When I chose to write this blog about dummies/pacifiers I was surprised to almost disappear down a research rabbit hole! This article considers the pros and cons of dummy use according to the available evidence, and I found there is a LOT of research to consider. Dummies or pacifiers have been used in various forms to settle infants for centuries. The dummies currently available are similar to those that have been available for decades.
Suckling without fluid transfer is called non-nutritive sucking (NNS). Non-nutritive sucking is considered a normal part of fetal and neonatal development. As early as 13–16 weeks gestation the fetus has started sucking and swallowing movements. These fetal movements are considered to be important precursors for the lifesustaining requirements of breathing and swallowing. Non-nutritive sucking is intimately related with the rooting reflex, which is the movement of the infant’s head and tongue towards an object touching its cheek. The object is usually the mother’s breast, but may also be a finger (parent’s or baby’s own) or a pacifier.
Non-nutritive sucking in infants is nearly universal and is considered normal. A variety of non-nutritive sucking habits exist, but thumb, digit and pacifier sucking are most common. Pacifiers/dummies encourage NNS – the immature front-back action of suckling.1
Some newborn babies demonstrate their own version of NNS by sucking their tongues or lips in utero. This habit established before birth can sometimes interfere with a baby’s ability to latch and effectively suckle at the breast, temporarily. “Suck training” on a parents’ finger can coaxe the babies tongue position forward, and when rewarded with small amounts of colostrum/breastmilk the baby discovers a more appropriate way of sucking which is more rewarding.
Concerns have been raised about the use of dummies and teats during breast feeding. Historically, the WHO Baby Friendly Health Initiative (BFHI) have strongly advised against the use of pacifiers and teats because it interferes with breastfeeding and significantly decreases duration of lactation. (BFHI Step 9). This advice was modified in 2018 in response to evidence-based research, to read: “Counsel mothers on the use and risks of feeding bottles, teats and pacifiers”.
The impact of pacifier use on breastfeeding has been the subject of numerous studies. The objective of one large study conducted in Argentina was to evaluate whether the recommendation to offer a pacifier once lactation was well established reduced the prevalence or duration of lactation. The population included 1023 mothers who were highly motivated to breastfeed whose newborns regained birth weight by 15 days. Mothers were randomly assigned to one of two groups: offering a pacifier, and not offering pacifier. The offering group received a package containing six silicone pacifiers, supplied by MAM
Babyartikel Gesmbh and not sold in Argentina. The study demonstrated that when mothers are determined to breastfeed for more than three months and they are successfully breastfeeding at two weeks the advice to use or not to use a pacifier does not affect breastfeeding. Results from four other randomised controlled trials also revealed no difference in breastfeeding outcomes in different types of pacifier interventions 2
There is little evidence that dummy use adversely influences breast feeding development in pre-term babies. The literature indicates benefits of using nonnutritive sucking with infants who are premature. Non-nutritive sucking benefits preterm babies in terms of successful transition to oral feeding and quicker discharge home. Note – this does not necessarily refer to breastfeeding, and may in fact refer to oral feeding via bottle and teat 3.
Providing NNS using a pacifier has shown to reduce babies’ distress during painful medical procedures. Likewise, a landmark study “Pacifiers and Sudden Infant Death Syndrome” carried out in 1993 first showed the connection between SIDS and pacifiers, specifically, the reduced risk of SIDS if a pacifier had been used.
This was supported by eleven further case-control studies which compare a treatment or intervention group with a group which have not received the treatment. These studies showed the risk of SIDS was reduced by approximately 50% if a pacifier was used. Additional meta-analyses (which analyse the results of multiple studies) also reached the same conclusion. Interestingly, the use of a pacifier at the onset of sleep appeared protective, even if the pacifier falls out of the mouth after the infant falls asleep.
How are pacifiers protective in the sleep environment? One recent study suggests that pacifiers lower the auditory arousal threshold, and they may provide a mechanical barrier to rolling over into the prone position. Sucking on a pacifier keeps the tongue forward maintaining upper airway patency. An infant who is soothed by a pacifier may not move as often during sleep, thus limiting the chance of becoming covered by blankets. It has also been suggested that pacifier use could lead to slight carbon dioxide retention and increase the respiratory drive4
So, the humble dummy might not be the demonic tool some clinicians warn parents must avoid. Common sense should have a place here, amongst the auspicious research. Like any tool, it is how it is used which determines its effectiveness, or otherwise. Dummies CAN be misused, for example, as a means of making baby wait longer between feeds aka “stretching feed times”. This is never appropriate. Regardless of whether baby is breastfed or bottle fed, babies should be fed when they indicate they are hungry.
