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母乳喂养 科普手册系列

多久喂一次？

大多数新生儿在出生后第一个小时内已经准备好吃奶。在此期间，如果他有机会在至少一个乳房上吃奶，将有助于开奶。第一次哺乳后，宝宝和妈妈可能都会昏昏欲睡一段时间，所以下一次哺乳可能会在 4 到 6 个小时后。这对足月新生儿来说没有关系。

有些宝宝会更频繁地吃奶，这也没关系。在最初的 24 小时后，一个足月健康的新生儿可能需要每小时哺乳几次，或每 3小时一次，这都是正常的。至少每 24 小时给宝宝喂奶 8 到 12 次，实际上大多数的宝宝吃奶的次数远高于这个数字。

请记住，有些宝宝会“密集哺乳”，这意味着他们可能会频繁吃奶几个小时，然后睡几个小时。有些宝宝每天也会睡四到五个小时的长觉（最好是在晚上！）24 小时内喂奶次数比喂奶间隔更重要。

你不必担心喂奶次数太频繁，通常新手妈妈的挑战是喂奶次数太少。最好建议你观察宝宝是否有饥饿的迹象，而不是看着钟表。

饥饿的迹象包括：

◆觅食反射 ( 当宝宝张开嘴，把头左右晃动时 )

◆把手放在嘴边

◆吃手

◆用头和嘴在你的肩膀上蹭

◆发出“呃，呃，呃”的声音

◆不要等宝宝哭了，你才知道他饿了。哭泣是非常晚的饥饿信号，会让你的宝宝难以好好吃奶

一个嗜睡的宝宝可能需要每两到三个小时被唤醒哺乳，特别是当他有黄疸的时候。如果宝宝无精打采难以唤醒喂奶，请咨询医生。

你的新生儿需要频繁哺乳

频繁哺乳以确保宝宝获得充足的营养和水分。你的乳汁是为婴儿设计的，很容易被他的身体迅速消化。婴儿出生时乳房产生少量的初乳，对婴儿小小的胃来说刚刚好。出生第 1 天新生儿的胃容量是 5-7毫升，第 3 天增加到 22-30 毫升，第 7 天大概是 44-59 毫升。频繁哺乳以确保你的乳房受到足够的刺激，从而建立充足的奶量。从乳房中移除的乳汁越多，你的身体就会产生越多的乳汁。

因为你的安全臂弯可以帮助婴儿顺利过渡到子宫外的生活。别担心，哺乳不会总是这么频繁。新生儿吃奶时还不是很有效率，而且他正在快速成长。随着月龄增长，他吃奶会更加高效，吃的次数会更少。有些宝宝似乎一直在吃奶，因为他们没有有效地摄入乳汁。

如果你觉得你的宝宝花了太多时间吃奶，请联系国际母乳会哺乳辅导或国际认证泌乳顾问（IBCLC）确认一下宝宝是否有效地摄入了乳汁。等你的乳房充盈再喂奶会减少你的奶量，因为当你的乳房充盈时，你的产奶速度会慢上很多。当你经常哺乳，你的乳房更柔软时，你实际上是在更快地产奶。

每次喂多久？

很难说每次喂奶应该持续多久，因为每个妈妈的乳房和每个宝宝的情况都不一样。有些妈妈更容易释放乳汁，有些宝宝更有效地吃奶。妈妈在一天的不同时间产奶量不同，这意味着没有人能告诉你应该喂多久。不应该限制在每个乳房哺乳的特定分钟数。

对于在 24 小时内吃奶 8-12 次的宝宝来说，大多数喂养在最初的几周和几个月里持续 30-40 分钟，直到他变得更有经验更熟练。经常吃奶的宝宝通常吃奶时间较短。

如果你发现喂奶时间比这更长，或者你的宝宝吸吮几次就睡着了，请联系国际母乳会哺乳辅导，她可以帮助您确认是否存在需要进一步调整的问题。

国际母乳会哺乳辅导联系方式

2022-09-03

国际母乳会建粉丝群啦！

2023-05-01

END

撰稿 | Victoria

审阅 | Victoria、楠楠

编辑 | 斯琦

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点击上方国际母乳会LLL 设为星标，获取哺乳信息    

你是否在母乳喂养时感到疼痛，可能还伴随着宝宝体重增长缓慢？虽然绝大多数这种哺乳问题可以通过调整哺乳和含乳姿势，再加上良好的母乳喂养管理来解决，但有时候舌系带过紧可能也会造成哺乳问题。

