Why can't babies have 2 milk

Too little milk when breastfeeding

A crying baby quickly makes the mother doubt herself (© Vojtech Vlk)

Breastfeeding mothers often complain about not having enough milk. This problem is the most common reason for supplementary feeding and premature weaning. Most mothers could produce enough milk for their babies, even for multiple babies. The following article summarizes the causes of insufficient milk, explains common challenges and refers to further sources.

The diagnosis and treatment of insufficient milk production are among the most complex tasks in breastfeeding counseling. It is estimated that at most about 5% of women have medical problems that actually impair milk production (see below). Occasionally, it is up to the newborn that they are not (yet) able to breastfeed effectively, e.g. because they were born prematurely, have temporary adjustment disorders, are too sleepy or suffer from anatomical features, such as a shortened frenulum of the tongue.

Causes of too little milk: An overview (© Dr. Z. Bauer, still-lexikon.de)

In most cases, however, it is due to unfavorable conditions at birth / in the puerperium that milk production does not start and the baby has to be fed. How the amount of milk can be increased in these cases is explained in the article "Increasing the amount of milk: How to produce more milk". In other cases, the impression of not being able to produce enough milk is due to outdated ideas about milk production and breastfeeding behavior, as well as the mother's lack of confidence in her own breastfeeding ability. In many cases, the baby is thriving, the mother mistakenly interprets certain signals as signs that there is not enough milk. This phenomenon is called “Perceived Insufficient Milk”, or PIM for short, in international specialist literature. After all, misconceptions on the part of the mother sometimes actually lead to the fact that she puts the baby on too seldom and possibly too short, or that she positions the baby incorrectly on the breast. These circumstances can actually lead to an undersupply of milk, even though the mother can actually produce enough milk. In many cases, there are even several problems at the same time, e.g. unfavorable starting conditions during childbirth / in the puerperium, lack of support in specific breastfeeding management and great uncertainty for the mother.

For optimal support, a mother suspected of having too little milk needs a midwife as well as a breastfeeding group, in which she can clarify her numerous uncertainties and receive emotional strengthening, and ideally also an IBCLC breastfeeding and lactation advisor, who identifies and identifies the causes of the problem guides the mother in several hours of personal consultations (see also our directory of lactation consultants).

Contents overview:

Do I really have too little milk?

The first major challenge when there is suspicion of insufficient milk is to determine whether the baby is actually drinking less milk than it needs. There is no single criterion by which this can be clearly determined, but numerous indications that together form a picture.

To see if the baby is getting enough milk, they can be weighed. Breastfeeding tests provide a first clue, regular weighing over a longer period of time enables a more accurate assessment. (© Miroslav Beneda)

Many mothers would like to be able to read off how much breast milk their baby is drinking on a scale, as is possible with feeding with a feeding bottle. However, this is not so easy with breastfeeding. The amount of milk drunk can essentially be determined by regularly weighing the baby before and after each breastfeeding for 24 hours (breastfeeding samples / weighing samples). The weight differences are added up to give the amount of milk drunk on a day. Since it is difficult to weigh each time you breastfeed, you can only weigh as many meals as possible in order to calculate the amount of milk likely to be consumed per 24 hours. Sometimes it is enough to determine the amount of milk consumed, e.g. when breastfeeding 3 times, to get an idea of ​​how much milk the baby is drinking per meal. However, it is most reliable if the measurement is actually carried out over 24 hours. A second person can help the mother with this. However, this approach is very complex and stresses both mother and baby, which in turn can inhibit the mother's milk reflex and disrupt the baby's natural breastfeeding behavior. Another challenge with breastfeeding rehearsals is that ideally you need very reliable and exact baby scales that can also determine differences of 1 to 2 g exactly - such scales are usually only available in hospitals and medical practices. Simpler baby scales, which weigh exactly to 10 g, only allow a rough orientation. Due to the disadvantages and challenges, weighing samples are only carried out in exceptional cases.

The knowledge of the amount of milk drunk alone is not enough to determine whether the baby is adequately nourished in the breast. It all depends on how much milk the baby actually needs and there are enormous differences. Some smaller, more slowly growing healthy babies drink less than 500 ml a day - even if more breast milk is available - while other healthy babies drink around 1300 ml a day: the range is enormous. On average, breastfed infants between the 1st and 6th month drink around 800 ml of breast milk in 24 hours, significantly less than artificially fed babies, among other things because breast milk can be better processed than industrial infant milk.