Dummy use may suppress hunger cues, or parents may miss noticing baby’s cues which can lead to less frequent feedings, insufficient weight gains and reduced
actation in breastfeeding mothers. Breastfeeds may be cut short if the mother does not permit a period of non-nutritive suckling towards the end of a feed phase, and gives baby a dummy instead. This can result in baby failing to cue for further phases of the feed which could compliment the initial breastfeed phase by providing an opportunity to transfer some of the higher-fat, slower flowing milk which completes the breastfeed.
Missing or misunderstanding hunger cues can happen more easily in the first few weeks of baby’s life. These early days of apparently endless feeds and nappy changes are crucial for baby’s wellbeing, as well as stimulating the initiation and establishment of a mother’s breast milk supply. For this reason avoiding dummy use in the first few weeks is usually recommended by health professionals.
Pacifier use has been implicated as potentially contributing to increased risk of ear infections, particularly in older infants. However, other studies have not found evidence to attribute direct causality, with socio-demographic characteristics influencing results 5 Which leads to the next question: Which dummy shape is the best?
The quest to answer this led me even deeper down the research rabbit hole. A venture to internet shopping revealed a dazzling range of dummy choices. To keep it simple, there are 4 basic shapes on offer – orthodontic, cylindrical, butterfly and cherry shapes.
This is where the research got heavy. Really, heavy. The pro-orthodontic shape recommendations are underpinned by elaborate modelling experiments which calculate the forces exerted by various shaped dummies inside a simulated infant oral cavity. This research was conducted by orthodontic clinicians investigating the role of the pacifier as a potential cause of dental malocclusions. Their findings indicate the orthodontic shape is less likely to compromise development of the midpalatine suture, and maintains support of the transversal diameters of the premaxilla, reducing the risk of open bite.6 That’s my simplified translation!
However, nowhere in this extensive body of complicated dental research did I see any reference to pacifier/dummy use and breastfeeding efficacy or support – no human babies were used (or harmed) during this research. Additionally, when I viewed the full text version I noted “Competing interests” are recorded, relating to several US patents (Smilo and Tomy). Keeping this information in context, the effects of pacifier use on infants’ intra-oral development is significantly determined by the duration of its use. Most commonly parents are advised to eliminate use of dummies/pacifiers by 2 years of age to avoid potential detrimental effects on the child’s primary dentition (baby teeth).
Breastfeeding is associated with optimal oral and craniofacial development in infants7 The round “cherry” shaped dummy is most commonly recommended by breastfeeding clinicians, as it most closely resembles the (ideal) shape of a human nipple. The rounded shape encourages “cupping” of the sides of the tongue, which is consistent with the tongue action during suckling at the breast. During swallowing, the tongue naturally moves towards the back of the throat, and a rounded “cherry” shape enables a similar action during non-nutritive sucking. Conversely, some “orthodontic” shaped dummies can encourage a humping of the tongue and reverse tongue movement towards the front of the mouth. This tongue action is incompatible with breastfeeding.
The cylindrical shaped dummy is commonly used in neonatal settings, often introduced to counteract pain responses during medical interventions. The small diameter of the bulb tends to suit small and premature baby’s mouths.
I have not been able to find any research which demonstrates the rationale for the flat peg-shaped bulb of the Butterfly dummy. Dr Browns butterfly pacifier is marketed as being developed by a pediatric dentist to help prevent dental issues. The contoured shape of the shield curves away from baby’s nose and cheeks.
Regardless of the scientific research and artificial modelling, the method of feeding or the parents’ pre-baby plans – ultimately the baby decides. Many babies flat out reject all types of dummies. Trial and error may result in the baby declaring which dummy is acceptable, following multiple dummy purchases.
Here’s what I have to say about using dummies in my book “NewBaby101 – A Midwife’s Guide for New Parents” Dummies or pacifiers and bottle feeding with a teat are not recommended for breastfeeding babies because they alter the way baby uses his tongue, which can confound baby’s tongue action when breastfeeding. If you choose to have a dummy on hand, choose one with a round bulb end (cherry style). The “orthodontic” or flat/wedge shaped dummies encourage a sucking action which may encourage the back of the tongue “hump” which can be detrimental to baby’s suckling action at the breast.