舌系带过紧(即舌系带过短)是由较紧或较短的舌系带(将舌头固定在口腔底部的膜)引起的。

舌系带通常在出生前变薄并向后缩。否则，舌系带可能会限制舌头的活动。舌系带过紧往往有家族遗传倾向，一般认为男孩比女孩更常见。高腭弓或上腭异常与舌系带过紧之间存在联系，因为舌头活动受限会影响上腭的形状。

母乳喂养的挑战也可能因其它原因产生。先识别原因再确定适合的解决方案很重要，因此要向有经验的人寻求帮助。

识别舌系带过紧

当宝宝试着抬起舌头或往前伸舌头时，舌头可能会变形、缩短或呈心形，舌系带明显往下拽住舌中央并限制舌的活动。或者你能看到或感觉到舌头和口腔底部之间的坚韧组织。

舌系带过紧的程度因人而异，可能难以准确诊断。又短又紧的后舌系带过紧比较罕见，但可能尤其难以诊断出。

母乳喂养会受到怎样的影响

舌系带过紧不同程度地影响到舌头的活动。舌系带越短越紧，就越可能影响母乳喂养。一些舌系带过紧的宝宝从一开始母乳喂养得就很好，另一些宝宝则在哺乳和含乳姿势改善后才能很好地哺乳。但是任何限制正常舌头活动的舌系带过紧都会导致母乳喂养困难。宝宝要能够自由活动舌头，并把舌头伸到下牙龈外，同时嘴巴张得大大的，才能很好地哺乳。下面的症状都与含乳欠佳有关，可能是由舌系带过紧造成的。

宝宝可能：

• 根本无法含住乳房
• 不能较深地含乳，导致乳头疼痛和损伤
• 难以持续含住乳房，发出“咔哒”声像是吸不住乳房
• 应对快速流动的乳汁时，会噗噗地呼气和呛奶
• 需要频繁哺乳才能吃到足够的奶量
• 体重增长不佳，或需要补充奶来保持足够的体重增加
• 出现需要治疗的黄疸
• 当乳汁流速减慢时，在乳房上很烦躁
• 出现肠绞痛

             

妈妈可能会经历：

• 哺乳时疼痛，伴有乳头损伤。刚喂完奶乳头可能被压扁或变形成楔形，就像新口红的形状一样，往往乳头尖上有一条横纹。
• 由于无效的乳汁移出而导致乳房肿胀、乳管堵塞和乳腺炎。
• 由于无效的乳汁移出而导致产奶量低
• 奶量过多——如果宝宝通过频繁吃奶来弥补哺乳不足的话
• 感到疲劳、沮丧和挫败
• 过早停止母乳喂养

母乳喂养对每个宝宝都很重要

虽然有时你会因为母乳量不足而临时补充配方奶，但这只是治标不治本。配方奶对你和宝宝都有短期和长期的健康风险。

舌系带过紧的宝宝也可能有奶瓶喂养的困难。乳汁可能会在喂奶时从他嘴里漏出来，他也可能患肠绞痛。

治疗

当舌系带过短引起母乳喂养问题时，可采取有效的治疗方案——特别是如果能及时治疗的话。虽然关注哺乳和含乳姿势有助于维持母乳喂养并在一定程度上提高舒适度，但有证据表明，通过舌系带松解术(见下文)治疗舌系带过紧会有效解决母乳喂养的困难。体重增长可以显著改善。舌系带松解术后继续母乳喂养，除了持续享受母乳喂养的好处外，还最大限度地提高了宝宝口腔(上腭)、语言和牙齿正常发育的机会。这包括提高了舌头的活动能力去舔食和移动口腔周围的食物颗粒，有助于预防蛀牙。   

