Will surgery affect my ability to nurse future children?
	How can I get my baby to sleep through the night?
	Why is my daughter so fussy?
	I am diabetic, should I pump immediately after birth?
	How can I prevent dry, cracked nipples?
	Can you breastfeed if you have shingles?
	Daughter has chickenpox, is it affecting her nursing?
	What is causing clogged ducts?

Will surgery affect my ability to nurse future children?

I have a suspicious lump in my left breast that has been biopsied, and my surgeon now recommends removal.  I am now needing to wean my son earlier than I had originally planned.  How will this surgical procedure affect my ability to nurse future children?  Are there certain ways this procedure can be performed to increase my chances of successful future nursing?





Dear Lori,

First let me say that I think it is wise to take out any suspicious lump, although I'm sure you know that over 95% of the time these lumps are benign.  That means lumpectomy is a frequent procedure and usually has no impact on future breastfeeding ability.  A note of caution - it is very important not to interrupt the ducts closest to the lactiferous sinuses, the little reservoirs of milk that lie beneath the areola.  Most surgeons can approach a lump located in this area cautiously and from "behind."  Remember that normally women can produce enough milk to nurse even multiples, so that a small section of breast tissue removed should not have significant impact if the collecting system is not significantly impaired.  Hope that is clear.

How can I get my baby to sleep through the night?

Hi. My son is really attached to my breasts.  He uses them as a soother.  He won't go to sleep without them.  He still gets up every two hours at night wanting to suck.  I have gotten to the point where I bring him into bed with me and let him suck just so I can get some sleep.  How can I break him from this bad and frustrating habit?  How can I get him to sleep all night?





Dear Jerrilynn,

Of course this is a common problem.  Let me start off by saying there is no "right" answer.  Everyone has very personal ideas and expectations about having children sleep independently or in a "family bed."  It sounds as though you would like to have Gregory be more independent in his sleeping habits.  Let's talk about this a bit.

There are four stages of sleep.  You and I get to our light sleep stage and we have learned to roll over, move our arm, not think of that thought, and fall asleep.  This is a LEARNED behavior.  The more a child becomes dependent on you helping him through this transition, the less likely he is to independently decide that, due to his current age, he should take the big step and handle things on his own.  A four month old has a limited repertoire of thoughts to distract him, in contrast to the 12 month old.  All he can do, perhaps, is roll over, but the 12 month old can pull himself to a stand, walk around the crib, maybe even scream your name.  The more highly developed (older) the child, the more distraction he'll have to learn to deal with before he can settle himself.

It sounds as though Gregory has been using you as a pacifier for both day and night time "transitional" moments.  These are moments of boredom, frustration, fatigue, etc.  Usually around 9 months, children will learn how to become more independent, attaching themselves to "lovies," blankets, their own thumb, etc.  Some babies, however, attach themselves to their mother.  If this is the case with Gregory, I would suggest the following.

First, change your day time habits.  Begin breastfeeding Gregory at strict, ritual times of the day.  For example, right before his nap, right before bedtime, first thing in the morning.  Always nurse in the same place (for example, his bedroom).  When he becomes frustrated and wants to nurse on other occasions, offer him cheerios, let him put his feet in the water in the sink - do anything but nurse him.  This is a week of hell, but then he begins not needing YOU for all of his "transitional" moments.  When he is quite comfortable with this, and not having temper tantrums in between nursing sessions, then take step 2.

On a Friday night, when no one has to go to work the next day and your neighbors are all prepared for noise, and perhaps your other sibling is informed of the plan and put to sleep in a distant room, nurse Gregory to sleep as usual.  Much easier for Gregory if he is but in his own room, not yours.  Then, when he predictably awakens, irate at being left, have his loving father go in and spend around 60 seconds with him, basically reassuring him that he is not deserted, but that he needs to learn to handle this himself.  Dad leaves, Gregory cries for 20-30 horrible minutes, Dad reappears, and repeats the exact same 60 seconds of behavior that certainly don't satisfy Gregory, but reassure him, again, that he is not alone.  I should have said to make sure that both you and Gregory's Dad are on the same "page" before you try this.  If one parent decides "oh, he is too young" and intervenes to rescue him, it simply makes it harder for Gregory later on to learn that keeping up the crying will not necessarily bring a parent.  Usually, Friday is rough, Saturday is much better, and Sunday you sleep.  Unless, as I said, Gregory has learned that if he cries long enough someone will rescue him.  I think it is quite reasonable to ask him to go without his Mother for 6 hours on Friday and 8 hours on Saturday and thereafter.  Most parents report this was easier than they thought.

Although this is a personal issue, I think the expectation for children's behavior is fine, and I don't think this routine is too hard on a child this age.  Frankly, I think everyone seems happier in the morning if he or she has had an uninterrupted night of sleep.  Hope this is helpful.