Amount of breast milk consumed in healthy infants with increasing age (according to Kent, 2006 and Neville, 1988)

AgeaverageRange (minimum-maximum)
7-14 days615 ml485-745 ml
14-28 days690 ml541-837 ml
1-6 months800 ml478-1298 ml

You can also use the successful positioning of the baby's breast, of the observed breastfeeding behavior (see also the signs of effective suction), and des proper breastfeeding management already assess. A baby that is fed up from the breast initially drinks in a concentrated manner, usually with open eyes and a “penetrating look”, but at the same time calm and satisfied. The lower jaw moves rhythmically about once per second (see the film by Dr. Jack Newman). Over time, the baby relaxes, its fists open slightly, its eyes close, it lets go of its breast contentedly and falls asleep on its mother's breast. An older baby no longer necessarily falls asleep on the breast, but begins to interact with the mother. Active, attentive behavior, a rosy skin color and good skin tension indicate a good supply of breast milk. A baby who is not getting enough milk from the breast often begins to fidget the breast, pull up its legs, kick its arms, and pull on the nipple. Other babies fall asleep on their chest after a few puffs before they have had enough to drink. The jaw movements are flatter and disorganized (suckling) or do not occur. If the asleep baby has not had enough water to drink, it will still not be easy to detach from the nipple and put it down. Some babies who get too little milk appear very easy to care for or even lethargic.

In addition, the Weight development and the baby's excretions the most important clues. In the first week of life, all healthy newborns lose weight, usually 5 to 7% of their birth weight, due to the excretion of body fluids and meconium. If the baby loses more than 7%, the breastfeeding management must be checked and, if necessary, corrected. However, babies who are very large or who drink a lot of intravenous fluids during childbirth (> 500 ml) may lose more weight in the first few days after birth. This is normal and not a sign of insufficient milk. Supplementary feeding is recommended from around 10% weight loss, because the baby does not seem to be adequately supplied with breast milk.

A successfully breastfed baby will regain its birth weight within 10 to 14 days. If the baby has not reached its birth weight after two weeks, there are often problems and the pediatrician and breastfeeding specialists should be contacted.

The baby's excretions provide important clues as to whether it is getting enough breast milk. (© Jozef Polc)

In addition to giving weight the baby's excretions Information about whether there is sufficient milk supply. In the first week of life, the excretion of stool is recorded. The color, consistency and amount of stool indicate whether the baby is getting enough milk or whether the mother is getting milk well (more about this in the article The stool of a newborn, breastfed baby).

For the first 4 to 6 weeks, a sufficiently breastfed baby will have bowel movements every day. After this time, the stool becomes less important for determining the amount of milk, as it is sometimes only excreted every few days or even weeks, with a light yellow to mustard-brown color and a liquid, soft consistency being a good sign. Dry, hard stools are always a sign of a clear undersupply and an immediate need for action.

After the first week of life, one can determine whether the baby is adequately supplied with breast milk, primarily based on the wet diapers. 6-8 wet cloth diapers (5-6 heavy disposable diapers) are considered sufficient. The urine is pale yellow to colorless and odorless. You can use our protocol template to record the eliminations.

That too Test weighing the baby at regular intervals continues to monitor weight development. If the breastfeeding process is unproblematic, it is sufficient for the aftercare midwife and pediatrician to weigh the patient during the preventive check-ups. If there is a suspicion of insufficient milk, baby scales can be borrowed or purchased online, in specialized pharmacies and medical supply stores. Daily weighing is recommended for the first few days and weeks until the newborn has reached its birth weight, and once or twice a week in the following weeks. After a month and a half, it is enough if the baby is weighed every 4–6 weeks. The baby should ideally be naked for weighing.

The WHO weight curves provide the best orientation

How much weight the baby should gain cannot be determined with absolute certainty, as each baby develops individually. However, the absolute lower limit is 170 g per week in the first few months. If a baby is gaining less weight, there is likely a problem and the pediatrician and breastfeeding professionals should be contacted. On average, babies gain 170 to 330 g per week in the first two months, 110 to 330 g in the 3rd and 4th months and 70 to 140 g per week in the 5th to 6th months.