• 继续母乳喂养

如果你已经很痛苦，再掌握母乳喂养的艺术有时会更有挑战。你往往需要下定决心才能坚持下去。这里的信息可以帮助你在治疗前后持续地母乳喂养。   

• 软化乳房

如果你的乳房很柔软，那么舌系带过紧的宝宝会更容易含上，所以要频繁地哺乳来避免乳房肿胀。宝宝摇晃着头去舔乳头时，他们会很自然地轻松含上乳。或者你也可以用反向压力软化法将体液从乳头区域推开，这样宝宝可以很好地含上乳。将一只手的五个指尖围着按在乳头根部。轻柔而稳定地按压约一分钟，在乳晕上留下一圈小窝。你也可以用手指侧面按压，把拇指放在乳头的一边，食指中指放在另一边，也就是放到宝宝含乳时嘴唇所在的位置。需要的话可以轻轻用手挤出来一点儿母乳。

• 生物养育法™

如果宝宝能够长时间依偎在妈妈胸前，他们往往会本能地含乳含得很深、很舒服。试着在半躺时让宝宝趴在你身上，这样他的胸部和肚子都会贴着你。这种“后躺”的哺乳姿势被称为“生物养育法™”，可以边做肌肤接触边哺乳，或者你和宝宝也可以穿点儿衣服这样地哺乳——只要能让你俩更舒适、更方便，怎么样都行。由于重力作用帮助宝宝保持舌头向前伸，这会极大地改善宝宝的吃奶效率和你的产奶量。

半躺式喂养姿势（生物养育法™）

图片来源：英国母乳会

          

• 较深地含乳

帮助宝宝尽可能较深地含乳。这会增加他们吃到的奶量，并减少妈妈乳头疼痛的几率。

图片来源：英国母乳会   

如果宝宝张开嘴时舌头缩回去了，就试着把他的下巴移得离乳头稍远一点，这样就能用舌头感受到乳房“更肥软”的部分。用手指在乳晕边缘按出凹痕，把宝宝的下巴放在此凹陷处也很有用。

图片来源：英国母乳会

你也可以试着把拇指或食指放在宝宝上唇要接触的乳头根部附近。按下去乳头就会翘起来偏离宝宝，他看到的是你的乳房，而不是乳头。随着宝宝嘴巴张开，搂紧他，用你的拇指或食指把乳房送入他嘴里。乳头是被最后吸入的，然后在他嘴里伸展开。需要的话，你可以把手指抽出来。

国际母乳会的哺乳辅导可以给你进一步的建议来帮助你改善宝宝的哺乳和含乳姿势。          

• 鼓励舌头的活动

为了鼓励宝宝把舌头往前伸，你也可以尝试：

1. 你半躺着，让宝宝趴在你身上。你试着往前和往后调整自己身体的角度，来感受重力作用是如何影响舌头位置的。
2. 鼓励宝宝在喂奶前后舔自己嘴唇或你的乳头上的乳汁。   
3. 你向宝宝伸出自己的舌头，来鼓励他模仿你。

• 维持住奶量

假如宝宝嗜睡或有黄疸，或者假如你乳房肿胀或乳头凹陷，那么舌系带过紧会雪上加霜。如果宝宝不能直接从乳房上吃到足够的母乳，你就需要挤奶喂给宝宝，直到他能有效地吃奶为止。如果宝宝不能彻底吸软乳房，就要一天至少8次用手挤奶或者用吸奶器吸奶。这样可以维持住你的奶量，还能确保他吃到足够的母乳。

你俩学习如何母乳喂养的同时，可以用勺子、杯子或注射器喂少量挤出的母乳。奶瓶或奶嘴会混淆宝宝的吸吮技巧，所以可以向国际母乳会的哺乳辅导咨询有利于母乳喂养的瓶喂或用哺乳辅助器的方法。这种装置在宝宝哺乳时，通过一根贴在乳房上的管子提供给他额外的乳汁，避免了用奶瓶吃奶。

• 上腭异常

由舌系带过紧引起的舌头活动受限，可能会影响宝宝上腭的形状，导致高腭弓或较深的泡状上腭。这可能是哺乳时吸吮中断、有“咔哒”声和乳头疼痛的一个原因。上腭异常的宝宝也可能因为干呕而抗拒较深地含乳。

以下方法会有所帮助:

