One in three moms who start breastfeeding will stop within 2 weeks. So, what will you do as A community pharmacist to support breastfeeding? ã…¡ Work as a team to help women with common breastfeeding concerns...
Sore or cracked nipples are often due to technique problems and usually get better once technique is corrected. Offer help if needed or suggest seeing a lactation consultant. Tell moms that they can try massaging a few drops of breast milk on the nipples before and after each feeding, or try applying purified lanolin (Lansinoh, Purelan, etc) or glycerin pads. Explain there's not good evidence topical products really help, but they're unlikely to harm.
Low milk production can be due to infrequent nursing, not drinking enough fluids, plugged ducts, medications, etc. If needed, try to avoid medications that DECREASE milk production such as combo oral contraceptives, diphenhydramine, or pseudoephedrine. Save metoclopramide (Primpran) or domperidone (Motilium) 10 mg three times a day for 10 days as a last resort. There's not much evidence it works, and it can cause side effects in the infant and mom. Don't recommend supplements. There's no proof fenugreek, brewer's yeast, or others increase milk supply, and they may be risky.
Mastitis or swollen breasts can be caused by plugged ducts, poor technique. Advise to breastfeed more often, massage the breasts and use warm compresses and take ibuprofen (Brufen) 400 mg 3 times daily with food or acetaminophen (Panadol) 500 mg to 1000 mg PRN for pain. Use Amox/Clav (Augmentin) or cephalexin (Ceporex) if antibiotics are needed.
Shiny, flaky, or burning nipples might be due to Candida infection. For Candida, use topical clotrimazole (Dermatin, Closol, Candistan) or miconazole (Daktarin, Micoban, Miconaz) on mom's nipples and prescribing nystatin drops (Fungifree, Orastatin, Mycostatin) 2 mL orally 4 times/day placed in baby's cheeks after feedings.
REFERENCES
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Wagner EA, Chantry CJ, Dewey KG, Nommsen-Rivers LA. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics. 2013 Oct;132(4):e865-75. Available at: https://publications.aap.org/pediatrics/article-abstract/132/4/e865/64817/Breastfeeding-Concerns-at-3-and-7-Days-Postpartum?redirectedFrom=fulltext
Dennis CL, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database Syst Rev. 2014 Dec 15;(12):CD007366. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007366.pub2/full
Ingram J, Taylor H, Churchill C, Pike A, Greenwood R. Metoclopramide or domperidone for increasing maternal breast milk output: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2012 Jul;97(4):F241-5. Available at: https://fn.bmj.com/content/97/4/F241.long
Barrett ME, Heller MM, Fullerton Stone H, Murase JE. Dermatoses of the breast in lactation. Dermatol Ther. 2013 Jul-Aug;26(4):331-6. Available at: https://onlinelibrary.wiley.com/doi/10.1111/dth.12071