Towards the end of a breastfeed baby may reduce nutritive suckling and revert to non-nutritive sucking as she drifts off the sleep. This normal transition is a legitimate part of the breastfeed, enabling the milk which is still moving from her throat to her stomach to be ingested gradually, and the comfort provided by the non-nutritive sucking enhances relaxation and the transition to sleep8
Here are some practical tips from The Raising Children’s Network 9 for everyday dummy use:
* If you’re breastfeeding, offer the dummy only when you can be sure your baby isn’t hungry – for example, after or between feeds. This helps to ensure that dummy-sucking doesn’t interfere with breastfeeding.
* Check the dummy regularly to see whether it’s worn or degraded. Replace the dummy if it’s broken or worn. Babies can choke on any loose bits. * Keep spare dummies handy. Your baby is sure to drop the dummy somewhere without you noticing, then get upset when they want it again. * Don’t dip the dummy in sweet drinks or sweet food like honey. This can cause tooth decay. * Don’t tie the dummy around your baby’s hand, neck or cot. This is a strangulation risk if the dummy chain or tie is long enough to catch around your baby’s neck.
Babies under 6 months should use dummies that have been sterilised. There are several ways to sterilise bottle-feeding equipment, which you can also use to sterilise dummies. From about 6 months, your child will be more resistant to infections. This means you need only to wash the dummy with soap and water, rather than sterilising it. Just make sure to squeeze out any fluid that gets inside. Choose a dummy that complies with Australian Standard AS 2432:2015 https://www.productsafety.gov.au/product-safety-laws/safety-standards-bans/mandatorystandards/baby-dummies-and-dummy-chains
An evaluation of the benefits of non-nutritive sucking for premature infants as described in the literature. C Hardy Arch Dis Child. 2009 Aug;94(8):636-40. doi: 10.1136/adc.2008.144204.
Socio-demographic associations with digit and pacifier sucking at 15 months of age and possible associations with infant infection. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood – PubMed (nih.gov)
Tesini, D.A., Hu, L.C., Usui, B.H. et al. Functional comparison of pacifiers using finite element analysis. BMC Oral Health 22, 49 (2022). https://doi.org/10.1186/s12903- 022-02087-4
Sanches MT. Clinical management of oral disorders in breastfeeding. J Pediatr (Rio J) 2004;80(Suppl 5):S155–S162. [PubMed] [Google Scholar]
https://www.NewBaby101.com.au
https://raisingchildren.net.au
This blog was written by Lois Wattis for Raising Mamas Sunshine Coast Mothers Group and first published in July 2023 https://www.raisingmamas.com.au
It has become commonplace for mothers to express their breastmilk to give to baby by bottle, or to freeze some extra breastmilk to store for later use. Pumping, and even “double pumping” has been popularised via social media and pump manufacturers’ advertisements, and embraced by mothers whose lifestyles or work commitments require baby to be separated from them for periods of time.
The ability to express quickly and conveniently, even while away from baby can certainly help mothers prolong breastfeeding their babies, rather than being forced to wean baby from the breast because of returning to work. Providing detailed guidance about expressing by pump is unfortunately beyond the scope of this book. Pumping information abounds on the internet via on-line resources. Be discerning and realistic about expressing goals, because along with the convenience there can be pitfalls as well. I offer the following suggestions to consider when you decide how to make the most of your precious expressed breastmilk.
Breastfeeding directly is the optimal way for baby to receive breastmilk as oral contact with the breast transfers pathogens from mothers skin to baby’s GIT, and baby’s saliva to the mother’s breast via the nipple, enhancing baby’s immune protection.
Frequent pumping in addition to breastfeeding can cause oversupply issues, leading to blocked ducts and mastitis. Likewise, using passive collection devices like the Haaka suction pump can cause oversupply if used excessively. It may also deprive baby of some milk during breastfeeds, potentially creating problems with weight gains.
Double pumping is not necessarily “better” than single pumping – it is a timesaver, for sure. However, if a mother is expressing to help increase her milk supply, expressing each breast individually combined with gentle breast massage and switching sides several times will usually give better results. This method simulates “switch feeding” breastfeeding technique which is an effective method of increasing milk supply when needed.
There are many pump choices available and quality and function varies. Choose carefully to ensure the pump suits your particular need, e.g. occasional use, regular use, or expressing periodically to establish or increase milk production.
If the reason for expressing is to supply breastmilk for a prematurely born baby, hiring a hospital grade pump for use at home is recommended for best results during this critical period. Further information about optimising breastmilk expression for a premature baby: https://med.stanford.edu/ newborns/professional-education/breastfeeding/maximizing-milk[1]production.html
Most modern breast pumps now feature “closed filtration” systems, which means milk cannot be accidentally transferred to the pump via the tubing creating a potential pathogen hazard. Closed filtration system pumps can therefore be loaned or sold between mothers safely, however purchase of new tubing is recommended. The older Medela personal use pumps (eg Swing) did not have closed filtration systems and are intended for single person use only.
