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Breastfeeding difficulties

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Breastfeeding difficulties
Infant nurses through nipple shield, a device which can assist with certain breastfeeding difficulties.
SpecialtyObstetrics, pediatrics, midwifery Edit this on Wikidata

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants,[1] there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

Difficulties can arise both in connection with the act of breastfeeding and with the health of the nursing infant.

Breastfeeding problems

While breastfeeding difficulties are not uncommon, putting the baby to the breast as soon as possible after birth helps to avoid many problems. The policy of the American Academy of Pediatrics on breastfeeding instructs to, "delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed."[2] Many breastfeeding difficulties can be resolved with research based hospital procedures, properly trained nurses and hospital staff, speech pathologists and lactation consultants.[3] Another source of information is the volunteer-based breastfeeding promotion organization, La Leche League.

A variety of factors and conditions can interfere with successful breastfeeding:

Low milk supply

Main article: Low milk supply
  • Primary lactation failure: occurs when the mother has a condition incompatible with full milk production, for example breast hypoplasia, breast reduction surgery, or bilateral mastectomy.
  • Secondary lactation failure: milk production that is low due to preventable factors, such as formula supplementation, poor milk transfer by the baby, or unrelieved breast engorgement.[17]
  • Chronic low milk supply is estimated to be experienced by 10-15% of women.[18]

Breast pain

Pain often interferes with successful breastfeeding. It is cited as the second most common cause for the abandonment of exclusive breastfeeding after perceived low milk supply.[19]

Inverted nipples

Inverted or retracted nipples sometimes make attachment to the breast difficult.[20] These mothers need additional support to feed their babies. Treatment is started after the birth of the baby. The nipple is manually stretched out several times a day. A pump or a plastic syringe is used to draw out the nipple and the baby is then put to the breast.

Engorgement

Breast engorgement is the sense of breast fullness experienced by most women within 36 hours of delivery. Normally, this is a painless sensation of "heaviness". Breastfeeding on demand is the primary way of preventing painful engorgement.

When the breast overfills with milk it becomes painful. Engorgement comes from not getting enough milk from the breast. It happens about 3 to 7 days after delivery and occurs more often in first time mothers. The increased blood supply, the accumulated milk and the swelling all contribute to the painful engorgement.[21] Engorgement may affect the areola, the periphery of the breast or the entire breast, and may interfere with breastfeeding both from the pain and also from the distortion of the normal shape of the areola/nipple. This makes it harder for the baby to latch on properly for feeding. Latching may occur over only part of the areola. This can irritate the nipple more, and may lead to ineffective drainage of breast milk and more pain. Reverse pressure softening (RPS) is a technique that can soften the areola enabling deeper latching and more milk transfer; RPS involves gentle positive pressure in the direction of the chest wall from the fingertips around the areola.[22] Engorgement may begin as a result of several factors such as nipple pain, improper feeding technique, infrequent feeding or infant-mother separation.

To prevent or treat engorgement, remove the milk from the breast, by breastfeeding, expressing or pumping. Gentle massage can help start the milk flow and so reduce the pressure. The reduced pressure softens the areola, perhaps even allowing the infant to feed. Warm water or warm compresses and expressing some milk before feeding can also help make breastfeeding more effective. Some researchers have suggested that after breastfeeding, mothers should pump and/or apply cold compresses to reduce swelling pain and vascularity even more.[23] One published study suggested the use of "chilled cabbage leaves" applied to the breasts. Attempts to reproduce this technique met with mixed results.[24] Nonsteroidal anti-inflammatory drugs or paracetamol (acetaminophen) may relieve the pain. A warm shower and using cold compresses to help ease the discomfort.[23]

Nipple pain

Sore nipples (nipple pain, or thelalgia) are probably the most common complaint after the birth. They are generally reported by the second day after delivery but improve within 5 days.[25] Pain beyond the first week, severe pain, cracking, fissures or localized swelling is not normal. The mother should see a doctor for further evaluation.[23] Sore nipples, a common cause of pain, often come from the baby not latching on properly. Factors include too much pressure on the nipple when not enough of the areola is latched onto and an improper release of suction at the end of the feeding. Improper use of breast pumps or topical remedies can also contribute.[26] Nipple pain can also be a sign of infection.[27]

Candidiasis

Symptoms of candidiasis of the breast include pain, itching, burning and redness, or a shiny or white patchy appearance.[28] The baby could have a white tongue that does not wipe clean. Candidiasis is common and may be associated with infant thrush.

