by Ashley Georgakopoulos | Oct 11, 2023 | Health Conditions, Infant Care and Breastfeeding
“The breasts are not an empty cavity to be filled with milk, but contain a network filled with alveoli that can be found even in the uppermost part of the breast tissues leading into the armpits. The ducts leading from these, channel the milk to meet behind the nipple inside the areola area, and release.”
Milk flow obstruction often results from milk not fully draining from the breast, causing inflammation and tenderness. If left unaddressed, clogged ducts can develop into more severe issues like mastitis, underscoring the importance of prompt and effective resolution.
Clogged, blocked, and plugged ducts. There are many terms for the same problem. Restricted milk flow, or “milk stasis”, leading from the milk-storing alveoli (those grape-like clusters in the breasts), may lead to a fatty blockage that soon becomes painful, and even infectious mastitis, if not treated quickly enough. These clogs can very well lead to other problems and occurrences, including lower supply thresholds, nerve pain in the breast tissue, lessened pumping output and bruising sensations.
The breasts are not an empty cavity to be filled with milk, but contain a network filled with alveoli that can be found even in the uppermost part of the breast tissues leading into the armpits. The ducts leading from these, channel the milk to meet behind the nipple inside the areola area, and release. Too much compression without proper release, be it due to improper bra fitting or tight, shallow latching, can cause buildup to occur. Poor suction from latching or pumping can also prevent proper drainage which leaves behind the fattier part of the milk and may lead to the same problem.
This “network” is also designed to be tapped into frequently. If milk is allowed to sit and settle for too long, say during block feeding versus feeding frequently and on demand, the risk for blockage to occur drastically increases.
Causes of Clogged Milk Ducts
Some of the most common reasons behind clogs are:
- Poor latching – shallow, weak, uncomfortable
- Restrictive clothing and bras
- Block feeding/feeding schedules
- Incorrect flange fit or pumping technique, if pumping
- Nipple damage/blebs- secondary issues from poor latching
- Abrupt weaning
- Long stretches in between pumping, 4+ hours
- Fibroids in the breast tissue pushing on ducts/channels
- Lowered immune system
- High stress
- Thrush or bacterial infections
Symptoms of Clogged Milk Ducts
Most women can feel the backed-up milk occurring with a clog. Clogs can be anything from a tender knot in the deep tissue to a blocked outlet on the nipple, also known as a bleb. Pain may also occur while hand expressing or having a letdown, as other channels push up against it. While a small fever may occur due to localized inflammation, clogged ducts are mostly a nuisance and a pain more than anything else. Symptoms beyond these are more in line with mastitis, which is an infection of the breast tissue, and need immediate attention. Expressed milk may show strings or a grainy appearance. While this may look unappetizing, it’s completely safe to give to your baby.
Treatment for Clogged Milk Ducts
Treating clogged milk ducts involves a combination of strategies to alleviate discomfort and restore milk flow. Effective methods include frequent nursing or pumping sessions to empty the breast, using warm compresses before feeding to encourage milk flow, gentle massage towards the nipple during feeds, and ensuring proper latch and positioning. Rest, hydration, and over-the-counter pain relievers can aid in reducing inflammation. If symptoms persist or worsen, seeking guidance from a healthcare professional is recommended to prevent complications like Mastitis.
The most common forms of treatment involve warm compression, massage and nursing through it while massaging the area during the feed, however, other methods have also been shown to be effective:
- Epsom soaks – dangling the breasts in a tub of warm water with epsom salt can encourage release of the clog.
- Dangle feeding – lying baby down on a safe surface and dangling over to feed.
- Vibration and gently shaking the breast are both ways to break up a clog.
- Lecithin – a fat constituent found in foods and supplement form, such as sunflower and soy, known to help emulsify fatty milk for easier release.
- Pump – if the baby does not feed well or has already fed, pump immediately after a feed to encourage more thorough emptying and clog removal.
- Stay hydrated – this is important in flushing out potential infectious tendencies.
- Rest- really prioritize rest and recovery.
- Pain relievers can be used, just check with your care provider and utilize resources, like LactMed, for safety while breastfeeding.
- Antibiotics are NOT needed unless it progresses into mastitis.
Another important note – while massage is a primary go-to for dealing with clogs, it’s crucial to realize that the clog is in FRONT of the backed-up milk, which is the knot most feel. Massaging in front of the knot will release the clog faster, while pushing behind it may be adding to the milk back-up.
Prevention
While clogs may happen regardless of effort, there are ways to help prevent them.
