Module 1: Syndrome of decreasing milk supply

Introduction to Late Onset Decreased Milk Supply

• Participants: Paula Valarino (host), Dina (IVCLC student), Dr. Jack Newman (pediatrician and IVCLC)

• Topic: Syndrome of decreased breast milk supply, also known as late-onset decreased milk supply.

• Importance: The topic is underrepresented in lactation education but has significant implications for breastfeeding success.

Characteristics of Late Onset Decreased Milk Supply

• Common occurrence seen in clinical settings; typically observed around three months post-birth.

• Initial good milk supply can diminish; mothers may exclusively breastfeed but report issues.

• Symptoms include:

  • Babies fussing or pulling at the breast.

  • Maternal sore nipples.

  • Night-time breastfeeding remains effective, but daytime feeding may be problematic.

Causes of Late Onset Decreased Milk Supply

• Confusion arises from advice to limit breastfeeding to one breast per feeding to ensure hind milk transfer.

• Inadequate breastfeeding due to poor latch, often caused by tongue-tie.

  • Mothers may experience sore nipples.

• Hormonal birth control (e.g., pills, IUDs) can decrease milk supply, leading to misdiagnoses of colic or reflux.

• Common misattributions:

  • Reflux and allergies, often resulting in unnecessary dietary restrictions or formula use.

Under-recognition of Tongue-Ties and Breastfeeding Issues

• Frequent underdiagnosis of tongue-ties, especially in hospital settings; families report inadequate checks.

• The lack of education among pediatricians and healthcare professionals regarding breastfeeding, milk supply, and subsequent care.

• Pediatricians often mislabel symptoms; mothers frequently dismissed with statements about normalcy of sore nipples.

Misconceptions about Feeding and Growth

• The medical community often overlooks:

  • Growth spurts and nursing strikes are normal developmental occurrences, but can mask underlying supply issues.

• Importance of differentiating normal behavior from signs of decreasing milk supply: fussiness, pulling at the breast, or refusal to nurse.

Differences in Education and Support for Parents

• Many parents receive conflicting information about breastfeeding from different healthcare professionals.

• The lack of proper understanding leads to confusion on topics such as tongue ties, latch issues, and milk supply.

Assessment and Management Protocols for Decreased Milk Supply

• Observing the baby's behavior during breastfeeding is crucial.

  • Variations seen from active drinking to nibbling, indicating potential issues with milk flow.

• Recommendations for addressing decreased milk supply:

  • Increasing milk supply through proper latch and technique.

  • Considering tongue-tie release when indicated.

  • Using lactation support tools (e.g., domperidone) as needed.

  • Emphasizing education for parents regarding differences in breastfeeding behaviors.

Addressing Clogged Ducts

• Clogged ducts are not solely due to oversupply, often linked to latch issues and tongue ties.

• Education needed to dispel myths that oversupply is the root cause of clogged ducts.

Steps for Improving Lactation Education

• Importance of prioritizing breastfeeding education in medical training to enhance understanding among healthcare providers.

• Engaging expectant mothers in prenatal education about normal breastfeeding expectations, emphasizing that sore nipples are not normal.

Conclusion

• The aim is to educate and empower mothers and healthcare professionals about breastfeeding challenges, ensuring better support and minimizing confusion and misdiagnosis.