Both mother and baby must be treated to get rid of this infection.[28] First-line therapies include nystatin, ketaconazole or miconazole applied to the nipple and given by mouth to the baby.[28] Strict cleaning of clothing and breast pumps is also required to eradicate the infection.[29]

Another non-prescription treatment of candidia is gentian violet.[28] It usually works, and relief is rapid. It is messy, and will stain clothing. The baby's lips will turn purple, but the purple will disappear after a few days.

Milk stasis

Milk stasis is when the milk ducts are blocked and cannot drain properly, usually due to swelling and insufficient breast emptying during the engorgement phase. This may affect only a part of the breast and is not associated with any infection. It can be treated by varying the baby's feeding position and applying heat before feeding. If it happens more than once, further evaluation is needed. Milk stasis is an urgent matter for mothers who wish to breastfeed, as failure to remove milk from the breasts causes milk production to decrease and eventually stop.

Mastitis

Main article: Puerperal mastitis

Mastitis is an inflammation of the breast. It causes local pain (dolor), redness (rubor), swelling (tumor), and warmth (calor). Later stages of mastitis cause symptoms of systemic infection like fever and nausea. It mostly occurs 2–3 weeks after delivery but can happen at any time.[30] Typically results from milk stasis with primary or secondary local, later systemic infection. Infectious organisms include Staphylococcus sp., Streptococcus sp. and E. coli. Continued breastfeeding, plenty of rest and adequate fluid supply is the best treatment for light cases.

Overactive let-down

Main article: Overactive let-down

Overactive let-down (OALD) is the forceful ejection of milk from the breast during breastfeeding. The forceful spray of milk can cause the baby to consume too much milk too quickly as well as to swallow air during the period of rapid swallowing following the let-down.

Raynaud's of the nipple

Main article: Nipple blanching
Nipple blanching, or vasospasm of the nipple

Nipple pain can be caused by vasospasm of the nipple. In essence, blood does not flow properly to the nipple which causes the nipple to blanch. This can be caused by trauma to the nipple through early breastfeeding or candidal infection of the nipple. The pain is intense during the latch stage and in between breastfeeding sessions there is a throbbing pain when the nipple is blanched. The nipple can be massaged to help blood flow return to reduce pain, as well as avoiding cold. In some instances, heart medication, nifedipine, is used to help the blood flow return to the nipple.[31]

Infant health problems

Infants with classic galactosemia cannot digest lactose and therefore cannot benefit from breast milk.[32] Breastfeeding might harm the baby also if the mother has untreated pulmonary tuberculosis, is taking certain medications that suppress the immune system.[32] has HIV,[32][33] or uses potentially harmful substances such as cocaine, heroin, and amphetamines.[2] Other than cases of acute poisoning, no environmental contaminant has been found to cause more harm to infants than lack of breastfeeding. Although heavy metals such as mercury are dispersed throughout the environment and are of concern to the nursing infant, the neurodevelopmental benefits of human milk tend to override the potential adverse effects of neurotoxicants.[34]

Weak sucking reflex

Artificial teats (nipples) or dummies (pacifiers) can suppress the sucking reflex in infants. In addition, when a baby is put to the breast for shorter periods of time, milk production decreases. The time spent sucking by the infant on the pacifier or artificial teat reduces the time on the breast.[35][36] The CDC also currently (2022) reports that early use of pacifiers can have a negative outcome on the success of breastfeeding and they suggest that it should be delayed until breastfeeding is firmly established.[37]

