When Breastfeeding Goes Off Road When Breastfeeding Goes Off Road Initial Visits Initial Visits • "Breastfeeding should hurt the first few weeks." • "It can take up to a month for breastfed babies to get back to birth weight." • "It's normal for breastfed babies to go 2 weeks without stooling." Disclosures • I have no actual or potential conflict of interest in relation to this presentation. • Owner: Metropolitan Breastfeeding LLC, Metropolitan Doulas, littlebeam LLC, dist. for Nibbly Bits. • Author: Start Here, Mother-to-Mother, Father- to-Father. • I will be discussing “off-label” uses of domperidone. When Breastfeeding Goes Off Road When Things Aren’t Normal When Things Aren’t Normal • "There's no such thing as tongue tie" • "You can't increase your milk supply." • "Babies don't get reflux." • "You can't take any medications while breastfeeding." Tethered Oral Tissue "Tongue-tie (ankyloglossia) is a condition present at birth that restricts the tongue's range of motion. With tongue-tie, an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue's tip to the floor of the mouth. A person who has tongue-tie might have difficulty sticking out his or her tongue. Tongue-tie can also affect the way a child eats, speaks and swallows, as well as interfere with breast-feeding." - Mayo Clinic Impact beyond breastfeeding • For children: • For adults: – Chewing difficulty – Pain in jaw – Dental issues – Migraine – Speech delay – Speech and eating – Speech difficulties/lisp difficulties Supply and Demand • Back to basics - remove the milk effectively. If baby can't perform this function, pumping needs to be introduced. • Forget the cookies, Gatorade, and Oreos: herbal galactagogues or prescription galactagogues are the appropriate choices. • Perceived milk supply vs. true low supply. Reflux • Present in infants • Symptoms include arching, hiccuping, crying after meals • Treatment options include Zantac, probiotics, positioning, among others. Medications • MOST MEDICATIONS ARE SAFE DURING BREASTFEEDING • There are many resources: – Infant Risk Center – LactMed – ToxNet • New concerns: marijuana and suboxone Medications Marijuana Suboxone/buprenorphine • Classified as an L5 by Dr. • ABM Protocol 21 (2015) Hale (InfantRisk) • the amounts of • Currently not enough buprenorphine in human research to make a final milk are small and are ruling, but preliminary unlikely to have short-term research by Dr. Hale is negative effects on the suggesting "the relative developing infant." infant dose is going to be • L3 per Dr. Hale small and the oral • Additional post-natal absorption poor." counseling recommended • Concerns remain for elevated risk from smoking, similar to tobacco usage. When Breastfeeding Goes Off Road Teething Teething • May interpret as a weaning attempt • Biting and sore nipples may discourage breastfeeding When Breastfeeding Goes Off Road Weaning Weaning • Weaning does NOT have to occur right at 12 months. • There are many benefits to extended breastfeeding. • Abrupt weaning can be cause for infection, abscess, or return of postpartum depression. • Support from pediatrician and other support providers crucial. .