Clinical Review

Managing common breastfeeding problems in the community

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2954 (Published 12 May 2014) Cite this as: BMJ 2014;348:g2954
  1. Lisa H Amir, principal research fellow1, medical officer2
  1. 1Judith Lumley Centre, La Trobe University, Melbourne, VIC 3000, Australia
  2. 2Breastfeeding Service, Royal Women’s Hospital, Parkville, VIC 3052, Australia
  1. Correspondence to: L H Amir l.amir{at}latrobe.edu.au

Summary points

  • Breastfeeding rates are lowest in groups most at risk of ill health: preterm infants, low socioeconomic status, and mothers who are young, overweight, or obese

  • General practitioners play a key role in managing breastfeeding problems in the community

  • Women experiencing nipple pain should be referred to a local infant feeding expert to ensure optimal attachment of the infant to the breast

  • In addition to nipple pain and damage from poor attachment, pain may be caused by anatomical problems, such as infant tongue-tie, maternal infection (bacterial, thrush, herpes), dermatitis, or nipple vasospasm

  • There is a continuum from engorgement or blocked duct (swollen area of breast with redness or systemic symptoms) to mastitis (red, painful, firm area of breast with fever or systemic symptoms) to breast abscess

  • Ongoing maternal milk supply is under local (autocrine) control: removal of milk stimulates the breast to produce more milk

Breast feeding is universally acknowledged as the first step in the promotion of health and wellbeing of children and their families. The World Health Organization recommends breast feeding for two years or beyond,1 with solids introduced around 6 months of age. Since WHO and Unicef established the baby friendly hospital initiative in 1991, maternity services around the world have been improving support within hospitals for breastfeeding initiation. Support for breast feeding in the community has not received the same attention, however, and women often cease breast feeding in the early weeks when they encounter or perceive problems. Medical practitioners may not receive education in managing breastfeeding problems and at times may provide advice that is inappropriate or unhelpful.

Sources and selection criteria

I searched the Cochrane database of systematic reviews, guidelines of the UK National Institute for Health and Care Excellence and US Academy of Breastfeeding Medicine, and my own EndNote library. I also searched PubMed using the terms …

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