Breastfeeding Telephone Triage and Advice

Maya Bunik, MD, MSPH, FABM, FAAP, is an associate professor of pediatrics at the University of Colorado Denver and medical director of the primary care teaching clinic at Children’s Hospital Colorado. As a practicing pediatrician, she has been helping mother-baby pairs with breastfeeding for more than 15 years. Her experience also includes serving as director of the Pediatric Advice Line Call Center at Children’s Hospital Oakland.

Alphabetic Contents
A
Alcohol Use
Allergy
B
Biting Breast, Onset at 6 Months
Breast Mass
Breast Pain
Breast Pain, Chronic >1 Week
Breastfeeding in the First Few Weeks: Simplify Your Life (Advice Only)
Breastfeeding Station Supplies (Advice Only)
C
Chestfeeding/Breastfeeding Support in LGBTQ+ Individuals
Child Care and Breastfeeding (Advice Only)
Clicking or Noisy Nursing
Color Change of Human Milk
Constipation in the Breastfed Baby
Contraception, Lactation Amenorrhea Method (Advice Only)
Cosleeping/Bed Sharing and Breastfeeding (Advice Only)
Cultural Issues with Breastfeeding
D
Distraction, Onset at 4 Months
E
Early Weight Loss, Birth Hospital or First Week
Emotional Symptoms with Letdown
Engorgement
Environmental Exposures and Toxins
Exclusive Pumping
Expression of Human Milk: Pumping, Parts and Cleaning Equipment, Hand Expression (Advice Only)
F
Fathers (Advice Only)
Feeding More Frequently
Feeding the Baby with Cleft Lip or Palate
Feeding the Baby with Hypotonia
Feeding the Baby with Trisomy 21 Syndrome (Down Syndrome)
Fortification of Human Milk Recipes (Advice Only)
Fussiness, Colic, and Crying in the Breastfed Baby
G
Gassiness in the Breastfed Baby
I
Induced Lactation
Itching of the Breast/Nipple Area
J
Jaundice, Newborn
L
Late Preterm Newborn
Lifestyle or Personal Care Questions (Advice Only)
Long-term Breastfeeding (Advice Only)
Low Milk Supply
Low Milk Supply in Older Baby >6 Months
M
Marijuana Use
Maternal Anesthesia/Analgesia (Advice Only)
Maternal Contraindications/ Causes for Concern with Breastfeeding (Advice Only)
Maternal Illnesses (Advice Only)
Maternal Ingestion of Foods and Herbs (Advice Only)
Maternal Medications (Advice Only)
Maternal Methicillin-Resistant Staphylococcus aureus
Maternal Postpartum Depression
Maternal Postpartum Vaginal Bleeding
Maternal Smoking, Vaping, and Cessation Strategies
Milk Leaking from Newborn’s Breasts (Galactorrhea)
Milk Storage and Return to Work/School
Mistaken Milk Ingestion, Milk Sharing
Multiples (Advice Only)
N
Newborn Contraindications to Breastfeeding (Advice Only)
Nipple Abnormality: Flat/Short, Inverted, Large, or Bulbous
No Latch or Inability to Latch
Nursing Strike or Refusal
Nursing with Pregnancy
O
Overactive Letdown/ Overabundant Milk Supply
P
Pacifiers and Slow-Flow Nipples (Advice Only)
Positions and Latch
R
Referral to Local Resources (Advice Only)
Refusing Bottle, Preferring to Nurse
Relactation
S
Sleepy Newborn
Sore Nipples
Spitting Up (Reflux)
Maternal Substance UseSubstances of Abuse (Illicit Drugs)
T
Tandem Nursing
Taste Change of Human Milk
Tongue-tie
V
Vitamin D, Iron, and Zinc Supplementation
W
Weaning
Appendixes
Appendix A: Breastfeeding Touch Points for Overcoming Obstacles to Exclusivity
Appendix B: Quick Reference for Pain with Breastfeeding
References for All Protocols

