Low breastmilk supply can be defined as insufficient amounts of breastmilk produced to meet a baby's growth requirements.
|
|
|
|
|
Assessment
|
Baby
|
Assess the following:
|
- Baby's latch is effective:
|
 | | - Effective suck/ swallow noted
|
|
|
- The baby's frequency of feeds is appropriate for age
|
| - <72 hours old = 1-3 hourly
| - >72 hours old = 2-4 hourly
|
|
|
- The baby's output is appropriate for age
|
| - <48 hours old = 1 wet nappy/24 hours
| - 48-72 hours old = 2-3 wet nappies/24 hours
| - >72 hours old = 6- 8 pale wet cloth nappies or 4 - 5 heavily wet disposable nappies
|
|
|
- Baby is gaining weight and growing appropriately for age
|
- Baby settles between most feeds
|
|
Oral examination: Look for;
|
|
|
|
- Oral dysfunction / disorganised suck
|
|
 |
|
Mother
|
History
|
- Past history of breast surgery, in particular breast reduction
|
- Past history of infertility, in particular polycystic ovary syndrome
|
- Current medical conditions eg. mastitis, diabetes
|
|
|
|
- Long labour / assisted or operative delivery
|
|
- Smokes cigarettes >15/ day
|
- Medications, including over the counter and herbal preparations eg. cold/ flu tablets
|
|
Assessment of breasts
|
- Inadequate breast tissue (widely spaced or tubular)
|
- Signs of previous breast surgery
|
|
|
|
|
|
Assessment of breastfeed
|
Can latch be improved by changes to positioning and attachment?
|
|
|
Signs of low supply
|
- < 6 wet nappies in 24 hours
|
- <2 bowel actions in 24 hours (aged less than 3 months)
|
- < 6 breastfeeds in 24 hours
|
- Baby difficult to settle or sleepy and lethargic
|
- Weight gains less than 25 grams per day (< 150 grams per week)
|
- Not regained birth weight by 2 weeks of age
|
|
Management
|
If there is no evidence of low supply, consider other issues.
|
If a cause is identified (eg tongue-tie), correct where possible and reassess in 48-72 hours.
|
To increase supply, consider:
|
|
|
- Effective milk expression after all feeds (including overnight)
|
- Switch feeding - offer each breast twice at each feed
|
- Complementary/Supplementary - expressed breastmilk (preferred)/ infant formula if needed
|
- Supplemental Nursing System / feeding line
|
- Suck training if suck is ineffective (refer to lactation consultant)
|
|
If changes to management have not been successful or are partially successful, consider adding a galactagogue to the plan.
|
|
|
Domperidone, a galactagogue (approved for use as an antiemetic).
|
Commence domperidone 10 mg three times a day for two days, increasing to 20 mg three times a day.
|
It may take up to a week before noticing an increase in breastmilk supply (where baby feeding well, settling between most feeds and top ups/supplementary feeds no longer needed)
|
For milk supply to increase to an appropriate level, domperidone may need to be taken for 2 to 4 weeks.
|
Once milk level is maintained, domperidone dose should be reduced over a period of at least a week, titrated to milk supply.
|
Refer Medications and herbal preparations to increase breastmilk production.
|
NOTE: Medication should not be used as a first approach to correct low breast milk supply. Appropriate changes to breastfeeding management should be maintained during treatment.
|
Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
|
Please remember to read our disclaimer.
|
