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Signs you need to see a lactation consultant (IBCLC) by Mirna Sabbagh, Nutritionist and IBCLC

When is breastfeeding normal and when should you seek a lactation consultant? An article by Mirna Sabbagh, nutritionist , dietitian, and IBCLC at myPediaclinic (Voted best pediatric clinic in Dubai)

If the mother does skin to skin at birth with her baby and breastfeeds within one hour and continuous to breastfeed on demand since birth, there should be no problems with breastfeeding, especially if the baby has a good latch. However this is not always the case and for many mothers breastfeeding does not get off to a right start and that affects the mother and the baby’s emotional and physical well being.

Some breastfeeding concerns may be easily solved by knowledgeable friends and communities such as the mother doubting herself or doubting her milk supply even though the baby is gaining weight and is in good health. However other problems need medical support from a health care professional, preferably an IBCLC (International Board Certified Lactation Consultant) who will be able to asses the baby’s latch, the baby’s weight gain, and the mother’s milk supply. There are times that the IBCLC will have to work with other members of the health care team to make sure the baby’s weight gain/loss is not due to medical reasons or anatomical problems such as tongue tie and lip tie in the baby. 

For this reason it is vital to seek help by contacting an IBCLC if you or a friend of yours is going through any of the following cases. The sooner you seek help, the better odds for a successful breastfeeding journey. Our Lactation Consultant (IBCLC) Mirna Sabbagh provides us with 7 reasons you need to contact an IBCLC today.

  1. Pain during breastfeeding

Pain during breastfeeding is actually abnormal. It could be caused either by an incorrect latch or by the baby having anatomical problems. Both of which could be assessed by an IBCLC. Tongue tie diagnosis is also best diagnosed and confirmed by a tongue tie expert. Please read more about tongue and lip ties by Dr. Medhat Abu-Shaaban, pediatrician and tongue tie expert at myPediaclinic in Dubai on “Tongue Tie Diagnosis and Treatment”

  1. Baby not latching on the breast

A baby could not latch on the breast for several reasons. Some of them have to do with the mother’s nipple shape such as inverted or flat nipples. Other reasons could have to do with the baby’s tongue or lip tie as mentioned above or cleft palate or other problems such as Down Syndrome or others. Either way an IBCLC will be able to figure out what is the problem and then help the baby latch. The IBCLC may resort to several techniques to help the baby latch such as everting the nipple before the baby latches and also by using nipple shields if needed. Do not use a nipple shield before discussing with an IBCLC first as it is difficult to wean off and may not be needed depending on the problem. For other problems such as Down Syndrome or Hypotonia an IBCLC will be able to use different latching techniques to help the baby on the breast.

  1. Losing weight

All babies lose up to 7-10% of their birth weight during the first week of birth. However losing beyond this range could signify a problem with either milk supply or baby’s ability to extract milk from the breast. An IBCLC will be able to assess the problem and provide support where needed be it by optimizing latch, or by increasing milk supply as needed before resorting to formula

  1. Not regaining birth weight by 14 days

This issue is similar to the problem above, the baby might be latched and gaining weight slowly but not at a pace that is appropriate for age. This is judged by plotting weight/age, height/age, and weight/height as per the WHO chart tables for breastfed babies. If the baby is falling off the percentile and not gaining adequate weight appropriate measures should be taken by trying to increase milk supply if all other medical reasons are excluded.

  1. Not gaining 20-30 grams per day after the initial 14 days

Similar to above. Breasts do not have measurements on them and we can not know how much the baby is getting per feed. Weight is one of the main measures of breastmilk intake, for this reason it is important to keep an eye on it so that the baby does not risk dehydration or growth delay.

  1. Appropriate diaper output

Diaper output is another measure of adequate breast milk intake. One stool on day 1. Two stools on day 2. Three stools on day 3. Four stools on day 4 and beyond. We should be able to also see similar wet diapers ranging between 4-6 pale urine outputs. If not, check with an IBCLC to make sure there is no problem with milk supply or milk extraction before checking for medical reasons or needing to supplement with formula.

  1. Mastitis

Mastitis is common among women with oversupply, women who mix feed bottle and breast, and women who pump. If you wish to pump during the early days make sure to do it at the same time every day as not to confuse the body. If you are giving supplements also make sure to give it at the same day. If you do develop mastitis, or begin to develop mastitis contact an IBCLC immediately so it does not progress. Signs of mastitis would be engorgement, swelling, redness, pain, fever, fatigue.

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