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(Pediatrics in Review. 1997;18:147-161.)
© 1997 American Academy of Pediatrics

Breastfeeding Update 2: Clinical Lactation Management¹

Nancy G. Powers, MD^*
Wendelin Slusser, MS, MD

^* Medical Director of Lactation Services, Associates in Neonatology, Columbia Wesley Medical Center; Clinical Associate Professor of Pediatrics, University of Kansas School of Medicine, Wichita, KS.

Assistant Clinical Professor, Department of Pediatrics, UCLA; Director, UCLA Breastfeeding Resource Program at the UCLA Center for Healthier Children, Families and Communication, School of Public Health, Los Angeles, CA.

	IMPORTANT POINTS

 

1. Physicians can help limit infants' exposure to medications in human milk without interfering with breastfeeding.
   
2. Maternal breast problems and conditions may be significantly related to feeding difficulties; to detect most of these, the pediatrician must obtain a thorough maternal history and physically inspect the breasts.
   
3. Despite the many advantages of human milk and breastfeeding for the preterm infant, required hospitalization imposes barriers to milk production and breastfeeding. These mothers require attention and support.
   
4. Early identification of the breastfed term infant who has inadequate intake will prevent morbidity while physician and mother work to preserve breastfeeding.
   
5. Very few maternal infections are a contraindication to breastfeeding.
   

Clinical lactation management is the science and art of assisting women and infants with breastfeeding. Until recently, lactation and breastfeeding rarely were addressed in medical school or residency training. If breastfeeding was taught, it was by lecture, not by clinical example. Because the mother-infant pair is dynamically interrelated for breastfeeding, it is imperative to consider both individuals when attempting to assess and "manage" breastfeeding. Multidisciplinary input is desirable and often critical.

	Current State of Affairs

 
During the past 5 years, with the resurgence of professional and lay interest in the promotion of breastfeeding, it has become increasingly common to encounter nurses who are lactation consultants. They may be working in hospitals, physician offices, or private practice. It also is becoming increasingly common for physicians to use their office nurses as "lactation educators" or "breastfeeding specialists" once these nurses have acquired sufficient knowledge, expertise, and experience. These individuals have an in-depth knowledge of early breastfeeding management and problem solving; they also are clinically competent to assist and support the mother-infant pair. Their particular areas of expertise include (but are not limited to): understanding the anatomy and physiology of lactation (Fig. 1) ; facilitating immediate breastfeeding postpartum; proper positioning and latch-on of . . . [Full Text of this Article]

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