Choose a pump with good range of variability of suction strength settings. Settings for frequency of suction may be less variable – increased variability of settings aids comfort and safety of use. I have seen several really nasty wounds inflicted by cheap pumps when mothers have had suction strength turned up high, trying to express more effectively. With breast pumps you get what you pay for. Make sure the flange size and shape suits the breast and nipple size and shape. Incorrectly fitted flanges can cause injuries and impair effective milk transfer. If friction is a problem even with a correctly fitted flange, placing a little coconut oil inside the nipple barrel can improve comfort and function.
Be aware expressing regularly can be both reassuring and worrisome. Mothers naturally take note of the volumes they are collecting and can become very focussed on meeting certain target amounts at each expressing session. Using “feeding or expressing apps” can be helpful to record volumes yielded, but can also be misleading if the app information dominates the mother’s focus, rather than observing her baby’s cues and responses. Breastmilk production naturally varies enormously at different times of the day or night, and from day to day influenced by a variety of factors, many of which are beyond the mother’s control.
The fourth trimester, the postpartum period, the babymoon – whatever you call it, new mothers discover it rarely resembles the curated images of motherhood portrayed in the media. The transition from pregnancy to mothering is a momentous life-changing experience. The relentless demands of a new little centre of the universe combined with sleep deprivation can feel totally overwhelming, and also very lonely. The postpartum weeks are a roller coaster ride of hormonally driven emotions and sensations so intense they challenge the most resilient, well-prepared bodies and minds.
What helps new mothers recover from their personal postpartum reality check? Reassuring support which acknowledges her vulnerable state and nurtures her physically and mentally, enabling her rite of passage in her own time. As new skills replace anxious fumbling and intuitive confidence develops, so the new mother emerges. And the knowledge that women throughout time have trod the same path – and survived – helps too.
“New Baby 101 – A Midwife’s Guide for New Parents” by Lois Wattis (Mother, Grandmother, Midwife and Lactation Consultant) provides practical and evidence-based information in a concise easy to read form, to navigate AND enjoy the fourth trimester. www.newbaby101.com.au
In the womb a fetus is exposed to the day-night chemistry rhythms of melatonin and cortisol in its mothers body, and this intimate synchronisation continues after birth, if the baby is breastfed. We know that breastfed babies’ gradually mirror their mothers’ circadian rhythms of night and day, over time, as they are influenced by her unique chemistry via her breastmilk. How does this happen?
Breast milk contains various components that oscillate in their levels over the course of the day. In addition to melatonin, cholecystokinin, and cortisol one of the most important circadian changes in breast milk are levels of the sleep-inducing amino acid tryptophan, which peaks at about 3 a.m. These subtle changes in the composition of breast milk help the infant’s circadian rhythms to adapt to the mother’s, with additional benefits for baby’s brain development.
Night time breastfeeding also enhances the mother’s sleep. A study conducted in California 1 found parents of infants who were breastfed in the evening or at night gained an average of 40-45 minutes sleep over parents who gave their babies formula at the same time. The quality of sleep was also higher – it was interrupted less.
For mothers who are feeding expressed breastmilk it is worthwhile labelling whether it was collected at day or night time, and matching the feeding time accordingly.
One reason bottle feeding a breastfed baby is not a good idea, particularly in the early weeks, is the effect on the mother’s breasts. If the breastmilk is not released regularly (for example, if a feed is missed) the breasts quickly become over-full and engorged, which can lead to problems such as inflammation and mastitis. When baby is given a bottle feed the mother actually needs to be expressing her breasts around the same time to avoid these problems. If the breasts are not drained well and frequently the breasts’ chemistry changes to down-regulate her milk production, which will reduce the mother’s milk supply.
Introducing bottle feeds using a teat requires baby to suck very differently than how he does at the breast. The breastfeeding baby’s tongue massages the nipple and breast tissue which fills baby’s mouth, working in union with the natural suck-swallow-breath/pause rhythm that nature has designed to allow safe, comfortable feeding. Breastfeeding also enhances the development of the baby’s mouth and facial anatomy as he grows.
When a baby is given milk by a teat with holes in it the milk pours straight into the throat, and baby responds by swallowing the milk. The flow of milk dictates baby’s suck-swallow-breath action, and often forces baby to feed faster and take greater volumes than is comfortable for baby. The tongue is shaped to conform to the teat and works in a piston-like action using the tongue muscles differently to when breastfeeding. This can quickly confound baby’s natural and instinctive tongue action at the breast, and “derail” the baby from breastfeeding. Consequently it is not advisable to introduce a bottle and teat for feeds until baby is well established with breastfeeding (after about 6 weeks of age).