• 先把指甲修剪整齐，并洗干净手指    

• 触摸宝宝的嘴唇，等到他们张开嘴

• 轻轻滑入你的手指，指腹朝上沿着他的硬腭伸入，触发呕吐反射前停下。

把这变成一个愉快的游戏，过几天，慢慢把你的手指伸得更深一些来克服宝宝的敏感。在舌系带松解开后，宝宝舌头运动的增加有助于让上腭形状变得更正常。

• 治疗舌系带过紧

能做什么？

舌系带松解术 ——把舌系带松解开——可以极大地提高妈妈和宝宝母乳喂养的舒适度和效率。松解开舌系带是一个又快又简单的手术。六个月以下的宝宝不需要麻醉。

有一些医疗专业人员接受过松解舌系带的专门培训。对舌系带过紧以及它如何影响母乳喂养的认知各不相同，所以值得坚持并寻求其他医生的意见。

等待是一种选择吗？

有时候很薄的舌系带会自然断开，或者可以通过轻柔按摩舌系带被拉伸开。舌系带越早松解开，母乳喂养的困难就越容易解决。为六个月以上的宝宝松解舌系带是一个比较复杂的手术，通常需要全身麻醉。   

舌系带松解术 ——会怎么做？

在医生初步评估后，宝宝会被包裹起来抱着(通常由助手抱着) ，所以在手术中他会保持不动，只需要一两分钟即可。医疗人员抬起宝宝的舌头，用一把圆头的无菌剪刀或高温烧灼消毒的剪刀，把舌系带松解开。

这个手术疼吗？

非常年幼的宝宝是不需要麻醉的，因为松解舌系带即使疼，也只会有点儿疼。一些宝宝对被包裹着的反抗多于对治疗本身。其他的孩子在整个手术中都在睡觉！一旦手术结束，就会让你马上给孩子哺乳，来慰籍他、清洁伤口、并让舌头尽快活动。宝宝口腔里面的伤口愈合得很快。一般术后唯一需要做的护理就是哺乳，以保持伤口清洁、让舌头活动。宝宝的舌头下方可能会有一块白斑，不过会在24到48小时内愈合。

如果问题没有解决？

通常妈妈注意到哺乳时她的舒适感会立刻改善。有时宝宝需要一到两周来适应舌头变得更灵活了。大一点的宝宝会发现较难适应舌头增加的灵活性，就会建议给他们进行舌头锻炼。偶尔宝宝的舌系带需要第二次松解，通常是因为第一次松解得不够彻底。如果你怀疑最初的手术没有解决宝宝的母乳喂养问题，就要另行咨询。要坚持去寻找解决方案。如果涉及好几个因素，解决问题就需要时间和专业知识。国际母乳会的哺乳辅导可以建议更多的探索方式，并提供持续的支持。

乳头疼痛

如果哺乳时很疼，使用不同的哺乳姿势可能有用。或者用你觉得最舒服的姿势，直到乳头愈合了。检查宝宝的含乳——如果宝宝从较深的含乳开始，但在哺乳的过程中不知不觉嘴会滑脱到乳头上，可能会让你疼痛。半躺的哺乳姿势或者在胳膊下多垫点儿可能会有帮助。

可以向国际母乳会的哺乳辅导询问乳房按压的相关信息，它有助于宝宝更快吃到更多的母乳。乳汁流速的增加也帮助他更有效地哺乳。

在哺乳前用手挤奶来刺激乳汁流动。或者从不太疼的那侧乳房开始哺乳，一旦来了奶阵就换一边。疼痛会减少乳汁流量，导致乳房肿胀和乳腺炎。请询问你的医生、助产士或家访护士如何使用合适的止痛药。在哺乳前温敷并做轻柔的按摩和放松动作有助于乳汁流动。

湿敷伤口愈合法    

潜在的问题被纠正后，湿敷伤口愈合法可以帮助乳头愈合而不会形成结痂。每次哺乳后，轻轻拍干乳头去除表面的水分。在每个乳头上涂薄薄一层超纯羊脂膏，要轻轻涂抹而不是摩擦。也可使用没有衬垫的水凝胶垫。

• 乳头皲裂处的血

乳头皲裂处的血对宝宝无害。你可以在继续哺乳的同时努力改善哺乳和含乳姿势。

• 如果愈合缓慢

一旦宝宝开始很好地含乳了，你应该觉得更舒服，并在几天内注意到伤口愈合的迹象。否则就要去看家庭医生——有时细菌感染或真菌感染会妨碍愈合。持续的疼痛可能表明宝宝的舌系带过紧需要治疗(或更进一步的治疗)

寻求帮助

这个时候在你当地的国际母乳会小组中得到其他妈妈的支持就是无价之宝了。

国际母乳会哺乳辅导联系方式

2022-09-03

你可以在此找到离你最近的哺乳辅导。

          

Tongue Tie

Are you experiencing pain while breastfeeding, possibly combined with slow weight gain for your baby? While the vast majority of such breastfeeding problems can be resolved by adjusting positioning and attachment, and with good breastfeeding management, occasionally tongue tie might be the cause of the problem.   