- Avoid block feeding or strict schedule regimens that space out expression opportunities more than 4 hours apart
- Don’t pressure “sleeping through the night,” neither mom’s supply or the baby is designed for that
- Ensure proper latching, so as to tap into all of the milk stores
Preventing clogged milk ducts involves maintaining a consistent breastfeeding or pumping routine, ensuring proper latch and positioning to facilitate efficient milk drainage, and avoiding tight-fitting clothing that might impede milk flow. Adequate hydration and proper self-care, including managing stress levels, also play crucial roles in preventing duct blockages. Being attuned to your body and seeking assistance from a lactation consultant if issues arise can further help in proactively preventing clogged milk ducts. Addressing latching issues as quickly as possible will not only help with frequently-occurring clogs, but help prevent them from happening again. If clogged ducts are a common occurrence, rule out latching and mechanical feeding problems.
If pumping, take time to learn proper handling and technique, and just as important, flange-sizing. Just like with a shallow latch or too much compression, a flange that is too big or too small will cause the same problems. Adjust strength settings to a comfortable level to avoid compression of the ducts.
Ashley Georgakopoulos is the Lactation Director at Motif Medical and an IBCLC. Her focus is in the clinical management of breastfeeding and pumping. Ashley is also a mother who has dealt with the obstacles and joys of breastfeeding. She educates families, connects them to resources, and helps the next generation be as healthy as possible: nutritionally and sustainably.
www.motifmedical.com
by Dr. Meghna Dassani, DMD | Sep 13, 2023 | Health Conditions, Infant Care and Breastfeeding, Parenting and Child Development
“Parents and healthcare providers need to take pediatric OSA seriously. But they should also know that the condition is highly manageable with the right treatment. Diagnosing pediatric OSA typically involves a comprehensive sleep study called polysomnography. This test monitors several physiological parameters during sleep, including brain waves, heart rate, oxygen levels, and respiratory patterns.”
Quality sleep is vital for children’s healthy growth and development. Unfortunately, some children have trouble achieving restful sleep due to obstructive sleep apnea (OSA), a common sleep disorder affecting between 1.2% and 5.7% of children of all ages.
Early detection and effective management of pediatric sleep apnea are important to ensure children can breathe freely and get the rest they need. Left untreated, pediatric OSA can have serious consequences, including:
- Impaired growth and cognitive development
- Learning difficulties
- Cardiovascular problems, like hypertension
- Behavioral issues
- Increased risk of accidents due to excessive daytime sleepiness
What Is Pediatric Obstructive Sleep Apnea?
Pediatric OSA is characterized by a partial or complete blockage of the upper airway during sleep. It results in repeated episodes of interrupted breathing, leading to brief periods of breathing cessation (apnea) or shallow breathing (hypopnea). These episodes can occur multiple times during the night and last for several seconds to minutes.
Airway obstruction typically occurs when the muscles at the back of the throat relax excessively, causing the soft tissues, such as the tonsils or adenoids, to collapse and block the airway. This can lead to reduced oxygen levels in the blood and disrupted sleep patterns. Pediatric OSA often arises from the following:
- Enlarged tonsils or adenoids
- Obesity
- Structural abnormalities, such as a tongue tie, narrow airway, or cleft palate
Recognizing the signs and symptoms of pediatric OSA is important for early detection and intervention.
One of the primary indications of pediatric OSA is persistent and loud snoring. Occasional snoring is normal. However, chronic and intense snoring in children should raise concerns for parents.
Other symptoms to watch out for include:
- Restless sleep
- Gasping or choking during sleep
- Bedwetting
- Excessive daytime sleepiness
- Irritability
- Difficulty concentrating
- Mouth breathing
- Morning headaches
If parents observe these signs, they should talk to a healthcare professional and ask for a sleep evaluation.
How to diagnose pediatric obstructive sleep apnea
Parents and healthcare providers need to take pediatric OSA seriously. But they should also know that the condition is highly manageable with the right treatment. Diagnosing pediatric OSA typically involves a comprehensive sleep study called polysomnography. This test monitors several physiological parameters during sleep, including brain waves, heart rate, oxygen levels, and respiratory patterns. A sleep study helps determine the severity and underlying causes of obstructive sleep apnea, enabling the development of an appropriate treatment plan.
Treatment options for children with OSA
The management of pediatric OSA may involve several approaches, depending on the child’s specific needs.