The rate the baby takes the milk is extremely important, and the “paced bottle feeding technique” is recommended for all bottle fed babies. Recent research has also indicated that some babies who are fed expressed breastmilk by bottle for every feed may be at increased risk of obesity, as they are unable to regulate the duration of feeds by signally they are feeling satisfied in the same way babies instinctively vary and regulate the frequency and duration of breastfeeds. The Paced Bottle Feeding Technique is key to allowing baby to signal feelings of satiety, and for the caregiver to respond accordingly.
There are numerous bottles and teats on the market which claim to provide a delivery system which is like breastfeeding, however in my experience most do not even come close. To maintain breastfeeding it is very important for babies to be offered teats which closely simulate the way breast milk flows from the breast. Slow flow teats are best, but check what actually happens by inverting the filled bottle and observing the teat for the rate of drips or stream; not all teats labelled “Slow” actually are!
Some teats do not have holes, instead have a Y shaped cut in the teat. Milk is only released from the teat when the baby applies pressure with the tongue and jaw as he sucks (similar to the action of breastfeeding) and when he pauses, the Y cut closes and milk flow pauses too. This also helps baby to “pace” the rate which milk is taken, enabling slower more comfortable feeding.
Ideally, the shape of the teat encourages baby to maintain a wide gape which resemble a good breastfeeding latch. Many wide-based bottles and teats are far too wide and baby’s mouth tends to slip to the tip of the teat, causing pursed lips and minimal jaw activity like sucking a straw, which does not resemble the oral activity of breastfeeding. Avoid “orthodontic” shaped teats (and dummies). These encourage abnormal tongue actions which can lead to changes in baby’s natural tongue and jaw action during breastfeeds. Consider if the teat or dummy shape is how you would like your nipple to look after a breastfeed!
When storing expressed breastmilk for feeding by bottle it is helpful to mark the time it was expressed as well as the date, and try to feed the milk at a similar time it was expressed (morning/afternoon/night). This is because the constituents of breastmilk varies slightly throughout the day and night which can influence how satisfied baby feels after being given the milk by bottle.
Take-home-message: giving occasional bottle feeds to a breastfed baby is fine, but it is important to consider HOW the feed is given, when and why in order to maintain baby’s breastfeeding reflexes and the mother’s breastmilk supply. This is adapted from “New Baby 101 – A Midwife’s Guide for New Parents” Third Edition. Available as an eBook or Paperback via www.NewBaby101.com.au and Amazon.
The pain and fatigue associated with inflamed breasts and mastitis can lead to mothers feeling they can’t continue breastfeeding. Knowing how to manage inflamed areas of the breast (previously called blocked or plugged ducts) promptly and effectively can avoid the problem progressing to mastitis.
“Plugging” is a colloquial term for microscopic inflammation of the breast milk ducts, causing narrowing of the milk duct pathway. Scientific evidence now demonstrates that mastitis encompasses a spectrum of conditions (from mild to severe). If ductal narrowing and congestion of breast milk cells are worsened by overstimulation of milk production, then inflammatory mastitis can develop, and acute bacterial mastitis may follow. (ABM Protocol #36)
Contributing factors could be poor attachment technique leading to poor milk transfer to baby, or something physical which affects the baby’s ability to breastfeed effectively – eg. jaundice, prematurity or tongue-tie. Most commonly “hyperlactation” or oversupply of milk is present, and the mother typically has an abundant milk supply.
Frequent expressing by pump or silicone milk collection device in addition to breastfeeding can result in hyperlactation. Mechanical breast pumps stimulate breast milk production by extracting milk differently to direct breastfeeding. The repetitive vacuum/release action of a breast pump does not allow for pauses between bursts of suckling as happens naturally with breastfeeding. Silicone collection devices (eg Haaka) create a constant vacuum which is efficient for milk removal, however the effect on lactating breast tissue is not physiologically normal. Expressing does not provide the opportunity for bacterial exchange between the baby’s mouth and the mother’s breast, which may predispose to dysbiosis (altered microbiome). Nipple shields also provide a barrier for this physiological exchange of baby’s saliva to the breast.
