Population: Women who are attempting to breastfeed.

Organization

ACOG 2021

Recommendations

–Recommend breastfeeding exclusively for 6 mo. Continue breastfeeding as complementary foods are introduced during the infant’s first year of life or longer, as mutually desired by the woman and her infant.

–Provide proactive lactation support, including education on hand expression, in anticipation of potential breastfeeding difficulties.

–Manage engorgement expectantly if symptoms are mild and the infant has good latch.

–Perform a focused history and physical exam to distinguish the specific cause of persistent pain while breastfeeding or nipple injury. Treat as indicated.

–Reassure women that their milk supply is adequate if the average feeding frequency is 8–12 times per day, steady weight is gained by day 4 or 5, and 6–8 wet diapers occur on average per day. Counsel on signs of low milk supply or dehydration such as jaundice, insufficient wet or soiled diapers, lethargy, inconsolability, unchanged stool color (not bright yellow by day 5), and a lack of steady infant weight gain.

–Encourage breastfeeding in women who are stable on medication-assisted treatment for opioid use disorders who are not using illicit drugs and who have no other contraindications to breastfeeding.

–Do not use galactagogues as a first-line therapy.

Source

–ACOG. Committee Opinion No 820. Breastfeeding Challenges. 2021.