ABM Clinical Protocol #26: Persistent Pain with Breastfeeding

Abstract

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Promoting self‐management of breast and nipple pain in breastfeeding women: Protocol of a pilot randomized controlled trial

“…We have expanded the risk and protective factors of breastfeeding pain to include the genetic makeup of each woman by selecting candidate genetic polymorphisms within known pain sensitivity genes. Genetic variation within a number of genes is associated with variation in women's interpretation of pain (sensitivity to pain due to ankyloglossia, infection, or engorgement) and can influence pain facilitation or inhibition at the molecular level of pain processing (Berens, Eglash, Malloy, & Steube, 2016;Diatchenko et al, 2005;Kent et al, 2015). Specifically, singlenucleotide polymorphisms (SNPs) of the catechol-O-methyltransferase (COMT) and oxytocin receptor (OXTR) genes influence pain sensitivity, the perception of pain and general mental well-being (Diatchenko et al, 2005;Rash, Aguirre-Camacho & Campbell, 2014;Stuebe, Grewen, & Meltzer-Brody, 2013).…”

Nipple Skin Trauma in Breastfeeding Women During Postpartum Week One

“…26 has defined purpura as bruising of the nipple due to changes induced by misuse of a breast pump. 15 Peeling is noted as changes in nipple trauma in some articles. 6,7 Although these skin changes are often overlooked in clinical settings, physicians and midwives must consider mechanisms underlying the development of nipple trauma.…”

ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017

“…2. The infant who is fussy at night or constantly feeding for several hours  Cluster feeding (several short feeds close together) is normal newborn behavior, but should warrant a feeding evaluation to observe the infant's behavior at the breast 35 and the comfort of the mother to ensure that the infant is latched deeply and effectively.…”