Research indicates mastitis is more likely to occur following Caesarean birth, exclusive pumping, nipple shield use, and other circumstances that alter the milk microbiome. Other contributing factors can be delayedbreastfeeds, such as when the baby sleeps for a longer period than usual, or the Mother has tried to extend the time between breast feeds eg “spacing feeds” strategies. Tight clothing especially bras that cause part of the breast to be compressed when it is full, or straps/pressure points from baby carriers or slings can also temporarily cause areas of the breast to be constricted and lead to a congested area of the breast. Incorrectly treated breast tissue congestion (eg. vigorous breast massage and frequent expressing) is a common cause of mastitis. Stress and fatigue are often identified by mothers as contributing to episodes of mastitis.
Whatever the cause, the milk flow in part of the breast has been impaired by narrowing of the milk duct which has caused inflammation in a defined area of the breast. Physiological breastfeeding and anti inflammatory measures provide the most effective treatment.
WHAT ARE THE SYMPTOMS?
Symptoms include tenderness, heat and redness in the specific area of the breast which are signs of inflammation. The mother is likely to feel hot (have an elevated temperature) and cold shivers (rigors), with aching muscles and joints. She will also feel very tired, and may have a rapid heart rate. The breast will feel hot and sore, and a red area will surround the section of the breast which is affected. Mastitis isinflammation of the breast tissue which can lead to infection.
MANAGEMENT
Continue Breastfeeding baby as normal. Most recent advice is to breastfeed baby from the UNAFFECTED BREAST first, and then offer the affected breast. (*This is the opposite of traditional advice). Application of heat to the affected breast before breastfeeding can provide comfort to the mother and assist milk to flow (letdown). Positioning the baby on the affected breast so his chin is pointing towards the congested area can be helpful, as well as alternating breastfeeding positions.
Avoid pumping the affected breast in addition to breastfeeds to remove larger volumes of milk, which will increase milk production. Instead, the aim is to down-regulate milk production of the inflamed affected breast, temporarily at least, but maintain function. If the mother is unable to breastfeed or usually pumps her milk for baby, only express the approximate volume baby would transfer from that breast.
Avoid vigorous massage of the breast. Deep, vigorous massage causes increased inflammation, tissue odema and breast tissue injury. Light, sweeping strokes over the breast towards the armpit area can help move odema (fluid in the breast tissue) – this is called lymphatic drainage. Gentle hand compressions of the breast during breastfeeding or pumping can provide a similar effect to hand expression, and is safe if excessive manual force is avoided.
Don’t miss or delay breastfeeds. Wake baby for a feed if your breasts become too full. If baby doesn’t want to feed express some milk by hand. Avoid persistent pressureon the breast during breastfeeds from your hand position or clothing, eg bras, feeding tops and baby carriers.
Avoid saline soaks, castor oil and other topical products. Do not use silicone vacuum devices (eg Haaka or similar) with Epsom Salts. These interventions can cause increased inflammation and maceration (damage) to the sensitive areola and nipple surface. Avoid excessive cleansing/sterilisation of pump parts and the breast/nipple area. Avoid giving formula feeds unless clinically necessary due to poor weight gain, or no breastmilk being available temporarily. Continue Breastfeeding!
TREAT THE SYMPTOMS
Pain relief – placing a cool pack or cold compress (wrapped in a cloth) on the affected breast afterfeeding can be soothing and reduce inflammation. * A wet face washer placed in the freezer for a few minutes is ideal to use as a chilled compress. Repeat the cold treatment as often as necessary. Oral pain relief can be taken safely – Ibuprofen and/or Paracetamol according to the directions.
Rest (in bed) with baby is best, allowing free access for breastfeeds to continue, and drink plenty of water which will help the recovery. The fatigue is the last symptom to leave a mother who has had mastitis.
Hand expression prior to latching baby to breastfeed may help baby to suckle effectively. Reverse Pressure Softening by a Lactation Consultant can also assist milk flow. Doctors rely heavily on Lactation Consultants to review the breastfeeding mother and baby’s unique story, and to provide insight that they may not uncover during their own treatment of the case. GP’s rarely have time to observe a whole breastfeed to watch how the mother and baby are interacting, and examine breastfeeding technique.
Therapeutic Ultrasound – uses thermal energy to reduce inflammation and relieve odema (swelling), and can be provided by an accredited physiotherapist.
If the breast pain and inflammation does not respond to anti-inflammatory medications, cold treatments, rest and continued breastfeeding, the inflammation can progress to infection, which will need to be treated with antibiotics prescribed by a GP.