Instead of absolute numbers, weight development is best measured using weight curves. However, the somatograms in the yellow medical check-up booklets only provide a rough guide and were determined on the basis of children who were not or not always exclusively breastfed. They are better suited WHO growth curves 2006, recorded from infants fully breastfed for 4–6 months (see the WHO weight curve for girls (0–6 months) and for boys (0–6 months)). With the weight curves, it doesn't matter which percentile the child is on. Everyone has their own weight: there are naturally slimmer and stronger, taller and shorter people. It is much more important that the child develops along its own percentile, i.e. parallel to its percentile curve. Even below the 3rd percentile, a child can develop healthily if there is no other evidence of illness or disorders.

Certain fluctuations around the percentile are quite normal (e.g. in the case of short-term illnesses), but The weight trend should tend to run parallel to the individual percentile curve. If the baby's weight curve rises more slowly than its percentile, breastfeeding management and milk transfer should be checked by a breastfeeding specialist. Weight stagnation (i.e. a horizontal line in the weight curve) and a downward trend are urgent warning signs of severe failure to thrive and require immediate medical intervention. If there is a risk of undersupply to the breast, a trained breastfeeding specialist should be consulted. She weighs the baby and interprets the weight curve (see also our directory). Parents can also enter the weight data in the WHO curve and contact a specialist if they are unsure. You can create a protocol for the weight development (see our protocol templates) and transfer the data to the curve.

Babies fed artificial infant milk gain weight more slowly than fully breastfed babies in the first few months, but more in the second half of the year. This must also be taken into account when feeding the baby.

Unjustified suspicion of insufficient milk (Perceived insufficient milk, PIM)

In our “highly civilized” society, misconceptions about breastfeeding are deeply ingrained. It is a common misconception that many mothers cannot produce enough milk. Self-doubts arise even in healthy mothers during pregnancy and lead them to interpret the child's behavior and other observations as a sign of insufficient milk, even though the child is thriving. Unfortunately, sometimes it is also the “experts” who urge the mother to feed it: “You don't want to starve your child, do you?”

The following incidents, among others, are misinterpreted as signs of insufficient milk:

  • Little milk in the first few days: Some mothers expect that they will produce larger amounts of milk in the first few days after giving birth and are unsettled by the few drops of colostrum. Babies drink very small amounts in the first few days after birth, and the mother also produces correspondingly little milk (see also Milk production in the first days after birth). The amount of milk increases from the 2nd day and reaches an average of 500 ml on the 4th day, whereby the individual differences are very large. At the age of 4 weeks, babies drink an average of 750 ml of breast milk per day, although <500 ml or 1300 ml of milk per day are completely normal.
  • At the time of the initial milk infiltration, the breast is large and firm and later becomes gradual smaller and softer. Some mothers mistakenly interpret this phenomenon as a reduction in milk yield. Instead, only the lymph congestion in the interglandular tissue is reduced. When the initial breast swelling passes, the difference in breast firmness can be felt before and after breastfeeding. Before the meal, the chest is plumper, then softer again. The mother can confirm this observation that she has enough milk. You can feel the difference best when the child drinks a lot after a long break. If a child breastfeeds very often, the difference in breast firmness may no longer be noticeable. Nevertheless, the baby is well supplied with breast milk.
  • The breast no longer runs out: Especially in the first five to six weeks after giving birth, many women have a lot of breast leaking (splashes during the milk donation reflex, wet nursing pads, etc.). Breast leakage subsides over time in most mothers and may even stop completely. However, this is not a sign of a decrease in milk production. The breast works more effectively and can calibrate the milk production more precisely to the needs of the baby.
  • The mother is insecure because the child drinks more / less often or spends more / less time on the chest than she thinks is normal. However, there is no norm. Every breast and every child is different. A baby who is breastfed only and on demand can drink 6 to 20 times a day. The amount of milk produced also varies considerably between mother-child pairs, although it depends mainly on the child's appetite and less on the breast. Sometimes babies breastfeed more often than usual without us always knowing why. Babies also breastfeed faster and more effectively over time and may need 15 to 30 minutes to empty their breasts during the newborn period, and maybe only 5 minutes later.
  • Also the so-called Cluster breastfeeding, in which the baby drinks from the breast very often for several hours (typically in the evening), unsettles the mothers. However, cluster breastfeeding is normal behavior and not a cause for concern. With cluster breastfeeding, babies get plenty of high-fat hindmilk, which is good for satiating, and keep the mother's milk production going.
  • At the pump or at the manual milk production very little milk comes out. This, too, does not have to be a sign of a low amount of milk.Hand or pump extraction is nowhere near as effective in emptying the breast as the baby. The milk ejection reflex is not triggered in every woman when pumping or winning hands.
  • The mother does not feel the milk ejection reflex. This, too, is absolutely no reason to assume that the milk ejection reflex is not there. Often mothers feel the milk ejection reflex only in the first few days or weeks, some mothers even never.
  • The child suddenly wants drink more often and / or for longer than the mother was used to. Or: Up until now the baby was already full after one breast, now it also needs the second breast. Again, this is not an indication that milk production has decreased. Such fluctuations have so far been explained by growth spurts, but in the meantime doubts have arisen as to whether growth spurts really exist. We don't have one-size-fits-all explanations as to why a baby's appetite fluctuates. In any case, we know that appetite and frequency of breastfeeding are irregular and can undergo noticeable changes at short notice, even if the milk production remains constant between the 1st and 6th month in the long term. If the mother breastfeeds her baby as needed, she can be sure that her milk production will adapt to the child's needs.