Transmission of infection

Tuberculosis

It is not safe for mothers with active, untreated tuberculosis to breastfeed until they are no longer contagious.[2] According to the American Academy of Pediatrics 2006 Redbook:

Women with tuberculosis who have been treated appropriately for 2 or more weeks and who are not considered contagious may breastfeed. Women with tuberculosis disease suspected of being contagious should refrain from breastfeeding or any other close contact with the infant because of potential transmission through respiratory tract droplets (see Tuberculosis, p 678). Mycobacterium tuberculosis rarely causes mastitis or a breast abscess, but if a breast abscess caused by M. tuberculosis is present, breastfeeding should be discontinued until the mother no longer is contagious.

In areas where BCG vaccination is the standard of care, the WHO provides treatment recommendations and advises mothers to continue breastfeeding.[38] TBC may be congenital, or perinatally acquired through airborne droplet spread.[39]

HIV

Main article: Breastfeeding by HIV infected mothers

Research published in the Lancet[40][41] has highlighted a lower risk of HIV transmission with exclusive breastfeeding by HIV positive mothers (4% risk), compared to mixed feeding (10-40% risk). Research on the timing of HIV transmission in 2000 revealed that a "substantial transmission occurs early during breastfeeding," concluding that 75% of all breast milk transmission had occurred within the first 6 months during a randomized control trial in Kenya.[42] This research is of particular importance in developing countries where infant formula is not widely available or safe to prepare. In fact, the World Health Organization recommended breastfeeding in 1987 and 1992 for seropositive and seronegative women in areas where malnutrition and infectious diseases are the major cause of infant mortality.[43][44] In 1996 UNAIDS issued a recommendation that women in developing countries consider the risks and benefits of each feeding practice on an individual level; they recommended women make an informed choice about infant feeding.[45] In the days before the AIDS epidemic was clearly understood, some researchers pointed to the need to increase breastfeeding rates and pointed to the risks of formula feeding, citing increased rates of marasmus and diarrhea.[46] D Jelliffe and E Jelliffe also criticized the marketing of infant formulas by US companies to resource-poor countries, something they termed "comerciogenic malnutrition." A more recent article from 1992 describes how the health of an infant can be compromised by water, which in many resource-poor countries holds the risk of environmental pathogens that are not present in breastmilk.[47]

Transmission of drugs and toxins

Main article: Breastfeeding and medications

Medications

The vast majority of over the counter and prescription medicines are compatible with breastfeeding, but there are some that might be passed onto the child through the milk.[48]

Tobacco smoke

See also: Women and smoking § Unique gender differences and health effects for Females

If one does continue tobacco smoking after giving birth, however, it is still more beneficial to breastfeed than to completely avoid this practice altogether. There is evidence that breastfeeding offers protection against many infectious diseases, especially diarrhea. Even in babies exposed to the harmful effects of nicotine through breast milk, the likelihood of acute respiratory illness is significantly diminished when compared to infants whose mothers smoked but were formula fed.[49] Regardless, the benefits of breastfeeding outweigh the risks of nicotine exposure.

The main concern about smoking and breastfeeding is that infants may have smoking-induced reductions to the milk iodine content.[49] Smoking can adversely affect the lactation process by decreasing milk production and altering the milk composition. Smoking reduces daily milk output by roughly 250–300 mL. Not only will this be problematic on a daily basis for not producing enough milk, it will also cause the mother to wean her baby early.[50] The altered milk composition also caused infants to exhibit daily behaviors such as colic and crying which can promote early weaning, again something that is not beneficial to the infant.[49]

Also, the nicotine obtained from smoking travels through a woman into her breast milk, thus giving nicotine to her child.[51]

