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Hypogalactia: How to identify it and how to accompany it?

Hypogalactia: How to identify it and how to accompany it?

Hypogalactia is defined as insufficient milk secretion to maintain exclusive breastfeeding. A woman may have milk secretion, but this may not be sufficient and she may need supplementation for the correct feeding of the infant.
Studies indicate that 36% of mothers attribute the end of breastfeeding to a lack of milk production. It is true that in the majority of cases this is only a perception and is not real, but real hypogalactia exists in 5% of mothers either due to anatomical variations of the mammary gland or medical illnesses.

Hypogalactia can be a multifactorial process, it can be caused by one cause, or there can be several aspects involved that also feed back on each other and can cause a more pronounced drop in production. Below is a list of possible causes that may occur alone or together:

  • Infant not drinking enough milk
  • Infant’s incapacitating illness
  • Premature infant
  • Lack of access to the breast (restriction with schedules)
  • Poor milk transfer (e.g. ankyloglossia, sucking difficulties, etc.)
  • Maternal pathology:

– Preglandular:
1. Retention of placental debris
2. Congenital prolactin deficiency
3. Sheehan’s syndrome / Acute anaemia (haemoglobin <10 g/dl)
4. Polycystic ovarian syndrome
5. Oral contraceptives
6. Medications
7. Social drugs
8. Transient hypogalactia (insulin-dependent diabetes, corticosteroid treatment, obesity) delays onset of lactogenesis II.

– Glandular
1. primary hypoplasia, which is congenital
2. Secondary hypoplasia: due to mammoplasty or due to radiotherapy

– Postglandular:
1. Lactation technique
2. Separation, routines, interference
3. Ineffective emptying
A proper diagnostic process with a mother-baby dyad suspected to be suffering from hypogalactia should be kept in mind.

 

Suspicion of hypogalactia may be given by the following signs:
– Infant irritable at the breast, crying a lot.
– Infant who does not seem to stay full, who sleeps little, long feeds
– Mother with a feeling of empty breasts
These are all perceptions that should be investigated in more detail during the breastfeeding consultation.

Identification of hypogalactia

The first step should be to check the evolution of the baby’s weight, to check whether the baby has regained the birth weight, how quickly, whether the weekly weight gain is adequate or not, etc. This step should be complemented with a follow-up of the infant’s stools, as sometimes, with a correct weight, or in the low limit, the key to the hypogalactia indicator can be revealed with this data.

Once the baby’s weight has been checked, it is necessary to discuss with the mother whether she has noticed any changes in her breast tissue during gestation and the immediate postpartum period, thanks to this information it will be possible to discern whether there is a cause of hypogalactia due to the mother’s pathology or not. This should be investigated if the response indicates this, and the above-mentioned differential can be followed.

Finally, among the three essential steps in a consultation of this type, it is necessary to assess the feeding, check if the transfer of milk is correct, see how the baby behaves when the breast is brought close to the breast, and thus assess if there is any factor dependent on the baby that may lead to a low stimulation of the mammary gland, which results in low milk production.

The resolution of the problem will obviously depend on the cause of the problem. In some situations it may be possible to correct the problem, such as an incorrect breastfeeding technique, or a medication that may reduce production. In other situations it will be necessary to help the mammary gland to be stimulated to increase production, for example with a pattern of extractions with a breast pump, or to suggest that the mother take a galactogogue. On other occasions it will be necessary to supplement the infant, especially if there are signs of dehydration or low weight. It will be necessary to assess with the mother which supplementation method is most appropriate for her situation and to explain the options available to the mother in relation to feeding her child.

 

References
  • Ramiro González MD, Ortiz Marrón H, Arana Cañedo-Argüelles C, et al. Prevalencia de la lactancia materna y factores asociados con el inicio y la duración de la lactancia materna exclusiva en la Comunidad de Madrid entre los participantes en el estudio ELOIN. An Pediatr (Barc). 2018;89(1):32-43. doi:10.1016/j.anpedi.2017.09.002
  • Lawrence, Ruth A.; Lawrence, Robert M. Lactancia materna. Una guía para la profesión médica. Séptima edición. Missouri: Elsevier Mosby; 2011.
  • Walker, Marsha. Manejo de la lactancia materna para el clínico. Using Evidence. 4rth Edition. Burlington, MA: Jones & Bartlett Learning; 2017.
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