Why is my daughter so fussy?

For at least six weeks, my exclusively breastfed baby has been occasionally pulling off the breast with frustration.  I am pretty sure it is because she is hungry and is not getting anything.  She becomes very impatient and cries.  I have always cue-fed her and my milk supply has never seemed to be lacking.  I don't know of anything in my diet that would cause a problem.  This pulling off and crying usually occurs in the evening, but sometimes during the day.  It occurs no more than two or three times a week, but when it does, I am at a loss for what to do.  What is the problem?





Dear Sarah,

I'm not completely sure what the issue is with Isabella.  Her weight gain looks very good, so I doubt that your production is the problem.  Sometimes babies this age become easily distracted.  For example, if someone walks in the room they may pull off out of curiosity. Usually, however, babies don't seem impatient and fretful with this.  Perhaps, you are not having a let down as quickly as she would like.  Many babies become very impatient when their mothers don't let down and have a high pressure system behind the milk.  Crying at you, and making you more tense, certainly doesn't help you.  As you are probably aware, many mothers are not aware of having a let down, while others feel a prickly sensations in their nipples or simply notice they leak from the other breast or the baby begins gulping.  If this is a possibility, try picking Isabella up while she is still asleep, but just about ready to wake up.  Instead of waiting until she is "national emergency" starving, place the sleepy baby in bed with you without changing her, turning on the lights, or talking.  Try to get her to latch on the breast without disturbing her too much.  You'll probably find that you are more relaxed and she has more patience.  I noticed you said that this behavior is more typical in the day time.  Mothers tend to have their strongest let-downs when they are fullest and most relaxed.  This is usually at night.   In the evening, most of us are at the peak of exhaustion.

Another thought, just to be sure, you might want to have her quickly looked at by your pediatrician, to make sure that nothing is hurting her, such as an ear infection, etc.

I am diabetic, should I pump immediately after birth?

I am diabetic (onset in childhood), for the protection of the baby he/she will be taken to the intensive care unit at the hospital where I give birth.  I do want to breastfeed.  My question is what should I do, should I pump and save the breast milk in that first hour or so after birth, should I see if they will bring the baby to me?  What other things should I know/think about before getting into this situation?  Thanks!





Dear Michelle,

A very good question.  I'm sure you are well aware that Kate/William will need to be followed for a low blood sugar, a high hematocrit, and possibly a low calcium.  These can easily be managed medically.  The more important question is how you can do everything possible to make breastfeeding successful.  I would suggest that you begin pumping as soon after your delivery as you can - at least 6 times on the first day and 8 times each day thereafter, whether or not Kate/William is able to feed at the breast.  For babies with "nipple confusion" or difficulty learning how to effectively use their mouth to breastfeed, the single most helpful thing is having a mother with a generous milk supply.

Kate/William sounds like she/he is your first baby.  You might be interested to know that if we took a sample of your breast tissue (which we won't) at the end of your pregnancy and compared it to a sample of breast tissue from another mother who has previously successfully lactated and is now at the end of her second pregnancy, what we would see under a microscope would be quite different.  The other mother would have much more highly proliferated, differentiated breast tissue.  She needs much less of a "trigger" or stimulus to bring her milk in, and her milk will probably come in sooner than with a primiparous mother.  The bottom line is, you need either Kate/William to begin suckling early and frequently, or a good pump.  In this situation, I would use a rental grade, electric, double pump, such as the Medela Classic (not even the Lactina, and certainly not the Pump In Style).  With this effort your milk should come in nicely by 72 hours out, and your little one will have a much easier time learning to nurse.

I have many diabetics in my practice (not just gestational diabetics) who have breastfeed successfully.  I know things can go well for you.  Good luck!

How can I prevent dry, cracked nipples?

This is my first child and I plan to breastfeed.  But I keep hearing these stories from women who have had trouble breastfeeding like dry, cracked nipples and actual bleeding.  What can I do to prevent this from happening?





Dear Sharon,

The most important way to prevent having dry, cracked nipples is to get the baby latched onto your breast well.  What does this mean?

If we draw an imaginary line from the tip of a baby's nose to his earlobe, the mid-point of this line we could call the "perfect point."  This is just where we need to get your nipple in your baby's mouth.  To experiment, allow your baby to suck on your finger and notice she/he pulls your finger back to exactly this point in her/his mouth.  All of the friction of the jaw and the tongue is on your fingernail, not on the tip of your finger.  Similarly, all of the friction of the baby's jaw and tongue should be on the areola, not on your nipple.  How do you get your nipple this far back in your baby's mouth? A good question.  Here, pictures are much more valuable than words, and this is exactly why I made a video about this.  Perhaps you can find some useful video clips on this Web site, or you could order the whole video and watch it in the privacy of your own home.

