Module 1: Low milk supply differential diagnosis

Introduction to Differential Diagnosis of Low Milk Supply

• Purpose of the webinar: Educational

• No conflicts of interest

Understanding Possible Causes of Low Milk Supply

• Importance of considering both the breastfeeding parent and the baby

Breastfeeding Parent Factors

1. Health History

   • Evaluate overall health before pregnancy, during pregnancy, early postpartum, and current status

   • Key conditions: hormonal imbalance, metabolic syndrome, and poor nutrition

2. Nutrition

   • Essential for breastfeeding: Requires additional 400-700 calories and adequate protein intake

   • Insufficient calorie or protein intake can negatively impact milk supply

3. Substance Use

   • Impact of alcohol, drug use, and medications/herbs

   • Some substances may act as galactagogues (increase milk supply) or anti-galactagogues (decrease milk supply)

4. Hormonal Treatments

   • Considerations for parents who underwent hormonal treatments for fertility

   • Possibility of new pregnancy, especially in lack of education about birth control during lactation

5. Feeding Technique and Management

   • Importance of proper latch and feeding management

   • Difficulty with latch can lead to decreased milk supply over time

   • Assessment of breast and nipple anatomy: scars, previous surgeries, and anatomical issues can complicate feeding

6. Early Postpartum Experience

   • Infections or sickness can prevent bonding and breastfeeding

   • Consideration of early introduction of bottles or pacifiers that may confuse feeding cues

7. Chronic Conditions and Physical Injuries

   • Relevant medical history and conditions that may affect breastfeeding positioning (e.g., Ehlers Danlos syndrome)

   • Importance of assessing for body tension and comfort during breastfeeding

8. Psychosocial Factors

   • Social pressures regarding motherhood and breastfeeding

   • Conversations with mothers to validate feelings and address social pressures vs. personal choices

   • Influence of sleep training, family support, and lifestyle on feeding

Baby Factors

1. Anatomy and Function

   • Importance of proper latch: anatomical issues can lead to ineffective feeding

   • Assessments for tongue/lip ties, high palates, and other deviations from normal anatomy

2. Behavior and Feeding Dynamics

   • Impact of feeding behaviors: fussy babies, oral aversions, and birth trauma

   • Evaluation of suck, swallow, and breath coordination

3. Optimization Strategies

   • Explore various holds and positions based on the baby’s unique needs (e.g., modified koala hold)

   • Importance of assessing for sensory processing issues or preferences for bottles vs. breast

Comprehensive Assessment Approach

• Separate assessments for mother and baby before combining findings

• Multiple potential causes of low milk supply should be considered

• Prioritization of Causes

  • Focus on what can be changed and the most impactful areas

  • Avoid overwhelming parents with all possible issues at once

  • Develop a step-by-step care plan over multiple consultations

Conclusion

• Expect multiple causes impacting milk supply

• Collaborative planning and prioritization essential for effective care

• Encouragement for parents to reach out with questions or for support