Weight gain in partially breast fed infants after switch to exclusive breastfeeding

Partial breast feeding adding herbal drinks and/ or formula using the bottle and/ or the pacifier usually causes nipple confusion. It also decreases demand on the breast leading to gradual decrease in maternal milk supply. The aim of the present work was to explore the effect of switch from partial breast feeding to exclusive breast feeding on the weight gain of partially breast fed infants and the impact of age at presentation, sore nipples and the use of supplements on infant weight. Eighty four, full term infants taking herbal drinks and/ or milk by bottle with or without pacifier were evaluated at presentation regarding their presenting weights and weight for age percentiles using the Egyptian Growth Charts. Their mothers' presenting breast conditions and milk flow were also evaluated. They were successfully switched to exclusive breast feeding using a dual protocol developed for the management of nipple confusion hand in hand with rebuilding the maternal milk supply. Their weight gain and percentiles were taken after one month of switch to exclusive breastfeeding and were compared with the presenting weights and percentiles. These wore correlated with the presence of sore nipples, the use of herbals, milk formula, and the age of presentation. The mean weight after one month of switch to exclusive breast feeding was very significantly increased [p=< 0.001]. The percentiles of weight for age were also very significantly higher after one month of exclusive breast feeding [p=< 0.001]. The difference between the mean weight for age percentiles of the infants whose mothers suffered from sore nipples was significantly lower than those of the infants whose mothers did not suffer from sore nipples [P-0.006].], The age of presentation had a significant inverse correlation with the percentile difference [p=0.016]. It appears that switch to exclusive breast feeding is possible, and it has a great effect on the weight gain of infants

Sore nipples: a multifaceted problem in breastfeeding

A sore nipple is a commonly encountered problem during breastfeeding. Though it is an easily preventable condition, once it happens it can lead to a lot of serial complications. Many mothers experience such painful sore nipples that they stop breastfeeding before they intended. The present work aims at exploring the problem of sore nipples regarding its association with poor lactation management, time of presentation after delivery, bottle and pacifier use and the infection hazards to both members of the mother/infant dyad. This is a case control study where forty nine nursing dyads with mothers complaining of nipple cracks or sores, were compared with fifty one dyads whose mothers had no nipple complaint. Study tools included: physical examination of infants and local breast examination of mothers. Pre-structured questionnaire was asked, demonstrating infant's medical history and including patterns of feeding. Also bacteriologic examination [swabs and cultures] for nipple of the mother, oral cavity of the infants and bottles and/or pacifiers were done. Forty nine [49] cases were included in the group having sore nipples and 51 were included in the control group with no sore nipples. Pattern of feeding significantly affected the event of sore nipples. None of the infants in the sore nipple group was exclusively breast fed, while all of the exclusively breastfed infants [100%] were located in the control group [P= 0.000]. Most of the sore nipple cases [95.9%] showed nipple and oral mucosa colonization to be compared with only 70.6% of the control group [P=0.001]. Nipple culture of pathogenic strains were almost four folds in the case group than in the control group [P=0.004]. Ninety two percent [92%] and 78.6% of the case and control groups' teats showed bacteriologic growth [P=0.596]. 98.5% of each of the nipple cultures and the oral mucosa cultures of those using bottle feeding with the breast showed colonization. 93.3% of each of the nipple cultures and the oral mucosa cultures of those using spoon feeding with the breast showed colonization, while only 11.8% [2 cases] of the exclusively breastfed infants showed colonization in each of their nipple cultures and oral mucosa cultures and these 2 cases were commensals [P=0.000]. There was no statistical difference as regards infants gender, the mode of delivery or maturity at birth [P=0.164, 0.229 and 0.332 respectively] between both groups. Sore nipples are a manifestation of poor lactation management, and are closely associated with the use of bottles and/ or pacifiers and early introduction of supplements even without bottle use. Bottles, pacifiers and other feeding utensils also carry the potential risk of infection to both members of the nursing dyad. The earlier the lactation management to achieve the goal of exclusive breastfeeding appears to be the only safeguard against such problems