Heavy use of cigarettes by the mother (more than 20 per day) has been shown to reduce the mother's milk supply and cause vomiting, diarrhoea, rapid heart rate, and restlessness in breastfed infants. Sudden Infant Death Syndrome (SIDS) is more common in babies exposed to a smoky environment.[52] Breastfeeding mothers who smoke are counseled not to do so during or immediately before feeding their child, and are encouraged to seek advice to help them reduce their nicotine intake or quit.[53]

Other substance abuse

With respect to alcohol, the American Academy of Pediatrics states that when breastfeeding, "moderation is definitely advised" and recommends waiting for 2 hours after drinking before nursing or pumping.[54] A 2014 review found that "even in a theoretical case of binge drinking, the children would not be subjected to clinically relevant amounts of alcohol [through breastmilk]", and would have no adverse effects on children as long as drinking is "occasional".[55]

If the mother consumes too much caffeine, it can cause irritability, sleeplessness, nervousness and increased feeding in the breastfed infant. Moderate use (one to two cups per day of coffee, tea, or cola) usually produces no effect.[56] Breastfeeding mothers are advised to restrict or avoid caffeine if her baby reacts negatively to it.[57] Cigarette smoking is thought to increase the effects of caffeine in the baby.[58]

Cannabis

Cannabis is listed by the American Association of Pediatrics as a compound that transfers into human breast milk. Research demonstrated that certain compounds in marijuana have a very long half-life.[59]

Diet

An exclusively breastfed baby depends on breast milk completely so it is important for the mother to maintain a healthy lifestyle, and especially a good diet.[60] Consumption of 1500–1800 calories per day could coincide with a weight loss of 450 grams (one pound) per week.[61] While mothers in famine conditions can produce milk with highly nutritional content, a malnourished mother may produce milk with decreased levels of several micronutrients such as iron, zinc, and vitamin B12.[34] She may also have a lower supply than well-fed mothers.

There are no foods that are absolutely contraindicated during breastfeeding, but a baby may show sensitivity to particular foods that the mother eats.

Workplaces

Many mothers have to return to work soon after their babies have been born. If their employers and fellow employees do not support mothers in breastfeeding (for example, providing a private breastfeeding room containing a fridge where mothers can express and safely store breast milk), mothers might stop breastfeeding. This is not ideal for their infants. A Cochrane review assessed the effects of workplace interventions to support and promote breastfeeding among mothers returning to work after the birth of their babies.[62] The review authors comprehensively searched in 2012 for studies addressing this question but found no eligible studies. "The return to work can impact the amount of breastmilk that your body produces due to the stress and changes of leaving your baby."

