Literature review for - Flourish Paediatrics

Table.
Management of breastmilk insufficiency
A narrative review on the clinical aspects of lactation recommends women with perceived
milk insufficiency regularly express any residual milk after a feed to establish and maintain a
regular supply (Neifert 1999).
A narrative review on assessing slow growth in breastfed infants suggests ‘switch nursing’,
supplementer tube at the breast and medications to assist lactation as possible methods of
managing low milk production (Powers 2001).
Amir’s review on managing breastfeeding supply difficulties provides practical suggestions
to increase milk supply; improve positioning and attachment, if appropriate increase number
and/or duration of feeds, offer both breasts at each feed, express after feed, use a
supplemental feeding line instead of a bottle (Amir 2006).
Risk factors for low milk production
Amir’s systematic literature review on maternal smoking and breastfeeding examined 16
studies on the effects of smoking on lactation. Amir hypothesized that nicotine in cigarettes
may lower prolactin levels which could lead to a decrease in milk supply but did not find
sufficient evidence for a physiological mechanism. No studies found maternal smoking was
associated with poor infant weight gain. Two studies found that milk volume of smokers was
significantly less than non-smokers however studies had a small sample size (n=20, n=41)
(Amir 2001).
A cross-sectional study of 384 women comparing mothers who report an inadequate supply
of breastmilk to mothers who report an adequate supply of breastmilk found that perceived
insufficient milk supply may reflect a lack of breastfeeding confidence (Hill and Aldag
1991).
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