of time of the bottle feed over the course of one to two weeks. So what is Breast/Nipple Confusion? This is often a big concern for parents who are told to never confuse their baby by offering a bottle over the breast.

The idea is that once the baby is exposed to that evil bottle, she is going to get confused and turn to the bottle. I have yet to see this type of confusion. Now, don’t get me wrong: breast is best. But I have faith in the natural instinct of a baby to recognize mom by the smell of her breast milk. That same baby is going to choose the easier mode of the two and that is most often the breast. A baby turns to a bottle when the breast mode is not working, and this is usually a cue to switch over at this point. There are already far too many moms who are made to feel guilty over a hopeless situation, and the guilt should not be prolonged. Sometimes a baby can have a real hard time feeding from a bottle or breast because of a remnant of skin found under the tongue, called a frenulum. It is present in all of us, attached underneath the tongue at the back, but in some babies it extends to closer to the tip. These babies are quite literally tongue-tied. A minor procedure done by a pediatrician within a few days of birth cuts the frenulum to correct the tongue.

There is also an upper frenulum attaching the upper gum to the part just above the upper front teeth. This does not cause a problem with feeding but as the upper front teeth develop, a gap forms between the teeth, forming the ‘Madonna’ or ‘David Letterman’ gap. This truly is a cosmetic issue but again can be dealt with at an early age to avoid this look. Breast Engorgement (or Lack Thereof): As you begin to breast-feed, you are stimulating the nipples to send a message to the pituitary gland to release prolactin, the hormone that stimulates breast tissue to produce milk. The more the breast is stimulated with feeding the more milk is produced. But sometimes, in spite of all efforts to breast feed, milk just does not come in. If this happens, it’s worth renting an electrical pump as a excellent stimulant until the milk comes in. Another alternative is to take Motilium®, or domperidone maleate (not the drink), which is a gastrointestinal drug used to improve sluggish contractions of the bowels. This drug is safe for breastfed babies and causes no side effects but will cause breast milk production. If your situation is the opposite and you are engorged with too much breast milk, do not attempt to pump, as this will stimulate even more milk production. You can reduce the engorgement by expressing milk in the shower, or by ensuring sure that your baby is feeding well and with not too long a period between feeds. If you are not planning to breast feed, the best management is to bind your breasts with a tensor bandage. Do not to stimulate them with any breastfeeding or pumping.

The drug Parlodel® is available to turn off the release of prolactin and works well, although it has fallen out of use as it has a small incidence (~0.01%) of stroke, which is naturally a negative incentive. Mastitis: Mastitis is one of the most common infections seen in breast- feeding mothers and is due to stasis of milk within the breast milk ducts. It is characterized by redness and pain on the involved side.  Generalized fever and chills usually warrant a more aggressive ap