母乳喂养

母乳不足的原因

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母乳不足是过早断奶最常见的原因之一。母乳不足的原因包括影响宝宝有效吸乳的医疗状况，例如舌系带过短、腭裂、神经系统问题、营养吸收不良以及代谢问题。如果不是宝宝健康问题，则可能是妈妈自身因素导致母乳不足。

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妈妈初期泌乳不足的发生率为百分之五，诱因是乳房异常、乳房或乳头手术（可能出于医疗原因或美容）或其他问题导致的腺体组织不足。二期泌乳不足的问题更加常见，通常是因为哺喂过程不正确或使用补品导致母乳合成能力下降，最终导致母乳供应量不足。

母乳不足的迹象

宝宝可能会出现排便延迟、尿量少、黄疸病、分娩后体重减轻以及嗜睡症状。在母乳喂养期间，宝宝吸乳时可能表现出嗜睡或沮丧或只是短时间的连续吸吮。

泌乳评估

第一步必须咨询哺乳顾问或保健专业人员。为诊断母乳是否不足，妈妈需在保健专业人员的指导下测量器泌乳量，即 24 小时内测量哺喂前以及哺喂后宝宝体重（不得更换宝宝衣物或附件）。健康宝宝平均正常吸乳量为 750 - 800 ml/天（478-1356 ml/天属正常范围） - 请参阅母乳喂养“正常”范围是多少？

管理

应在哺乳顾问或保健专业人员的配合下实施并监测管理计划。提高乳汁供应量的关键是频繁有效地排乳。由于大多数宝宝可吸出乳房中 67% 的可用乳汁，通过频繁有效地排乳有助于更好地排空乳房，帮助妈妈更加快速地合成乳汁。

结合保健专业人员建议，为提高母乳供应量可实施的循证方案包括：

辅助哺喂姿势和宝宝衔乳
母乳喂养期间，尽量有肌肤接触，提高哺喂时的身心舒适度
增加母乳喂养频率，两次哺喂间隔不要超过三个小时，每天哺喂 8-12 次
每次哺喂之后暂时吸乳；双侧吸乳（同步吸乳）有助于提高排乳速率以及更好地排空乳房
在吸乳期间按摩乳房
吸乳期间穿戴合身的吸乳护罩：不得挤压乳房，否则将损伤乳头。如果管道过紧，则有多种吸乳护罩尺寸可选
吸乳时要使用放松技巧，例如音乐或深呼吸
医疗人员可考虑使用催奶剂药物，帮助刺激泌乳。

研究摘要

Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants

Breastmilk remains the optimal form of enteral nutrition for term and preterm infants until up to six months postnatal age. Mothers of preterm infants who ...

Donovan TJ, Buchanan K (2012)

Cochrane Database Syst Rev. 14;3:CD005544

Impact of Measuring Milk Production by Test Weighing on Breastfeeding Confidence in Mothers of Term Infants

The duration of exclusive breastfeeding is affected by maternal confidence and perception of milk supply, but objective measurement of milk supply is rarely used. ...

Kent JC, Hepworth AR1, Langton DB2, Hartmann PE (2015)

Breastfeed Med. 10:318-25

参考文献

American Academy of Pediatrics and The American College of Obstetricians and Gynecologists. Breastfeeding Handbook for Physicians 2006).

Donovan, T.J. & Buchanan, K. Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants. Cochrane. Database. Syst. Rev 3, CD005544 (2012).

Hill, P.D., Aldag, J.C., Chatterton RT. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact. 2001;17(1):9-13

Hill, P.D., Aldag J.C., Chatterton RT, Zinaman M. Comparison of Milk Output Between Mothers of Preterm and Term Infants: The First 6 Weeks After Birth. J Hum Lact. 2005 February 1, 2005;21(1):22-30.

Kent, J.C. et al. Importance of vacuum for breastmilk expression. Breastfeed Med 3, 11-19 (2008).

Kent, J.C. et al. Longitudinal changes in breastfeeding patterns from 1 to 6 months of lactation. Breastfeed Med 8, 401-407 (2013).

Kent, J.C., Hepworth, A.R., Langton, D.B. & Hartmann, P.E. Impact of Measuring Milk Production by Test Weighing on Breastfeeding Confidence in Mothers of Term Infants. Breastfeed Med (2015).

Morton, J., Hall, J.Y., Wong, R.J., Benitz, W.E. & Rhine, W.D. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 29, 757-764 (2009).

Parker, L.A., Sullivan, S., Krueger, C. & Mueller, M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med (2015).

Prime, D.K., Garbin, C.P., Hartmann, P.E. & Kent, J.C. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med 7, 442-447 (2012).