Mother, Infant and Young Child Nutrition & Malnutrition Mother, Infant and Young Child Nutrition & Malnutrition - Feeding practices including micronutrient deficiencies prevention, control of wasting, stunting and underweight
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Home  »  Healthy Nutrition  »  About Essential Nutrition Actions  »  Common Breastfeeding Difficulties

About Essential Nutrition Actions at Critical Stages in the Life Cycle of Women and Children

Common Breastfeeding difficulties

Difficulty or Condition


Correct positioning and attachment

Breastfeed immediately after birth

Breastfeed on demand (as often and as long as baby wants) day and night: 10 - 12 times per 24 hours

• Allow baby to finish first breast before switching to the second breast

1. Apply cold compresses to breasts to reduce swelling; apply warm compresses to "get milk flowing."

2. Breastfeed more frequently or longer

3. Improve infant positioning and attachment

4. Massage breasts

5. Express some milk

6. Apply a warm bottle (demonstrate use of warm bottle)

Sore or Cracked Nipples

Correct positioning of baby

Correct latch-on

• Do not use bottles, dummies or pacifiers

• Do not use soap on nipples

1. Make sure baby is positioned well at the breast

2. Make sure baby latches on to the breast correctly

3. Apply drops of breast milk to nipples and allow to air dry

4. Remove the baby from the breast by breaking suction first

5. Begin to breastfeed on the side that hurts less

6. Do not stop breastfeeding

7. Do not use bottles, dummies or pacifiers

8. Do not use soap or cream on nipples

9. Do not wait until the breast is full to breastfeed. If full, express some milk first.

Plugged Ducts
and Mastitis

• Get support from the family to perform non-infant care chores

• Ensure correct attachment

• Breastfeed on demand

• Avoid holding the breast in scissors hold

• Avoid sleeping on stomach (mother)

• Avoid tight clothing

• Use a variety of positions to rotate pressure points on breasts

1. Apply heat before the start of breastfeeding

2. Massage the breasts before breastfeeding

3. Increase maternal fluid intake

4. Rest (mother)

5. Breastfeed more frequently

6. Seek medical treatment; if mastitis antibiotics may be necessary

7. If mother is HIV-positive: express milk and heat treat or discard

8. Position baby properly

Breast milk

Mother "thinks"
she doesn't have enough milk

• Breastfeed more frequently

• Exclusively breastfeed day and night

• Breastfeed on demand

Correct positioning of baby

• Breastfeed on demand at least every 3 hours

• Encourage support from the family to perform non-infant care chores

• Avoid bottles and pacifiers

1. Withdraw any supplement, water, formulas, tea, or liquids

2. Feed baby on demand, day and night

3. Increase frequency of feeds

4. Wake the baby up if baby sleeps throughout the night or longer than 3 hours during the day

5. Make sure baby latches-on to the breast correctly

6. Reassure mother that she is able to produce sufficient milk

7. Explain growth spurts

8. Baby takes fore and hind milk

Breast milk

weight gain

Fewer than 6 wet diapers per day

Dissatisfied (frustrated and crying) baby

• Same as above

Same as above

Refer mother and baby to nearest health centre


Special Situations

Special Situation

Sick Baby

Baby under 6 months: If the baby has diarrhoea or fever the mother should breastfeed exclusively and frequently to avoid dehydration or malnutrition.

• Breast milk contains water, sugar and salts in adequate quantities, which will help the baby recover quickly from diarrhoea.

• If the baby has severe diarrhoea and shows any signs of dehydration, the mother should continue to breastfeed and provide ORS either with a spoon or cup.

Baby older than 6 months: If the baby has diarrhoea or fever, the mother should breastfeed frequently to avoid dehydration or malnutrition. She should also offer the baby bland food (even if the baby is not hungry).

• If the baby has severe diarrhoea and shows any signs of dehydration, the mother should continue to breastfeed and add ORS.

Sick Mother

• When the mother is suffering from headaches, backaches, colds, diarrhoea, or any other common illness, she should continue to breastfeed her baby.

• The mother needs to rest and drink a large amount of fluids to help her recover.

• If mother does not get better, she should consult a doctor stating that she is breastfeeding.