Tongue tie (ankyloglossia) is caused by a tight or short lingual frenulum (the membrane that anchors the tongue to the floor of the mouth). The frenulum normally thins and recedes before birth. Where this doesn’t happen, the frenulum may restrict tongue mobility. Tongue tie often runs in families and is thought to be more common in boys than girls. There is an association between high or unusual palates and tongue tie, because restricted tongue movement can affect the shape of the palate.

Breastfeeding challenges can also occur for other reasons. Identifying the cause is important when deciding on appropriate solutions, so seek help from someone skilled.

Identifying tongue tie

When your baby tries to lift their tongue or move it forwards it may appear misshapen, short or heart-shaped, with the frenulum clearly pulling its centre down and restricting its movement. Or you may be able to see or feel firm tissue where their tongue meets the floor of his mouth. Degrees of tongue tie vary and it can be difficult to diagnose accurately. A short, tight, posterior tongue tie is rarer, but may be particularly hard to spot.

How breastfeeding may be affected

Tongue tie affects tongue movement to varying degrees. The shorter and tighter it is, the more likely it is to affect breastfeeding. Some babies with a tongue tie breastfeed well from the start, others do so when positioning and attachment are improved. But any tongue tie that restricts normal tongue movement can lead to breastfeeding difficulties. A baby needs to be able to move their tongue freely and extend it over the lower gum with their mouth open wide to be able to breastfeed well. The symptoms below are all associated with poor attachment that may be caused by tongue tie.

A baby may:

• Be unable to latch on to the breast at all.  
• Be unable to latch on deeply, causing nipple pain and damage.
• Have difficulties staying on the breast, making a clicking sound as he loses suction.
• Splutter and choke when coping with fast flowing milk.
• Breastfeed constantly to get enough milk.
• Have poor weight gain or need supplementation to maintain adequate weight gain.
• Develop jaundice that needs treating.
• Be fussy at the breast when the milk flow slows.
• Develop colic.

A mother may experience:

• Pain during feeds, with damaged nipples. Her nipple may be compressed or distorted into a wedge shape like that of a new lipstick immediately after feeding, often with a stripe at its tip.
• Engorgement, blocked ducts and mastitis because of ineffective milk removal.
• Low milk production because of ineffective milk removal.
• Oversupply—if her baby compensates for not being able to breastfeed well by nursing very frequently.
• Tiredness, frustration and discouragement.
• A premature end to breastfeeding.
  
  

Breastfeeding is important for every baby

Though sometimes needed as a temporary supplement if your milk production is very low, introducing infant formula is not the answer. It has short-term and long-term health risks for both your baby and you. A baby with tongue tie can also have difficulties with bottle feeding. Milk may leak from his mouth during feeds and he may suffer from colic.

Treatment

Where a tongue tie is causing breastfeeding problems, treatment options are available and effective— especially if the treatment is prompt. Although attention to positioning and attachment can help maintain breastfeeding and improve comfort to a certain extent, there is evidence that treating tongue tie by frenotomy (see below) is effective in resolving breastfeeding difficulties. Weight gain can improve dramatically. As well as the continued breastfeeding benefits, continuing to breastfeed after frenotomy maximizes a baby’s chance of normal mouth (palate), speech and dental development. This includes tongue mobility for licking and moving particles of food around the mouth, helping prevent tooth decay.    

Keeping breastfeeding going

Mastering the art of breastfeeding can sometimes be a challenge and it takes determination to keep going if you are in pain. The information here can help you keep breastfeeding, both before and after treatment.

Soften your breast

A baby with tongue tie may find it easier to latch on if your breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, they naturally makes it easier to latch on. Or you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola. You can also press with the sides of your fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby’s lips will be. Gently hand express a little milk if needed.

