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Special Situations and Breastfeeding

Created by: Melissa Werner
Posted : Monday January 01, 1900

Some babies are born with conditions that may interfere with or make breastfeeding more difficult

Some babies are born with conditions that may interfere with or make breastfeeding more difficult. However, in all of the following cases, breastfeeding is still best for the baby to thrive.


Jaundice is a condition that is common in many newborns. It appears as a yellowing of the skin and eyes and is caused by an excess of bilirubin, a yellow pigment that is a product in the blood. All babies are born with extra red blood cells that undergo a process of being broken down and eliminated from the body. Bilirubin levels in the blood can be high because of higher production of it in a newborn, an increased ability of the newborn intestine to absorb it, and a limited ability of the newborn liver to handle large amounts of it. Many cases of jaundice do not need to be treated-a health care provider will careful monitor the baby's bilirubin levels. Sometimes infants have to be temporarily separated from the mother to receive special treatment with phototherapy. In these cases, breastfeeding may be discouraged and supplements or other fluids may be given to the baby. However, the American Academy of Pediatrics discourages against stopping breastfeeding in jaundiced babies and suggests continuing frequent breastfeeding, even during treatment. If your baby is jaundiced or develops jaundice, it is important to discuss with your health care provider all possible treatment options and share that you do not want to interrupt nursing (if this is at all possible).

Babies with Reflux:

It is not unusual for babies spit up after nursing. Usually, babies can spit up and show no other signs of illness, and the spitting up disappears as the baby's digestive system matures. As long as the baby has six to eight wet diapers and at least two bowel movements in a 24 hour period (under six weeks of age), and your baby is gaining weight (at least 4 ounces a week) you can be assured your baby is getting enough milk.

However, some babies have a condition called gastroesophageal reflux (GER), which occurs when the muscle at the opening of the stomach opens at the wrong times, allowing milk and food to come back up into the esophagus (the tube in the throat). Symptoms of GER can include:

  • severe spitting up, or spitting up after every feeding, or hours after eating
  • projectile vomiting, where the milk shoots out of the mouth
  • inconsolable crying as if in discomfort
  • arching of the back as if in severe pain
  • refusal to eat or pulling away from the breast during feeding
  • waking up frequently at night
  • slow weight gain
  • difficulty swallowing
  • gagging or choking
  • frequent red or sore throat
  • frequent hiccupping or burping
  • signs of asthma, bronchitis, wheezing, problems breathing, pneumonia, or apnea.

NOTE: Many healthy babies might have some of these symptoms and not have GER. But there are babies who might only have a few of these symptoms and have a severe case of GER. Not all babies with GER spit up or vomit.

Some babies with GER do not have a serious medical problem, but caring for them can be hard since they tend to be very fussy and wake up frequently at night. More severe cases of GER may need to be treated with medication if the baby, in addition to spitting up, also refuses to nurse, gains weight poorly or is losing weight, or has periods of gagging or choking.

If your baby spits up after every feeding and any of the other symptoms mentioned above, it is best to see your health care provider so your baby can be correctly diagnosed. Other than GER, your baby could have another condition that needs treatment. If there are no other signs of illness, he/she could just be sensitive to a food in your diet or a medication he/she's receiving. If your baby has GER, it is important to try to continue to breastfeed since breast milk still is more easily digested than formula. Try smaller, more frequent feedings, thorough burping, and putting the baby in an upright position during and after feedings.

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