In cases where enlarged tonsils or adenoids are identified as the primary cause, doctors may recommend surgical intervention through an adenotonsillectomy. This is the most common way to treat pediatric OSA. The procedure removes the airway obstruction, allowing for improved airflow and a reduction of sleep apnea symptoms.
Some children have structural abnormalities, like a tongue tie or narrow airway, that can lead to OSA. In these cases, doctors may suggest a tongue release, also known as frenuloplasty, or the use of expanders to widen the upper jaw.
For children with persistent sleep apnea or underlying factors, like obesity, additional interventions may be necessary. Lifestyle modifications, such as weight management programs, regular exercise, and a healthy diet can reduce the severity of sleep apnea.
In some instances, doctors may prescribe continuous positive airway pressure (CPAP) therapy. CPAP involves wearing a mask during sleep that delivers a gentle flow of air. It ensures that children’s airways remain open and unobstructed.
Creating an optimal sleep environment is also important for children with OSA. Establishing consistent bedtime routines, creating a comfortable sleep space, and promoting good sleep hygiene all contributes to a better sleep quality. Limiting screen time before bedtime and maintaining a regular sleep schedule also improves sleep patterns.
Parents should follow up regularly with healthcare providers to monitor the effectiveness of their child’s treatment and make any necessary changes. Open communication with children about their sleep experiences and any changes in symptoms is also important. Parents who provide emotional support and reassurance can help children cope with managing their sleep apnea.
Dr. Meghna Dassani has practiced dentistry for over two decades and is passionate about the role dentists play in whole-body health. She earned her DMD at Boston University Goldman School of Dental Medicine and opened Dassani Dentistry in Houston, TX in 2011. You can learn more on her website: MeghnaDassani.com.
by Dr. Sarah Dirks | Aug 30, 2023 | Health Conditions, Infant Care and Breastfeeding, Parenting and Child Development
“The pressure used during therapy is less than the weight of a nickel and most of the movements are so slight that they are often missed by the parents as the practitioner moves through the treatment. “
It’s 2:00 in the morning and your one month old newborn has been screaming since midnight. You and your partner have tried everything… nursing/bottle, diaper change, warm bath, rocking, bouncing, white noise, singing, a walk outside… but the screaming seems endless. This continues for several days and you both decide to call the pediatrician. You are told that your baby is perfectly healthy, the screaming is normal, and there is nothing to worry about. Now what? Do you just grit and handle the screams every night? What other options do you have? You still feel like something is off and that your baby is in some pain or discomfort. You and your partner may even feel lost as to what to do next.
Navigating the first year of a baby’s life can be extremely challenging for any parent. Pediatrician, night nurse, lactation consultant, physical therapist, chiropractor, occupational therapist, myofunctional therapist, pediatric dentist… Sometimes it feels like there is an overwhelmingly endless list of people to help your child. Let’s take a deeper look into the option of craniosacral therapy to help you decide if it is the best option to help your child.
What is Craniosacral Therapy?
Craniosacral therapy is a very gentle manual technique used to assess and enhance the function of the structures surrounding the brain and spinal cord. Alleviating tension in these structures can promote improved functioning in the nervous system and subsequently the other bodily systems, which allows the body to respond better to the stressors of life. Craniosacral therapy facilitates the body’s natural healing process and can therefore be used to increase the body’s resistance to disease.
What Can Craniosacral Therapy Help With?
Craniosacral therapy can help infants who struggle with many different ailments. Some of the most common are difficulty gaining weight, latching issues, colic, reflux, gassiness, difficulty sleeping, mouth breathing, torticollis and/or muscle tension (clenching fists constantly or straightening legs/arching back during diaper changes.)
Is Craniosacral Therapy Safe?
The pressure used during therapy is less than the weight of a nickel and most of the movements are so slight that they are often missed by the parents as the practitioner moves through the treatment. With this small amount of pressure it is safe to use on most infants and newborns, however it should not be used in conditions in which a slight change in intracranial pressure would cause instability.
What to Expect During Craniosacral Therapy.
Craniosacral therapy is typically performed in a quiet, calm, dimly lit room with the infant lying comfortably on a massage table. The practitioner will first identify the craniosacral rhythm by placing their hands gently on the baby. They will then feel the baby’s head, neck, torso, and spine while assessing and alleviating tension in the craniosacral system. Many of the movements are so subtle that they can be imperceivable except for the calming effect and relief seen in the child.
What If My Baby Cries Constantly or Doesn’t Sit Still?