Many babies are restless in the afternoon and evening. (© Vojtech Vlk)

  • Restless baby: Restlessness and screaming can be for a variety of reasons and are not a reliable sign of hunger (see The First Signs of Hunger). However, if a baby is regularly restless or cries a lot, the milk transfer and weight gain should be checked by a breastfeeding specialist. Restless behavior in the baby and crying are sometimes even that Signs of too much milk. If the mother then takes measures to increase milk production, the symptoms worsen (more on this in the article Too much milk).
  • Lots of babies screamin the afternoon and in the evening a lot and often want to be breastfed. Various theories exist to explain this behavior. Some suspect too much stress behind it, others see an innate behavior pattern in it, which dates back to the time of the hunter-gatherers. However, the chest is most likely innocent of this dissatisfaction. In the case of insatiable, excessive crying, one speaks of regulatory disorders, which should be examined and treated by specialists (see also our article Regulatory disorders: When the baby cannot be calmed down).
  • Typical Hunger signsuch as “bring your hand to your mouth” and “suck your hand” also do not reliably indicate hunger. They just indicate that the baby wants to be breastfed. Babies can calm down best on their breasts with any kind of stress: Overstimulation, pain, fatigue and also hunger (see also When to put on?).
  • Also if a childmore delicateis than others, it doesn't have to be due to the mother's inability to produce enough milk. Some children just have less appetite than others and there are genetically determined differences in growth. The main thing is that the child is healthy and develops in accordance with its age.
  • Gaining weight in the chest too slowly or even failure to thrive: Even these problems do not always stem from the mother's inability to produce enough milk. There are many other possible reasons a child may not thrive when breastfed; too little milk is just one. In rare cases, excessive overproduction of breast milk can cause failure to thrive. In the event that a breast-fed child gains too little weight, both a pediatrician and an experienced IBCLC breastfeeding and lactation advisor should be contacted.

Unfavorable breastfeeding management as a cause of too little milk

Even if the mother is physiologically able to produce sufficient milk, suboptimal breastfeeding management can lead to the baby receiving too little milk. Frequent and effective emptying of the breast in the first days after birth (at least 8 to 12 times in 24 hours from the first hour of birth) is the prerequisite for the production of mature breast milk. Frequent and effective breastfeeding remains the most important prerequisite for maintaining abundant milk production.

By breastfeeding as needed, every healthy mother can then produce as much milk as the baby needs. The production of mature breast milk depends on the Child's appetite from.

⇒ A child who is breastfed on demand regulates milk production through demand.

Milk production depends on the one hand frequency from breastfeeding, on the other hand from how much the child drinks per breastfeeding meal. This in turn depends on how long and how effectively the child is sucking. Because the baby practically never drinks the breast empty. It only drinks as much as it needs. If he drinks more, more milk is produced (see also: Increasing the amount of milk - How to produce more milk).