References

  1. ^ Picciano MF (February 2001). "Nutrient composition of human milk". Pediatric Clinics of North America. 48 (1): 53–67. doi:10.1016/S0031-3955(05)70285-6. PMID 11236733.
  2. ^ a b c Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, Eidelman AI (February 2005). "Breastfeeding and the use of human milk". Pediatrics. 115 (2): 496–506. doi:10.1542/peds.2004-2491. PMID 15687461.
  3. ^ Newman J; Pitman T (2000). Dr. Jack Newman's guide to breastfeeding. HarperCollins Publishers. ISBN 978-0-00-638568-4.
  4. ^ Genna CW (2002). "Tongue-tie and breastfeeding". LEAVEN. 38 (2): 27–29. Archived from the original on 2017-08-26. Retrieved 2007-08-27.
  5. ^ Ballard JL, Auer CE, Khoury JC (November 2002). "Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad". Pediatrics. 110 (5): e63. doi:10.1542/peds.110.5.e63. PMID 12415069.
  6. ^ Hagan J Jr (September 2001). "The assessment and management of acute pain in infants, children, and adolescents". Pediatrics. 108 (3): 793–797. doi:10.1542/peds.108.3.793. PMID 11533354.
  7. ^ a b "How do I breastfeed?". nichd.nih.gov/. Retrieved 2020-10-29.
  8. ^ "Will stress during pregnancy affect my baby?". nichd.nih.gov/. Retrieved 2020-10-29.
  9. ^ "Supporting Nursing Moms at Work". womenshealth.gov. 2018-07-12. Retrieved 2020-10-29.
  10. ^ Brent NB (September 2001). "Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment". Clinical Pediatrics. 40 (9): 503–506. doi:10.1177/000992280104000905. PMID 11583049. S2CID 12091215.
  11. ^ Bentley-Lewis R, Goldfine AB, Green DE, Seely EW (November 2007). "Lactation after normal pregnancy is not associated with blood glucose fluctuations". Diabetes Care. 30 (11): 2792–2793. doi:10.2337/dc07-1243. PMC 4428539. PMID 17698611.
  12. ^ Genna CW (2002). "Tactile Defensiveness and Other Sensory Modulation Difficulties". LEAVEN. 37 (3): 51–53. Archived from the original on 2017-08-06. Retrieved 2007-08-27.
  13. ^ Livingstone V (January 1996). "Too much of a good thing. Maternal and infant hyperlactation syndromes". Canadian Family Physician. 42: 89–99. PMC 2146202. PMID 8924818.
  14. ^ Mohrbacher N, Stock J (2003). The Breastfeeding Answer Book (3rd (revised) ed.). La Leche League International. ISBN 978-0-912500-92-8.
  15. ^ "Breastfeeding a baby with a health problem | womenshealth.gov". womenshealth.gov. February 2017. Retrieved 2018-11-07.
  16. ^ "d-mer.org". d-mer.org. Retrieved 2010-09-10.
  17. ^ Hurst NM (2007). "Recognizing and treating delayed or failed lactogenesis II". Journal of Midwifery & Women's Health. 52 (6): 588–594. doi:10.1016/j.jmwh.2007.05.005. PMID 17983996.
  18. ^ Lee S, Kelleher SL (August 2016). "Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology". American Journal of Physiology. Endocrinology and Metabolism. 311 (2): E405–E422. doi:10.1152/ajpendo.00495.2015. PMC 5005964. PMID 27354238.
  19. ^ Woolridge MW (December 1986). "Aetiology of sore nipples". Midwifery. 2 (4): 172–176. doi:10.1016/S0266-6138(86)80042-0. PMID 3643398.
  20. ^ "Challenge: Inverted, flat, or very large nipples". Common breastfeeding challenges. U.S. Department of Health & Human Services. Office on Women's Health. February 2017. Retrieved 7 November 2018.
  21. ^ Hill PD, Humenick SS (June 1994). "The occurrence of breast engorgement". Journal of Human Lactation. 10 (2): 79–86. doi:10.1177/089033449401000212. PMID 7619260. S2CID 25908855.
  22. ^ Pednekar, Priyanka Sandeep (2021-04-02). "Effectiveness of Reverse Pressure Softening of Areola in Women with Postpartum Breast Engorgement". Indian Journal of Physiotherapy and Occupational Therapy. 15 (2): 50–58. doi:10.37506/ijpot.v15i2.14513. S2CID 241146508.