The most important features are these.  Number one, shape the breast more like a sandwich so that it is easier to have the baby latch onto the breast, not just the nipple.  Keep your fingers parallel to your baby's lips so that you are shaping the breast to fit in her/his mouth easily.  Position him so that she/he begins with nipple to nose.  Stroke, her/his upper lip with the nipple and wait for her/him to open his mouth wide, then swiftly bring him to the breast, being careful that his lower jaw is as far below the nipple as possible.  Again, I think it is easiest to see this in the video.

Women develop sore nipples not from nursing too long, but from nursing "wrong."  If you have flat or retractile nipples, you will probably need some help from an experienced lactation consultant.  The breast shells can help shape the nipple.  I would discourage using soft nipple shields in this situation.  Hope this is helpful.

Can you breastfeed if you have shingles?

Should one discontinue breastfeeding if diagnosed with shingles?  Don't have all the details, but a co-worker was told to stop breastfeeding for 14 days so she stopped completely





Dear Glenda,

Shingles is a reactivation of chicken pox.  People who are most likely to develop shingles are those who had a very mild case of chicken pox that did not adequately stimulate their immune system.  Usually, these are individuals who acquire the virus in the first year of their lives.  At this time, maternal antibody is protecting the young child who does not have to mount as high of a response to the infection as an older child would.  Sometimes chicken pox is so mild in the first year of life that there are no symptoms at all.  Personally, I was totally unaware as a pediatrician-mother than my older child developed chicken pox sometime during the first year of her life.

If an individual with shingles is fairly intimately exposed to an individual who has never had chicken pox and has no maternal antibody protecting him, the exposed individual may well develop chicken pox.  So whether it makes sense to stop breastfeeding if one has shingles would depend on a variety of issues.  Is the baby immunologically normal and not on drugs that may affect the course of chicken pox (such as steroids)?  Unlikely, but an important point.  Probably, this is a baby who is healthy and protected by his mother's antibody.  In this case, there would be no real need to stop breastfeeding.  Hope this is helpful.

Daughter has chickenpox, is it affecting her nursing?

Just recently my daughter has come down with Chickenpox.  I am finding now that she is not nursing as well as she normally does.  She is also not as interested in eating her solids.  I have tried to look in her mouth, but she has been fighting me on that - she is also teething on top of the chickenpox.  Could the chickenpox be affecting her nursing?  I am also curious as to how long she will be contagious with the chickenpox?  She first started breaking out on Sat June 25th - exactly 2 weeks since she had been exposed.  Thank you.





Dear Dawne,

As we discussed before, chicken pox is usually not too severe in a child this young.  Lesions may very well develop on mucosal surfaces, such as the mouth or the genitalia.  Also, remember that when you are sick with any infection, your appetite goes down.  It is very common for babies to prefer fluids rather than solids even with a bad cold.  I would not be so concerned about this, but simply respect her cues that she is not hungry, as much as you respect her cues when she is.

Parents usually become very concerned that their children need to drink a lot, or they become dehydrated.  The way that babies become dehydrated is usually not from refusing to drink, but due to vomiting or massive diarrhea.  A child who is not lethargic and extremely ill, but who is becoming dehydrated, will usually readily drink so that most babies who refuse to drink when they are sick don't need to drink.  Forcing them to drink is much more likely to provoke vomiting.

Children with chicken pox are usually contagious for about 5-7 days before their lesions have become crusted.  The incubation period (the time between exposure and clinical disease) is usually 2-3 weeks.

What is causing clogged ducts?

1. During the day because she hates to lay down to nurse she sits facing me and nurses with her head laying over on my arm.  Could this cause a clogged duct?
2. I wear an underwire bra, but have always worn the same ones.  I'm also under a great deal of stress right now.  Any help would be greatly appreciated.

Dear Kristi,

This is an excellent question - one that I don't know the answer to.  We see plugged ducts most frequently in women who produce more milk than their baby needs.  A common feature of over production.  Also, when women develop mastitis, the inflammation of infection can cause an irregularity of the ducts and collecting system which may predispose the milk flow to turbulence and incomplete emptying.  This may be a precursor of a plug.  Mothers who use pumps frequently are also more likely to develop plugged ducts, perhaps because of uneven or incomplete emptying.  For the same reason, you could postulate that a baby who is latched on poorly may also not be effectively or evenly emptying the milk ducts beneath the areola.

My advice is to vigilantly inspect your breast after feeding by palpating for lumpy, undrained areas of the breast.  Learn how to massage and manually express these areas to avoid milk stasis.  I am not sure if the underwire bra is contributing to your problem.  It does seem, however, that over the past five years, as we have developed more "products" for breastfeeding, such as nipple ointments, nursing pads, nighttime bras, etc., that we have had more problems with nipple and breast infections.  Personally, I would suggest wearing as little as possible when you are at home and allowing your breasts to be exposed to air, even sunshine, when you can.




 

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