Breastfeeding–troubleshooting

We pediatricians spend a good part or our time encouraging young mothers to breastfeed your babies.  The list of advantages to both mother and baby is long and worth reviewing.  Still, there are pitfalls.  Let’s review some of the challenges that mothers face, what it means, and what you can do about it.

• “Grandpa lips”–the baby’s lips are tucked under as the child does not open her mouth wide enough, resulting in poor latch.  Untuck baby’s lips and consider start feeding before the baby is too awake and alert which may make latching easier.
• Discomfort in the first few days of nursing is often caused by high sucking pressure.  Lanolin to the nipples; sometimes deep breathing can provide some relief.
• If baby pulls off gagging and/or with milk squirting from the nipple this can be milk “oversupply.” Try nursing while lying on your back to better control milk flow.
• Baby’s tongue doesn’t extend beyond the gums? Sometimes this is “tongue tie.” It is usually a benign condition; however in some instances where the baby is causing Mom pain a “frenulectomy” can be performed.  This is a simple procedure where the skin under the tongue is clipped which frees the tongue to be extended more naturally
• If baby bites late in the nursing episode, this is often his way of saying “I’m full,” so a good place to stop.
• A white bleb at the tip of the nipple can be a “bleb” and can be simply and gently lanced by your doctor
• Pink tinged nipples, itching and “shooting” pains can be a candida yeast infection.  See your doctor and me for treatment for mother and baby.
• Dry, scaly rash on the nipple can be eczema, especially if you have a history of allergies. OTC or prescription creams can help manage this problem.
• Blisters on the nipple can be herpes.  Do not feed on that side until lesions dry up.
• If nipples are very sensitive and sometimes change color in response to cold that can be a variation of Reynaud’s phenomenon and should be evaluated by your doctor.
• If you experience soreness and redness in your breast beyond the nipple area this can be  mastitis and should be evaluated by your doctor.

All of our area hospitals take great pride and dedicate significant resources to assist new mothers to successfully breast feed their new babies.  Be sure to keep in touch with your hospital’s lactation consultants.  They are devoted to helping you raise a healthy baby.  So give them a call–they want to hear from you!

Or you can call your ob or me, and thanks for following.

Infants with reflux–medication risk

I have touched on this subject before so I’m sorry to “go on” a bit.  However, the subject–the use of medications for babies with reflux–is very important, and there is some significant new information that I wish to share, so here goes.

Another large study now demonstrates additional risks of side effects besides those previously reported with the use of certain medications in the management of reflux in the first year of life: “PPI’s (proton pump inhibitors) like prilosec (omeprazole) or prevacid (lansoprazole) and the more commonly used “H2 (histamine type 2 receptor) blockers” like zantac (ranitidine).

The study reviewed cases in 874,447 children born between 2001-13 in the US Military System who had taken the above medicines in the first year of life and were followed for at least 2 years afterwards (so they had really good records and really good follow up). The children tended to be at least slightly premature and of lower birth weight.  Children who took PPI’s had on average a 23% greater risk of bone fractures and those receiving H2 blockers had 13% greater risk.  Taking both increased the risk by 32%; those who had one fracture had an increased risk of repeat fracture by a whopping 85%.  The risk was slightly greater in boys and the majority of the children received these medications in the first 6 months of life.  Longer treatment was associated with increasing risk.  For PPI’s, <1mo treatment had 19% increased risk, 23% for 60-150 days, and >150 days the risk was 42% greater.  For H2’s  the numbers were < 1 mo 14% greater risk, > 120 days of treatment demonstrated 22% increased risk.  Children who received both medications for > 9 months had a 50% greater risk of bone fractures.

These drugs are not infrequently prescribed for symptoms such as fussiness, poor feeding, arching, or frequent spitting up/vomiting.  Yet controlled double blind studies have not shown any discernible benefit for these symptoms from their use–children who receive placebos or no medicines appear to do just as well over time.  Now, I do not wish to imply that there is no place whatsoever to ever consider these treatments for children with some of those problems.  Nevertheless, we must remember that these are not benign medicines, as noted here; additionally, we should recall the other established risks from GER medicines in infants like malabsorption and poor weight gain, increased risk of infections like pneumonia, and kidney inflammation.  Let’s take the conservative, more natural approach for the large majority of children who’s symptoms are mild to moderate and will be well managed that way, and in particular for those “happy spitters”–the little kids who barf all over everybody and everything while happily growing and developing normally.

For babies with more severe and disruptive symptoms, give me a call and let’s discuss it.  And thanks for following.