The following factors, among others, can lead to the baby receiving too little milk, even though the mother could produce enough milk:

  • A common cause of too little milk is that the mother has the child investing too seldombecause she thinks she has to keep a 3 or 4 hour rhythm. The myth of such standstill intervals is very widespread and persists even among experts. Any restriction of breastfeeding can lead to a reduction in milk production and an insufficient increase. To ensure that the baby is well supplied with breast milk, it is important to offer the breast to him at the first signs of hunger, even if the last feeding was only an hour or ten minutes ago. For the first 6 months and beyond, most babies will need at least 8 to 12 breastfeeds in 24 hours. Many successfully breastfeeding women report that they even breastfeed every 1.5 to 2 hours. Some babies sleep relatively long in a row and then want to be breastfed all the more often. (On this topic, see also: The right breastfeeding management and why breastfeeding often does not work.)
  • Avoiding Breastfeeding in Public: In our western civilization, the breast is often seen as a sex object, which according to part of the population should not be shown in public even for breastfeeding. Some mothers therefore do not dare to breastfeed their children outside their own four walls or even in the presence of their friends or relatives. You limit breastfeeding meals or even bottle feed on the go. This limitation of breastfeeding and the insufficient stimulation of the breast reduces milk production. A solution has to be found here as to how the baby can often be breastfed in public. You can hide the baby under loose clothing or e.g. a nursing scarf or even sew or buy your own nursing clothing. There are many retreats where women can breastfeed. Lately these have been increasingly identified by their own symbols. If all young mothers dared to breastfeed in public, this would become a matter of course over time.
  • In Germany and in other “modern” civilizations it is customary to take the baby from the mother sleep separately in your own bed allow. This makes it very difficult to breastfeed at night. An essential prerequisite for successful breastfeeding is that the child's breastfeeding needs are also met at night, even if the child wants to breastfeed every two hours or more. However, this can only be achieved if the baby sleeps next to the mother and can be breastfed while half asleep (see also: Breastsleeping - a paradigm shift and bedsharing promotes breastfeeding).
  • Another cause of too little milk is when the child is taken from the chest prematurely becomes. One often hears the wrong advice that sore nipples can be avoided by brief breastfeeding. Breastfeeding on demand also means that the baby lets go of the breast on its own when the time comes. Babies five to seven days old take 7-30 minutes to breastfeed, but 45 minutes is quite normal. Under no circumstances should the baby be removed from the breast if swallowing noises can still be heard! Some newborns fall asleep on their chest before they have finished drinking, especially if they are too warmly dressed. Then they have to be woken up and dressed less warmly. If the baby has not fallen asleep and lets go of the breast, the other breast can be offered. If a full baby is still suckling something while sleeping, without sucking, it can be carefully removed from the breast with a finger in the corner of the mouth. Otherwise it could injure the nipple with its half-hearted sucking movements.
  • It can also be more pronounced Pacifier use lead to the fact that the child satisfies his need to suckle the pacifier and spends too little time on the breast. Ideally, a baby should satisfy all of its breastfeeding needs, with a few exceptions, e.g. while driving.
  • Many mothers give their babies tea or water. As a result, the babies get less breast milk. Studies have shown that this habit leads to stunted growth. Exclusive breastfeeding means that babies are given no food or drink other than breast milk, even in hot temperatures. Drinks should be introduced with the complementary food at the earliest. In the nutrition plan of the Research Institute for Child Nutrition, drinks (water, possibly tea) are only recommended with the transition to family food at the end of the first year of life.
  • Only offer one breast: Milk production can decrease if the mother only offers one breast per meal. The baby should always be given the opportunity to drink from the second breast when it has finished the first breast. Not always and not all babies need the second breast, but it should not be denied if the child still wants to drink. If the baby still wants to drink after the second breast, then it can be placed on the first breast again, in the meantime some milk has formed. Alternate breastfeeding is very effective in stimulating milk production.
  • Unfortunately hang sore nipples and too little milk often together: If the milk runs poorly, the risk of sore nipples is increased. If the woman has pain while breastfeeding, milk production often does not get under way, as pain often indicates a suboptimal application, in which the breast is insufficiently emptied. The pain also leads to the fact that the milk ejection reflex is inhibited and the mother delays the application and the baby thus spends too little time at the breast.
  • Nipple shield: Some lactation consultants observe that the amount of water consumed by women who breastfeed with nipple shields decreases after a certain period of relatively successful breastfeeding. It is therefore recommended that nipple shields be weaned as soon as possible. If the nipple shields are indispensable for a longer period of time, it makes sense for the women to be closely supervised by breastfeeding experts and to also empty their breasts by pump or manually after breastfeeding, at least 1-2 times a day, to maintain milk production.

Feeding the baby when there is not enough milk

If the milk is really not enough, the baby has to be fed, ideally at the breast, in order to promote the mother's milk production and the baby's ability to suckle.

