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Infant health: what you need to know about Suppression of lactation with medications for healthcare.

Can medication help suppress lactation after childbirth?

The simplest and safest way to suppress lactation is to let milk production stop on its own.

Suppression of lactation with estrogen or the drug bromocriptine is no longer recommended due to possible side effects.

To let milk production diminish naturally, don't breast-feed, stimulate your breasts or express milk. To relieve breast engorgement and pain, you might:

• Wear a supportive bra

• Apply ice packs to your breasts

• Take over-the-counter pain relievers.

What causes a low milk supply during breast-feeding?

Various factors can cause a low milk supply during breast-feeding, such as waiting too long to start breast-feeding, not breast-feeding often enough, supplementing breastfeeding, an ineffective latch and use of certain medications. Sometimes previous breast surgery affects milk production.

Other factors that can affect milk production include:

• Premature birth

• Maternal obesity

• Pregnancy-induced high blood pressure

• Poorly controlled insulin-dependent diabetes

Although many women worry about low milk supply, insufficient breast milk production is rare. In fact, most women make one-third more breast milk than their babies typically drink.

To boost milk production:

• Breast-feed as soon as possible. Waiting too long to start breast-feeding can contribute to a low milk supply. Hold your baby skin to skin right after birth and your baby will likely breast-feed within the first hour after delivery.

• Breast-feed often. For the first few weeks, breast-feed eight to 12 times a day about every two to three hours.

• Check your latch. Make sure your baby is latched on and positioned well. Look for signs that your baby is swallowing.

• Be alert to feeding problems. Offer both breasts at each feeding. It's OK for your baby to nurse on only one breast at a feeding occasionally but if this happens regularly, your milk supply will decrease. You might pump the other breast to relieve pressure and protect your milk supply until your baby begins taking more at each feeding.

• Don't skip breast-feeding sessions. Pump your breasts each time you miss a breast-feeding session to help protect your milk supply.

• Hold off on the pacifier. If you choose to give your baby a pacifier, consider waiting until three or four weeks after birth. This will give you time to establish your milk supply.

• Use medications with caution. Certain medications decrease milk supply, including medications containing pseudoephedrine and others. Your health care provider might also caution against certain types of hormonal contraception, at least until breast-feeding is firmly established.

• Avoid alcohol and nicotine. Drinking moderate to heavy amounts of alcohol can decrease milk production. Smoking can have the same effect.

Maintaining your milk supply during breast-feeding is important for your baby's health and growth. If you're concerned about your milk supply or your baby's feedings, talk to your doctor, your baby's doctor or a lactation consultant.

Once your newborn establishes a pattern of weight gain and reaches the birth-weight milestone, however, it's generally OK to wait for feedings until he or she wakes up.

Most newborns need eight to 12 feedings a day about one feeding every two to three hours. While waking up a sleeping baby might seem like a bad idea, frequent feedings early on are important for a couple of reasons:

• Crying is a late sign of hunger. The sooner you begin each feeding, the less likely you'll need to soothe a frantic baby. Look for early signs of hunger, such as hand-to-mouth activity, smacking lips, rooting and stirring while asleep.

• Frequent feedings support early breast-feeding. If you breast-feed, frequent feedings will help you establish your milk supply.

Keep in mind that premature babies often have special nutritional needs. They might not reliably show late hunger cues, such as crying. If your baby was born prematurely or you're concerned about your baby's feeding patterns or weight gain, consult his or her doctor for specific recommendations.

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1.Hagan JF, et al, eds. Promoting healthy nutrition. In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed.

2.Meek JY, ed. A perfect design: How breastfeeding works. In Academy of Pediatrics New Mother's Guide to Breastfeeding. 3rd ed. 2017.

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