  23. ^ a b c "Overcoming breastfeeding problems: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2020-10-29.
  24. ^ Nikodem VC, Danziger D, Gebka N, Gulmezoglu AM, Hofmeyr GJ (June 1993). "Do cabbage leaves prevent breast engorgement? A randomized, controlled study". Birth. 20 (2): 61–64. doi:10.1111/j.1523-536X.1993.tb00418.x. PMID 8240608.
  25. ^ Ziemer MM, Paone JP, Schupay J, Cole E (December 1990). "Methods to prevent and manage nipple pain in breastfeeding women". Western Journal of Nursing Research. 12 (6): 732–43, discussion 743–44. doi:10.1177/019394599001200603. PMID 2275191. S2CID 9921276.
  26. ^ Cable B, Stewart M, Davis J (December 1997). "Nipple wound care: a new approach to an old problem". Journal of Human Lactation. 13 (4): 313–318. doi:10.1177/089033449701300417. PMID 9429367. S2CID 22804136.
  27. ^ Amir LH, Garland SM, Dennerstein L, Farish SJ (1996). "Candida albicans: is it associated with nipple pain in lactating women?". Gynecologic and Obstetric Investigation. 41 (1). Karger: 30–34. doi:10.1159/000292031. PMID 8821881.
  28. ^ a b c d Wiener S (March–April 2006). "Diagnosis and management of Candida of the nipple and breast". Journal of Midwifery & Women's Health. 51 (2): 125–128. doi:10.1016/j.jmwh.2005.11.001. PMID 16504910.
  29. ^ Tanguay KE, McBean MR, Jain E (August 1994). "Nipple candidiasis among breastfeeding mothers. Case-control study of predisposing factors". Canadian Family Physician. 40: 1407–1413. PMC 2380126. PMID 8081120.
  30. ^ Evans ME, Heads J (February 1999). "Incidence of mastitis in breastfeeding women during the six months after delivery: a prospective cohort study". The Medical Journal of Australia. 170 (4): 192. doi:10.5694/j.1326-5377.1999.tb127735.x. PMID 10078195. S2CID 31019946.
  31. ^ Kernerman E. "Vasospasm and Raynaud's Phenomenon". Centre for Breastfeeding Education. Archived from the original on 2012-03-18. Retrieved 2012-10-18.
  32. ^ a b c "When should a mother avoid breastfeeding?". Centers for Disease Control and Prevention. 2006-08-26. Retrieved 2007-03-04.
  33. ^ "HIV and Infant Feeding". Unicef. Archived from the original on 2018-05-11. Retrieved 2006-08-19.
  34. ^ a b Mead MN (October 2008). "Contaminants in human milk: weighing the risks against the benefits of breastfeeding". Environmental Health Perspectives. 116 (10): A427–A434. doi:10.1289/ehp.116-a426. PMC 2569122. PMID 18941560. Archived from the original on 2008-11-06. Retrieved 2008-10-23.
  35. ^ Marmet C, Shell E, Aldana S (November 2000). "Assessing infant suck dysfunction: case management". Journal of Human Lactation. 16 (4): 332–336. doi:10.1177/089033440001600409. PMID 11188682. S2CID 208505043.
  36. ^ Jaafar SH, Ho JJ, Jahanfar S, Angolkar M (August 2016). "Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding". The Cochrane Database of Systematic Reviews. 2016 (8): CD007202. doi:10.1002/14651858.CD007202.pub4. PMC 8520760. PMID 27572944.
  37. ^ "Infant Safety in Maternity Care Practices that Support Breastfeeding in US Birth Facilities". CDC. 28 January 2021. Retrieved January 14, 2022.
  38. ^ The WHO Archived November 7, 2006, at the Wayback Machine on Breastfeeding and maternal tuberculosis; acquired 2006-08-19
  39. ^ Nemir RL, O'Hare D (March 1985). "Congenital tuberculosis. Review and diagnostic guidelines". American Journal of Diseases of Children. 139 (3): 284–287. doi:10.1001/archpedi.1985.02140050078028. PMC 5209150. PMID 3976610.
  40. ^ Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML (March 2007). "Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study". Lancet. 369 (9567): 1107–1116. doi:10.1016/S0140-6736(07)60283-9. PMID 17398310. S2CID 6183061.