BLEBS – Sometimes a mother may have a white spot visible on the nipple pore (outlet), which can be a consequence of disturbed microbiome in the breast (dysbiosis). The white spot (called a bleb) does not cause a fever but the mother is likely to have increasing pain in the affected area if the congested area of the breast is not relieved quickly. Blebs may appear some time after an episode of mastitis. Oral lecithin and application of a topical moderate potency steroid cream such as 0.1% triamcinolone may be used to reduce inflammation on the surface of the nipple. This is safe with breastfeeding and can be wiped off with a tissue or towel before feeding the infant. The bleb should not be “unroofed” using a sharp instrument or needle.
IS THE BREASTMILK SAFE FOR BABY WHEN THE MOTHER IS ON ANTIBIOTICS?
YES, the breastmilk from a mother who has mastitis and is on antibiotics is safe for baby to drink. A small amount of the antibiotics will pass to the baby via the milk and may cause some tummy rumbles and alteration of baby’s stools. The milk production in the affected breast is likely to reduce temporarily. Continuing breastfeeding from both breasts will support the recovery of the mother’s supply over the following weeks.
In some cases the mastitis has already become infective prior to treatment and an abscess can form in the breast. The collection of pus is identified by ultrasound examination and usually treated in hospital by needle aspiration during ultrasound examination to extract the fluid, and intravenous antibiotics may be given to the mother. It may take several treatments of needle aspiration to remove the abscess sufficiently for the antibiotics to reduce and eliminate the infection. Even in this scenario, it is recommended for the mother to continue breastfeeding from the affected breast if possible, or to express the breastmilk by hand or pump to enhance the recovery of the breast from the infection.
Breastfeeding mothers who experience repeated episodes of blocked ducts and/or mastitis can benefit from taking Sunflower or soy lecithin 5-10gms daily by mouth which may reduce inflammation in ducts and emulsify milk. Probiotic treatmentis usually recommended to assist the recovery of the mother’s breast microbiome following the administration of antibiotics. QIARA is an Australian product developed specifically to aid mothers’ recovery from mastitis. The active ingredient of this probiotic was originally derived from human breastmilk and provides the specific strain of lactobacillus fermentum which the mastitis affected breast requires for recovery.
(Excerpt from NewBaby101 p102-103) Most babies enjoy being swaddled which reminds them of the confined safe environment of the womb. Using a light cotton or muslin wrap to swaddle baby will provide the feeling of security without overheating baby, and additional wraps or blankets can be added if the room is very cool. Baby’s hips and legs should always be wrapped more loosely than his upper body. See the NewBaby101 video “How to swaddle your baby” for suggested wrapping techniques (which align with Rednose/SIDs recommendations).
Another option is the various swaddle suits which are like sleeping bags which close securely around baby’s upper body keeping his arms inside. Some Mums find these easier and more effective than wrapping or swaddling baby. SIDS/Rednose have advised against using swaddle suits designed to position baby’s arms raised upwards as they are regarded as risky if baby turns or rolls over, and concerns that restriction of arm movement could impede gross motor development and affect midline orientation. (Source: SIDS Education on-line forum 2021) Wrapping should be discontinued as soon as the baby shows the first signs of being able to roll. Positioning aids that restrict movement of the baby are not recommended and have been associated with infant deaths.
Specifically, Red Nose state: “items such as these and similar that secure an infant’s arms inside by means of a zip, Velcro or ties are not recommended by Red Nose… All sleeping attire designed to cover the baby’s shoulders should have separate neck and arm holes or should ensure that they do not allow the face covering if the baby was to move their arms in different positions.”https://rednose.org.au/article/wrapping-babies #Safebabysleep #Rednose #Swaddlingbaby #Babywrapping #NewBaby101 #Birthjourney #Armsupsleepers
Each mother-baby combination is unique and responsive feeding ensures baby’s individual and frequently changing needs are met optimally. Breast milk storage capacity varies greatly from woman to woman, and most breastfeeding women find one breast is more productive than the other – this is normal. Breast fullness also varies depending on whether feeding during the night or daytime. If the breast baby fed from previously still feels quite heavy with milk, it is advisable to return the baby to the same breast for the second phase of the feed. The milk he takes in the second phase of the feed is likely to now be milk which is higher in fat (however, this is not visible). This fattier milk will be digested more slowly than the milk taken earlier, and helps baby feel comfortable and satisfied. He may even repeat this a third or fourth time at some feeds.
Be flexible about feeding and trust his cues. At the next breastfeed you offer the opposite breast first, following the baby’s cues as above. This pattern ensures both breasts are well drained a number of times during each 24 hour period, enhancing the establishment of an ample breastmilk supply. As baby grows he may drain the first breast in a couple of phases and still want more, so the feed may need to be completed on the second breast. In this case start the next feed on the breast which was drained the least – probably the second breast.