Premature Baby

• Mother needs support for correct latch-on.

• Breastfeeding is advantageous for pre-term infants; supportive holds may be required.

• Direct breastfeeding may not be possible for several weeks, but expressed breast milk can be stored for use by infant.

• If the baby sleeps for long periods he/she should be unwrapped to encourage waking and held vertically to awaken.

• Mother should watch baby's sleep and wake cycle and feed during quiet-alert states.

Note: Crying is the last sign of hunger. Cues of hunger detection include rooting, licking movements, flexing arms, clenching fists, tensing body, and kicking legs.


• Mothers need to eat extra food - "Feed the mothers, nurse the baby"

• Mothers need to take micronutrients

Mother who is
separated daily
from her infant

• Mother should express or pump milk and store it for use while separated from the baby; the baby should be fed this milk at the same times he/she would normally feed.

• Mother should frequently feed her baby when she is at home.

• Mother who is able to keep her infant with her at the work site should feed her infant frequently.


• The mother can exclusively breastfeed both babies.

The more the baby nurses, the more milk is produced.

Inverted Nipples

• Detect during pregnancy

• Try to pull nipple out and rotate (like turning the knob on a radio)

• Make a hole in the nipple area of a bra. When a pregnant woman wears this bra, the nipple protrudes through the opening

• If acceptable, ask someone to suckle the nipple

Baby who refuses
the breast

• Position the baby properly

• Treat engorgement (if present)

• Avoid giving the baby teats, bottles, pacifiers

• Wait for the baby to be wide awake and hungry (but not crying) before offering the breast

• Gently tease the baby's bottom lip with the nipple until he/she opens his/her mouth wide

• Do not limit duration of feeds

• Do not insist more than a few minutes if baby refuses to suckle

• Avoid pressure to potential sensitive spots (pain due to forceps, vacuum extractor, clavicle fracture)

• Express breast milk, and give by cup


• There are three important things known about drugs and human milk:

1. Most drugs pass into breast milk

2. Almost all medication only appears in small amounts in human milk, usually less than 1% of the maternal dosage

3. Very few drugs are contraindicated for breastfeeding women

Cleft Lip and/or

• Let mother know how important breast milk is for her baby

• Try to fill the space made by the cleft lip with the mother's finger or breast

• Breastfeed infant in a sitting position

• Express milk and give to the infant using a cup or a teaspoon

Mother who is
away from her
infant for an
extended period

Mother expresses breast milk.

Caregiver feeds expressed breast
milk from a cup.

• Mother expresses breast milk by following these steps:

1. Wash hands

2. Prepare a clean container

3. Gently massage breasts in a circular motion

4. Position thumb on the upper edge of the areola and the first two fingers on the underside of the breast behind the areola

5. Push straight into the chest wall

6. For large breasts, first lift and then push into the chest wall

7. Press the areola behind the nipple between the finger & thumb

8. Press from the sides to express milk from the other segments of the breast

9. Repeat rhythmically: position, push, press; position, push, press

10. Rotate the thumb and finger positions

Mother stores breast milk in a clean, covered container. Milk can be stored 8-10 hours at room temperature in a cool place and 72 hours in the refrigerator

Mother or caregiver gives infant expressed breast milk from a cup. Bottles are unsafe to use because they are difficult to wash and can be easily contaminated

Mother who is
chooses to

• Mother should practice exclusive breastfeeding for 6 months. At 6 months mother should introduce appropriate complementary foods

• Mother who experiences breast difficulties such as mastitis, cracked nipples, or breast abscess should breastfeed with the unaffected breast and express and discard milk from the affected breast

• Mother should seek immediate care for a baby with thrush or oral lesions

• Mother who presents with AIDS-related conditions (prolonged fever, severe cough or diarrhoea, or pneumonia) should visit a health centre immediately

Note: A lactating woman should use condoms when having sex to protect herself from exposure to infected semen

Mother who is
chooses to replacement feed

• Mother should practice safe and appropriate use of infant formula or animal's milk (with additional sugar) exclusively for the first 6 months

• Mother should use a cup, not a bottle

• Mother should not mix-feed - "Give only breast milk substitutes, do not breastfeed"

14 September, 2019

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