 
Topic Contents
Mother
Alcohol Use
Breast Mass (cyst, abscess vs other)
Breast Pain (plugged ducts vs mastitis)
Breast Pain, Chronic >1 Week
Breastfeeding Station Supplies (Advice Only) (setup of station, eg, Boppy or My Brest Friend pillows, chair, stool, water, snacks)
Contraception, Lactation Amenorrhea Method (Advice Only)
Emotional Symptoms with Letdown
Engorgement
Partners/Fathers (Advice Only)
Itching of the Breast/ Nipple Area
Lifestyle or Personal Care Questions (Advice Only) (hair color, jogging/ exercise, weight loss, travel, nipple piercing, tattoos)
Low Milk Supply (growth spurts/cluster feeds, galactagogues, switch nursing, reverse-cycle nursing, no substitute for milk extraction)
Low Milk Supply in Older Baby >6 Months
Marijuana Use
Maternal Anesthesia/ Analgesia (Advice Only)
Maternal Contraindications/ Causes for Concern with Breastfeeding (Advice Only)
Maternal Illnesses (Advice Only) (cold, influenza, asthma, seizures, headache, allergic rhinitis, hypertension)
Maternal Ingestion of Foods and Herbs (Advice Only)
Maternal Medications (Advice Only) (contraindications, over the counter, references to Infant Risk Center or LactMed)
Maternal Methicillin-Resistant Staphylococcus aureus
Maternal Postpartum Depression
Maternal Postpartum Vaginal Bleeding
Maternal Smoking, Vaping, and Cessation Strategies
Nipple Abnormality: Flat/ Short, Inverted, Large, or Bulbous
Referral to Local Resources (Advice Only)
Sore Nipples (bleeding, sores/lesions, yeast infections, bacterial infections, herpes, milk bleb/blister, Raynaud disease, vasospasm)
Substances of Abuse (Illicit Drugs)
Milk Expression
Exclusive Pumping
Expression of Human Milk: Pumping, Parts and Cleaning Equipment, Hand Expression (Advice Only) (types of pumps, pain, milk volume by age, pumping frequency early on/frequency for late preterm newborns, nipple shield use and cleaning, flange size, tubing, cleaning/sharing a pump with others)
Milk Storage and Return to Work/School (freezing, reheating, bags vs glass bottles, building a stockpile, talking with employer)
Baby, Early
Breastfeeding in the First Few Weeks: Simplify Your Life (Advice Only)
Clicking or Noisy Nursing
Color Change of Human Milk
Cosleeping/Bed Sharing and Breastfeeding (Advice Only)
Early Weight Loss, Birth Hospital or First Week
Feeding More Frequently (days and nights mixed up, growth spurt, cluster feeding, shallow latch, inefficient suck)
Fussiness, Colic, and Crying in the Breastfed Baby
Gassiness in the Breastfed Baby
Jaundice, Newborn
Late Preterm Newborn
Milk Leaking from Newborn’s Breasts (Galactorrhea)
No Latch or Inability to Latch
Nursing Strike or Refusal
Overactive Letdown/ Overabundant Milk Supply (pulling away during feeding)
Pacifiers and Slow-Flow Nipples (Advice Only)
Sleepy Newborn
Spitting Up (Reflux)
Taste Change of Human Milk (soapy, salty)
Tongue-tie
Vitamin D, Iron, and Zinc Supplementation
Baby, Later
Biting Breast, Onset at 6 Months
Constipation in the Breastfed Baby (usually after adding formula or solids; breastfed stool variant)
Distraction, Onset at 4 Months
Long-term Breastfeeding (Advice Only) (adding solids, adding bovine milk, immune effects)
Refusing Bottle, Preferring to Nurse
Weaning
Special Circumstances
Allergy
Child Care and Breastfeeding (Advice Only)
Environmental Exposures and Toxins
Feeding the Baby with Cleft Lip or Palate
Feeding the Baby with Hypotonia
Feeding the Baby with Trisomy 21 Syndrome (Down Syndrome)
Fortification of Human Milk Recipes (Advice Only)
Mistaken Milk Ingestion, Milk Sharing
Multiples (Advice Only)
Newborn Contraindications to Breastfeeding (Advice Only) (galactosemia, phenylketonuria)
Nursing with Pregnancy
Tandem Nursing
Appendixes
Appendix A: Breastfeeding Touchpoints for Overcoming Obstacles to Exclusivity
Appendix B: Quick Reference for Pain with Breastfeeding
References for All Protocols