  41. ^ Breastfeeding alone cuts HIV risk
  42. ^ Nduati R, John G, Mbori-Ngacha D, Richardson B, Overbaugh J, Mwatha A, et al. (March 2000). "Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial". JAMA. 283 (9): 1167–1174. doi:10.1001/jama.283.9.1167. PMID 10703779.
  43. ^ World Health Organization. Statement from the Consultation on Breast-feeding/Breast Milk and Human Immunodeficiency Virus (HIV). Geneva, Switzerland: WHO; 1987.
  44. ^ Global Programme on AIDS (1992). "Consensus statement from the WHO/UNICEF consultation on HIV transmission and breast-feeding". Weekly Epidemiol Record. 67: 177–179.
  45. ^ Joint United Nations Program on HIV/AIDS. (1996). "HIV and infant feeding". Weekly Epidemiological Record. 71: 289–291.
  46. ^ Jelliffe DB, Jelliffe EF (August 1978). "Feeding young infants in developing countries: comments on the current situation and future needs". Studies in Family Planning. 9 (8): 227–9. doi:10.2307/1965868. JSTOR 1965868. PMID 715834.
  47. ^ Dettwyler K; Fishman C (1992). "Infant Feeding Practices and Growth". Annual Review of Anthropology. 21: 171–204. doi:10.1146/annurev.an.21.100192.001131.
  48. ^ American Academy of Pediatrics Committee on Drugs (September 2001). "Transfer of drugs and other chemicals into human milk". Pediatrics. 108 (3): 776–789. doi:10.1542/peds.108.3.776. PMID 11533352.
  49. ^ a b c Mennella JA, Yourshaw LM, Morgan LK (September 2007). "Breastfeeding and smoking: short-term effects on infant feeding and sleep". Pediatrics. 120 (3): 497–502. doi:10.1542/peds.2007-0488. PMC 2277470. PMID 17766521.
  50. ^ Najdawi, F and Faouri, M 1999. Maternal smoking and breastfeeding. Eastern Mediterranean Health Journal. 5(3): 450-456
  51. ^ The U.S. Surgeon General's Report Archived 2011-08-06 at the Wayback Machine (Chapter 5; pp. 180–194).
  52. ^ Gunn AJ, Gunn TR, Mitchell EA (October 2000). "Is changing the sleep environment enough? Current recommendations for SIDS". Sleep Medicine Reviews. 4 (5): 453–469. doi:10.1053/smrv.2000.0119. PMID 17210277.
  53. ^ Villamunga D (2004). "Smoking and Breastfeeding". LEAVEN. 40 (4): 75–78. Archived from the original on 2018-01-27. Retrieved 2007-08-27.
  54. ^ American Academy of Pediatrics. "Fetal Alcohol Spectrum Disorders Toolkit Frequently Asked Questions". Retrieved 15 Nov 2017.
  55. ^ Haastrup MB, Pottegård A, Damkier P (February 2014). "Alcohol and breastfeeding". Basic & Clinical Pharmacology & Toxicology. 114 (2): 168–173. doi:10.1111/bcpt.12149. PMID 24118767.
  56. ^ "Your Guide to Breastfeeding" (PDF). Office of Women's Health. U.S. Department of Health and Human Services. Archived from the original (PDF) on October 17, 2020. Retrieved November 7, 2018.
  57. ^ "Things to Avoid When Breastfeeding". HealthyChildren.org. Retrieved 2018-11-07.
  58. ^ Lawrence RA, Lawrence RM (1999). Breastfeeding: A Guide for the Medical Profession (5th ed.). C.V. Mosby. p. 369. ISBN 978-0-8151-2615-7.
  59. ^ American Association of Pediatrics Archived September 27, 2007, at the Wayback Machine on cannabis (see table 2); acquired 2006-08-19
  60. ^ Tamborlane WV, Weiswasser JZ (1997). The Yale guide to children's nutrition. New Haven: Yale University Press. p. 33. ISBN 978-0-300-07169-6.
  61. ^ "How can I lose weight safely while breastfeeding?". La Leche League International. 2006-08-29. Archived from the original on 2007-02-20. Retrieved 2007-02-12.
  62. ^ Abdulwadud OA, Snow ME (October 2012). "Interventions in the workplace to support breastfeeding for women in employment". The Cochrane Database of Systematic Reviews. 10 (10): CD006177. doi:10.1002/14651858.CD006177.pub3. PMC 7388861. PMID 23076920.
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