Biological nurturing™
A baby often instinctively attaches more deeply and comfortably if they can snuggle up close to their mother’s chest for periods of time. Try letting your baby lie on your body as you recline so both their chest and tummy are against you. This kind of ‘laid-back’ breastfeeding contact is known as Biological Nurturing™ and can be done skin-to-skin or with you and your baby lightly clothed—whatever is more comfortable and convenient for you both. Because gravity helps a baby keep their tongue forwards, this can make a real difference to how well your baby feeds and how much milk you make.   

          Biological Nurturing

A deeper latch
Help your baby get as deep a latch as possible at the breast. This will maximize the amount of milk they get and minimize nipple pain.  

If your baby retracts (pulls back) their tongue when they open their mouth, try sliding their chin a little further from the nipple so he can feel the ‘fatter’ part of the breast with his tongue. Denting the breast at the edge of the areola with a finger and placing your baby’s chin in the dent may also help. 

You could also try placing your thumb or finger near the base of the nipple where your baby’s upper lip will be. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. If needed, you can then slip your finger out. An LLL Leader can give you further suggestions to help you improve your baby’s positioning and attachment

Encourage tongue mobility

To encourage your baby to move their tongue forward, you can also try:
• Reclining with your baby on top of you. Try leaning forward and back yourself to understand how gravity affects tongue position.
• Encouraging them to lick milk from their lips or from your nipple before and after feeds.1-9
• Sticking your tongue out at your baby to encourage them to copy you.

Maintain milk production

If your baby is sleepy or has jaundice, or if you have engorgement or inverted nipples, then a tongue tie can make things worse. If they are not able to take enough milk directly at the breast then you will need to express it and give it to your baby until they are able to breastfeed effectively. Express by hand and/or with a pump at least 8 times a day if your baby is not draining the breast well. This will maintain your milk production and ensure they get enough milk.

Small amounts of expressed milk can be offered by spoon, cup or syringe while you both learn how to breastfeed. Bottles or dummies can confuse your baby’s sucking technique so consult an LLL Leader about breastfeeding friendly ways to bottlefeed or about using a nursing supplementer. This device delivers extra milk through a tube along your breast as your baby nurses, avoiding the need for bottles.

An unusual palate

Restricted tongue movement caused by tongue tie may affect the shape of a baby’s palate, leading to a high palate or a bubble palate with a high spot. These may be a factor in broken suction, a clicking sound and pain during breastfeeding. A baby with an unusual palate may also resist a deeper latch due to gagging. 

The following may help.

• Start with a clean finger with closely trimmed nail.
• Touch your baby’s lips and wait until they open their mouth.
• Gently slide in your finger, pad side up along his hard palate, stopping just before the gag reflex is triggered.

Make this a pleasant game and, over a few days, gradually move your finger back to overcome sensitivity. After a tongue tie is divided, a baby’s increased tongue movement helps the palate shape become more normal

Treating Tongue Tie

What can be done?
Frenotomy—dividing the tongue tie—can dramatically improve breastfeeding comfort and efficiency for both mother and baby. Dividing a tongue tie is a quick and simple procedure. No anaesthetic is needed for a baby under six months of age.

There are health professionals who have been specifically trained to divide tongue ties. Knowledge about tongue ties and how they affect breastfeeding varies, so it is worth persisting and seeking a second opinion.

Is waiting an option?
Sometimes a very thin tongue tie breaks spontaneously or can be stretched by gentle massage of the frenulum. The earlier a tongue tie is divided, the easier it is to resolve any breastfeeding difficulties. Dividing a tongue tie in a baby over six months old is also a more complicated procedure and usually requires a general anaesthetic.

Frenotomy—what will happen?
After the health professional’s initial assessment, your baby will be swaddled and held (often by an assistant) so they stay still during the procedure, which only takes a minute or two. The health professional lifts the tongue and divides the frenulum by cutting it with a pair of round-ended sterile scissors or by cauterising it.

Does it hurt?
No anaesthetic is needed for a very young baby as having a tongue tie divided only hurts a little, if at all. Some babies protest more at being swaddled than about the treatment. Others sleep right through the procedure! You will be asked to breastfeed your baby as soon as the procedure is over, to offer comfort, clean the wound and get their tongue moving as soon as possible. The inside of a baby’s mouth heals very quickly. The only treatment usually needed is to breastfeed to keep the wound clean and keep his tongue mobile. There may be a white patch under your baby’s tongue, but this heals within 24 to 48 hours.