Don’t stress if your child is fussy or has the wiggles during an appointment. Some treatments occur while infants are breastfeeding or even with them laying on top of a parent. A skilled therapist has encountered a wide array of baby obstacles and has many options to help calm them. Typically by the end of the session the baby is relaxed, quiet, and/or sleeping.
Dr. Sarah Dirks is a pediatric and prenatal chiropractor, specializing in craniosacral therapy and Webster Technique. She received her doctorate of chiropractic at Los Angeles College of Chiropractic in 2010. Dr. Dirks is in private practice and collaborates frequently with midwives, lactation specialists and pediatric dentists to provide a comprehensive treatment for all of her patients.
She is a wife and mom to a one year old daughter and a three year old son. In her free time she enjoys spending time with her family, as well as swimming, traveling and going to concerts. After having her son, who was colicky, tense, and struggled to gain weight, she began to dive deeper into craniosacral therapy. The technique gave him so much needed relief.
by Dr. Michelle Tsai | Dec 14, 2022 | Labor and Delivery, Pregnancy
” If your cervix is dilated, your physician may offer you a membrane sweep, which is basically a bit of a massage of the baby’s head. This is not harmful to you or your baby. The membrane sweep feels like a longer cervical check; this can be uncomfortable but should not be painful. This can cause your body to release your own hormones to lead towards labor naturally.”
Congratulations on your pregnancy! Once you are past 37 weeks, baby is considered full term, and your doctor may offer you a pelvic exam at an OB visit. There is no strict recommendation on when (and if) cervical exams are done at the end of pregnancy – I personally do not routinely perform cervical or pelvic exams unless there is a good reason (exams can be uncomfortable, especially during this time in pregnancy!). If you are having any signs of early or prodromal labor (what I like to call “pre-prelabor” – your body is releasing hormones called prostaglandins to make change towards the big day), your doctor may check your cervix. And, of course, if you are having signs of labor (tightening/cramping of your abdomen every 5-10 minutes for one hour or leakage of fluid like your water bag broke), your physician may check your cervix to see if you are indeed in labor. Labor is defined as contractions that start opening up the cervix; you may be contracting painfully without your cervix opening just yet. This is called prodromal labor.
A cervical check has several parts to it. Dilation, or how open your cervix is, is the one that many patients think is the most important, however the other parts of the exam are just as important. We evaluate the cervix also for effacement (how “thinned out” it is) and baby’s station (where the baby’s head is in relation to mom’s pelvis), as well as position (where the cervix is in relation to the front and back of your body) and consistency (how much the cervix has softened). Even if your cervix has not yet dilated, if it has softened and thinned out, this can be a sign of labor.
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The cervical exam generally can be uncomfortable but should not be painful. It can feel like a bit of cold pressure. After the exam you may have some cramping and even some small spotting (generally a bit of pink/red on wiping with toilet paper), this is normal and expected with any cervical exam especially later in pregnancy. You should not have any heavy vaginal bleeding – if you have bleeding filling up a pad or pantiliner, please kindly contact your physician.
If your cervix is dilated, your physician may offer you a membrane sweep, which is basically a bit of a massage of the baby’s head. This is not harmful to you or your baby. The membrane sweep feels like a longer cervical check; this can be uncomfortable but should not be painful. This can cause your body to release your own hormones to lead towards labor naturally. If you are nearing your due date and not having any signs of labor, this can be a very natural way to help your body along, without medications for induction of labor. This is an especially helpful tool especially if you are trying for a trial of labor after cesarean section, as if you go into labor on your own, it can increase the rate of success of a vaginal delivery. Of course, every patient’s situation can be quite different, and it is always a good idea to discuss with your physician what is best for your individual situation. Best of luck and congratulations on your new addition to the family!
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Dr. Michelle Tsai grew up in LA’s San Gabriel Valley and received her bachelor’s degree at the University of California – Berkeley. She taught English in Asia for a year prior to attending medical school at Virginia Commonwealth University. She completed her residency training at the University of Hawaii in Honolulu and moved to the San Francisco Bay Area to open her own private practice.
Dr. Tsai is currently an assistant professor of OB/GYN at UCLA. She is the director of the UCLA Marina Del Rey OB/GYN office which is opening in 2023. She divides her time seeing patients in the office, performing gynecologic surgeries, delivering babies, teaching medical students and residents, and serving as an independent contractor in the community for the underserved. When she is not working, she enjoys spending time with her husband and miniature schnauzer Sadie, as well as traveling, exercising, and trying out new restaurants in her community. They welcomed their first child in October 2020.