Women with smaller breastmilk storage capacity may need to feed baby from both breasts, sometimes several times, for baby to be satisfied. There are no rules, however returning baby to the starting breast at least once (if possible), before offering the second breast can ensure the breast is well drained and stimulates ample milk production. Women with smaller breasts still make ample volumes of milk – it is just received by baby in more phases as she switches sides more frequently. Baby will let her know when she has had enough. Other terms used for this natural style of breastfeeding are “demand feeding” and “responsive feeding”. This differs from “scheduled feeding” and is likely to result in somewhat irregular intervals between feeds, although feeding patterns will emerge. Advice to always feed baby from both breasts is naive becauseevery mother-baby combination is unique. (Excerpt from New Baby101 – A Midwife’s Guide for New Parents” pages 32-33)
It is important how a baby is held during bottle feeding. Breast fed babies spend lots of time in close contact with their mothers, allowing time for them to gaze at one another, enhancing bonding. Bottle fed babies can miss out on this physical and eye contact time, particularly as bottle feed can be completed in a shorter time than a full breast feed. (See Paced Bottle Feeding).
Alternating which side baby is held while bottle feeding simulates the natural variation of positioning which occurs when mothers switch sides while breastfeeding. Start the bottle feed by stroking the baby’s lips with the teat to coax her to open her mouth. Put the teat into baby’s mouth resting gently on her tongue, allowing her to gape and flange her lips around the wider part of the teat. Refer to the information about Paced Bottle Feeding for guidance about feeding technique.
Watch baby’s response to the milk going into her throat and how comfortably she swallows. The flow should be steady but not fast, allowing baby to suck, swallow and breathe without struggling with any part of the process.
Expect baby to take rest periods, or even a nap, between the instalments of the bottle feed. Swap sides during the feed, similar to how baby alternates sides during breastfeeding. Bottles should never be propped for a baby of any age to drink unattended.
Water – Breastfed babies do not require extra water even in hot weather. Breastmilk contains exactly the right amount of water to meet baby’s hydration needs, however baby may feed more frequently in hot weather to quench his thirst. Giving water to a breastfed baby makes baby’s stomach feel full and may cause him to refuse a breastfeed, missing out on the nutrients he needs.
Babies under 6 months of age are not able to safely process water alone due to the immaturity of their kidneys. Giving water can lead to a serious condition called water intoxication, which can be fatal. Formula fed babies may need extra water as a supplement to formula feeds in hot weather – this may be offered as separate sips of boiled water. Extra water should not added in a bottle of formula because it will alter the concentration of the formula and baby would receive less nutrients.
Never mix expressed breastmilk and formula together. If feeding baby with both milk options, always give all the available breastmilk first, separately. Then offer some formula if baby is still showing signs of hunger. Always use the “Paced Bottle Feeding Technique” so baby can determine the rate and the volume which he is comfortable to take at that time. This technique simulates how baby takes a breastfeed, with pauses during swallowing, and stopping when he feels satisfied.
Visit www.NewBaby101.com.au to access reliable information about feeding your baby safely, making infant formula, breastfeeding and answers to every question new parents ask! Available as an eBook $9.95 and Print book in Australia $23.95, also Amazon and Booktopia.
Listen to this interview with Lois Wattis to discover how New Baby 101 was born, what’s in the book and why parents will enjoy having this valuable resource on hand to prepare for and confidently welcome their new baby, with a goldmine of reliable information at their fingertips. #Qiara #NewBaby #newparents #NewBaby101 #birthjourney https://www.facebook.com/QiaraProbiotics/videos/637941414431025
Compliments and Reviews
The people you often turn to for advice are your midwife, lactation expert, friends and family (especially those with young children) and, of course, your mum. But now you can Read more
Stacey Vanoska,
Lois Wattis is an experienced voice when it comes to babies and she has written a manual for new parents to be able to access anytime, anywhere, because we all Read more
Michelle,
New Baby 101 is the creation of Lois Wattis, a Registered Midwife, International Board Certified Lactation Consultant and Fellow of the Australian College of Midwives. Lois is also a mother Read more
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They say that until you've had a baby you can't understand the impact it has on your life. Well, they were right! When we were lucky enough to have little Read more
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“At last! Everything new parents need to know is at your fingertips!” New Baby 101 eBookReview: Produced by local qualified midwife and lactation consultant Lois Wattis, New Baby 101 aims Read more
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Two Mums give positive feedback after reviewing New Baby 101 – A Midwife’s Guide for New Parents