Sometimes the baby's droppings or weight gain actually point to insufficient milk. In such cases, of course, the baby needs to be fed to ensure adequate nutrition - this is the highest priority. The baby should have enough excretions and gain weight in parallel to the percentile, see above (Do I really have too little milk?). If you are unsure about milk production and / or weight gain, it is often worthwhile to consult a breastfeeding and lactation advisor.

DISPLAY

Supplementary feeding with artificial baby food can lead to an (additional) reduction in milk production, especially if the baby is fed with the bottle. A vicious circle is created and there is a risk that the child will be weaned completely over time. If additional feeding is necessary, it is advisable to choose alternative feeding techniques so that the baby does not get used to the bottle. If a baby learns to prefer the bottle, it can be a great challenge to get it used to the breast again (see also: Getting a baby used to the breast from the bottle). The main problem, however, is that bottle-feeding does not stimulate the breasts enough and, as a result, milk production decreases over time. Therefore, the baby should not be given a feeding bottle or pacifier even if additional feeding is required. The baby's need to suckle should be completely satisfied at the breast: both for nutrition and for calming and falling asleep.

If a baby is fed, it can make sense to keep a breastfeeding and feeding protocol and to record the amount of milk fed over time (see also our protocol templates and the article A second start of breastfeeding (relactation)).

First measures to increase milk production again

As a result of suboptimal breastfeeding management in the hospital or at home, it can happen that a baby does not actually receive enough breast milk, even though the mother is physiologically able to produce enough milk. The mother can take various measures to stimulate milk production.

  • "Nursing Vacation": The mother puts other obligations aside and spends several days with her baby in intensive skin contact and breastfeeds him at every opportunity. The mother relaxes, allows family members to take care of her and any work to be done. By reducing stress, milk production can get going better (stress inhibits the milk donation reflex). A lot of skin contact (bare baby skin on bare mummy skin) increases the lactation hormones prolactin and oxytocin. Most importantly, the baby should be able to empty the breast frequently and thoroughly. The baby should be as close to the breast as possible. In this way, mother and baby can spend a lot of time together in bed, e.g. by laying the baby on the mother's bare breast. During the day, the mother can also carry the baby around in slings, but if possible, she doesn't wear any clothes or bra under the sling. The baby then has the milk bar right in front of their nose and can help themselves to whatever they want. (see also: Promoting milk production with slings).
  • Change silences: The speed with which milk is formed in the breasts depends primarily on how much the milk is emptied. Within one day, the milk production rate changes five-fold, depending on how much the baby has previously emptied. The mother does not notice the speed with which milk is being formed in her breasts. Older babies and toddlers who suddenly need more milk switch back and forth between breasts: after they finish one breast, they switch to the other breast. When they are done there too, switch back to the first breast, until then there will be some milk available again. You empty both breasts 3-4 times per breastfeeding meal, drinking less and less with each cycle. With this strong emptying of the breast, the milk factory is in full swing. If the hungry baby is offered the breast several times a day in this way, the milk production can be significantly increased in the short term. If the breast is emptied strongly in this way over several days and weeks, more active mammary gland tissue is formed and the mother can produce even more milk.
  • Additional emptying of the breast: If a baby is unable to empty the breast as much on its own initiative, e.g. because it is sleepy or poorly suckling, the amount of milk can be increased by emptying the breast as well. To do this, the breast can be emptied manually or with a high-quality electric breast pump after breastfeeding. Relaxation, breast massages before emptying and heat applications allow the milk to flow better. If the emptying is repeated several times in a row - with pauses to massage and warm the breast - then the breast can be emptied more effectively and milk production can be started better.

With the milk bar right in front of your nose, milk production can also be started. (© Vitalinka)

Further measures to increase milk production can be found in the article Increasing the amount of milk: How to produce more milk. The article pumping and storing breast milk also provides information on how the amount of milk can be increased using a pump and manual emptying. In the article Relaktation you will learn how breastfeeding can be re-established after a failed breastfeeding start if you only produce a little milk.

