Assessing for Insufficient Milk Supply

SCREENING FOR MILK SUPPLY PROBLEMS

MOTHER: Secondary LACTATION CURVE RISKS OR RED FLAGS  Poor latch  Early return of menses  Poor breast/mouth fit  Chronic breast inflammation  Firm, inelastic breast tissue  Low baseline prolactin  Infrequent feeds (<8x/24 hrs)  Overweight  Restricted feeding times  Insulin resistance  Schedule feeding  Smoker  Infrequent pumping sessions ______ Infant suck/ bfg struggles/ early term  Reliance on poor quality breast pump  New pregnancy  Medications ______ Family hx alcoholism  Hormonal birth control started: ______ Chronic incomplete breast drainage  Pill  Patch  IUD  Injection  Herbs ______MOTHER: IGT risk factors  Poor nutrition or <1500kcals/day  Breast type (Huggins): 1 2 3 4  Breast infection  Unusual breast shape______ Distance between breasts > 1.5” MOTHER: Delayed /Suppressed lactation:  Significant asymmetry of breasts  Milk in >72 hrs ______ Prenatal breast growth? 0 1 2  Premature labor & milk in before birth  Postpartum breast growth? 0 1 2  Corticosteroids for premature labor  Stretch marks with little breast growth  Swelling after birth (edema)  Scant veining  Hypertension  Bulbous areola  Difficult birth/stress/urgent c-section  Sparse palpable glandular tissue  Severe PP bleeding/ hypotensive / anemia  Exposure to disruptive chemicals  Placental problems during preg/delivery  Androgynous body type  Retained placental tissue  Late breast development  Placenta accreta, increta, percreta  BCPs before breasts fully developed  Gestational ovarian theca-lutein cyst  Obese/insulin resistant prior to puberty  SSRIs in late pregnancy or early pp  Insulin tx of GDM  Advanced Maternal Age MOTHER: Milk Ejection  History of abuse  Recent traumatic event or birth MOTHER: Primary  Post-traumatic stress disorder or bfg pain  Breast augmentation  Sick premature baby  Breast reduction  Alcohol  Breast biopsy/surgery  Cigarettes  Breast radiation  Thyroid problems, esp hyper (CX-43 prob)  Blunt trauma to chest or burn wounds  Diabetes? (CX-43 prob)  Spinal cord injury//accidents  Obstructed ducts or nipple pores  Previous severe mastitis or abscess BABY:  History of Infertility______ Cardiac or respiratory problems  Obesity or Gastric bypass surgery  Suck/swallow/breathe difficulties  Thyroid dysfunction (hypo/hyper, or PP)  Stridor (squeaking)  GDM/ T1 / T2 Diabetes/ Metabolic Syndr  High or low muscle tone  Hyperandrogenism// clinical or lab  Torticollis (head pulls to one side)  PCOS  Small or Large for gestational age baby  Hx of hyperPRL: tx? ______ Very receding chin  High PRL, low milk, ok breasts: macro?  Hard/soft/submucousal cleft palate  Hx autoimmune condition  Bubble palate  Other ______ Restrictive lingual frenulum/tongue-tie  Lip-tie  Clicking, Tongue retracting or thrusting  Weak suction or slips off a lot