Medical reasons for a restricted milk supply

In rare cases, there are medical problems that lead to the child receiving too little milk:

  • This happens in the first few weeks after the birth Remaining placental remnants in the uterus.In these cases, the woman usually has increased and prolonged bloody weekly flow and can also have persistent pain in the abdomen. The milk can appear noticeably watery. Placental remnants can be discovered by an ultrasound examination in the clinic or at the gynecologist. The consumption of placenta preparations may have a similar effect (see also Placenta preparations can inhibit milk production). At the same time, some mothers can fully breastfeed without any problems despite their placenta.
  • Anemia as a result of severe blood loss or pronounced iron deficiency can also lead to problems with milk production.
  • Probably among the relevant hormonal imbalances are those underactive thyroidwhich can also appear for the first time after birth, and an undiscovered one Insulin resistance most frequently. So is the so-called. polycystic ovarian syndrome, which can also be associated with insulin resistance, a relatively common disease in which, in addition to the difficulty of getting and staying pregnant, milk production can also be inhibited. Postpartum depression can be a symptom of an underactive thyroid. Women with diabetes (diabetes I, II or other forms) have to pay close attention to a good attitude in order to be able to produce milk normally, and need tailored advice and support from qualified breastfeeding specialists and doctors.
  • Furthermore, reduce various Medication milk production. If the woman takes medication, she should have her doctor, pharmacist or a breastfeeding and lactation advisor check the IBCLC for breastfeeding tolerance. For most diseases there are products that are compatible with breastfeeding (see also Medicines and Breastfeeding). On Estrogen-based contraceptives should be avoided if possible during breastfeeding (see hormonal contraceptives can inhibit milk production).
  • Also Luxury foods (especially heavy alcohol or tobacco consumption, see luxury foods during breastfeeding) as well as an intensive one Reduction diet or massive malnutrition of the mother (see nutrition of the breastfeeding mother) can be responsible for “too little milk”.
  • stress and anxiety can inhibit the milk donation reflex.
  • There are also rare cases where the breast is actually unable to produce enough milk because of not enough mammary gland tissue is available. This suspicion arises if a woman's breast does not enlarge during pregnancy. Sometimes the breasts of women with this problem show very large differences in size. Tubular and conical breast shapes can indicate insufficient breast tissue. Sometimes the number of milk ducts in inverted nipples is greatly reduced. In the event of such problems, you should contact the IBCLC breastfeeding and lactation consultants (see e.g. our directory) in good time - ideally during pregnancy. With their support, there is a very good chance of being able to breastfeed fully or partially.
  • In the event of medical problems, it is often advisable to use the breast feeding set

    Furthermore, at Operations or at Injuries Removed or injured mammary gland tissue to varying degrees. Even if there is still enough mammary gland tissue, severing the milk ducts and larger nerves prevents the breast from emptying. In particular, an incision around the nipple is associated with a loss of the ability to breastfeed. If a breast or most of the mammary gland tissue is left intact, more frequent berthing is likely to provide full breastfeeding. Otherwise, partial breastfeeding is often possible (e.g. with a breast feeding set). Whether and how breastfeeding will work has to be tried out. The accompaniment of an IBCLC breastfeeding and lactation advisor is recommended. In many operations today it is possible to use selected techniques to avoid cutting the milk ducts and larger nerves. Breast augmentations can be carried out in such a way that the ability to breastfeed is retained, but even with breast reductions there may still be a chance of being able to breastfeed. More on this in the article Breastfeeding after breast enlargement and reduction.

  • It can also be on infant if the milk production is not started sufficiently. A newborn may be too sleepy or have difficulty sucking, e.g. due to a premature birth, a shortened frenulum of the tongue, neonatal jaundice, cleft lip, jaw, palate, receding chin, Down syndrome, Pierre Robin sequence, neurological impairments, etc. Many diseases can cause the child to fail to thrive. In the case of suction problems, e.g. due to limited tongue mobility with the short tongue, there are also cases in which the milk formation problems only occur after several weeks of successful breastfeeding.

For all these problems, in addition to the aftercare midwives and the responsible doctors, experienced breastfeeding and lactation consultants IBCLC are the right people to contact.

Swell:

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  • Guóth-Gumberger G: Weight history and breastfeeding. Documenting, assessing, accompanying. Mabuse Verlag, 2011. pp. 40-45 (How often do you weigh?) ​​And 89 (a tongue that is too short).
  • Breastfeeding and breast milk nutrition, basics, experience and recommendations; Concrete Health Promotion Volume 3, from the Federal Center for Health Education (publisher), Cologne 2001.
  • Lawrence RA and Lawrence RM: Breastfeeding. A guide for the medical profession. 5th edition, 1999, Mosby and 6th edition, 2005, Elsevier Mosby
  • Riordan J and Auerbach KG: Breastfeeding and Human Lactation, 2nd edition, 1999; Jones and Bartlett Publishers

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