If things don’t resolve
Usually a mother notices an instant improvement in her comfort during breastfeeds. Sometimes it takes a week or two for a baby to adjust to their tongue’s greater mobility. An older baby may find it harder to adjust to increased tongue mobility and tongue exercises may be recommended. Occasionally a baby’s frenulum needs dividing a second time, usually because the division was not quite extensive enough the first time. If you suspect that the initial procedure has not resolved your baby’s breastfeeding problems arrange another consultation. Do persist with finding solutions. If several factors are involved it can take time and expertise to resolve the problem. An LLL Leader can suggest further paths to explore and provide ongoing support.

Painful nipples

Using different feeding positions can help if breastfeeding is painful. Or use the position you find most comfortable until your nipples heal. Check your baby’s attachment later in the feed—if they slip down your nipple, this may cause you pain. Reclining breastfeeding positions or extra support under your arms may help.

Ask your LLL Leader about breast compression, which can help your baby get more milk quicker. An increase in milk flow may also help them breastfeed more effectively.

Hand express to stimulate milk flow before feeding.Or start on the least painful side, switching sides once your milk lets down. Pain can reduce milk flow, leading to engorgement and mastitis. Ask your doctor, midwife or health visitor about using a suitable painkiller. Applying warmth and using gentle massage and relaxation exercises just before feeds can help milk to flow.

Moist wound healing

When the underlying problem is corrected, moist wound healing can help your nipples heal without scab formation. After each feed gently pat your nipples dry to remove surface wetness. Apply a tiny smear of ultra pure modified lanolin to each nipple, dabbing it on rather than rubbing. Hydrogel pads without a cloth backing can also be used.

• Blood from cracked nipples

Blood from cracked nipples is not harmful to your baby. You can continue to breastfeed whilst working to improve positioning and attachment.

• If healing is slow

Once your baby starts latching on well you should feel more comfortable and notice signs of healing within a few days. If not, visit your GP—sometimes a bacterial or fungal infection can prevent healing. Continued pain may be a sign that treatment (or further treatment) of your baby’s tongue tie is needed.

Seek support

This is a time when the support of other mothers in your local LLL group can be invaluable.

You can find your nearest Leader.

2022-09-03

参考文献  References

Hazelbaker, AK. Tongue-Tie: Morphogenesis, Impact, Assessment and Treatment. Columbus, OH: Aidan and Eva Press, 2010.

  

Mohrbacher, N. Breastfeeding Answers Made Simple. Amarillo Tx: Hale Publishing, 2010.

Watson Genna, C. Supporting Sucking Skills in Breastfeeding Infants. Burlington, MA. Jones & Bartlett, 2012.    

Geddes, DT. et al. Frenulotomy for breastfeeding infants with ankyloglossia: Effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 2008; 12(1):e188–94.

Hogan, M. Westcott, C. and Griffiths, M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005; 41:246–50.

Hong, P. et al. Defining ankyloglossia: A case series of anterior and posterior tongue ties. Int J Ped Otorhinolaryngology 2010; 74:1003–6.

Knox, I. Tongue tie and frenotomy in the breastfeeding newborn. Neoreviews 11 (9) Sept 2010.

Miranda, BH. and Milroy, CJ. A quick snip—a study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. JPRAS 2010; 63:e683–5.

NICE Guidelines

Watson Genna, C. And Coryllos, EV. Breastfeeding and tongue-tie. J Hum Lact 2009; 25(1):111–2.

资料来源：https://www.laleche.org.uk/tongue-tie/

END

作者：英国母乳会

翻译：传艳

审稿：Lynn、Marien、张艳莹、核桃

编辑：斯琦

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本篇文章来源于微信公众号: 国际母乳会LLL

点击上方国际母乳会LLL 设为星标，获取哺乳信息

母乳喂养 科普手册系列

如何含乳？

刚开始哺乳的时候，意味着你和你的宝宝都在学习一项新技能。随着不断练习，你们很快就会掌握要领。

在与宝宝磨合期间请尝试以下技巧：

◆如果此时宝宝正在哭闹，请先花点时间安抚他，让他平静下来。

◆用靠垫、枕头等支撑你的背部和手臂让自己感到舒适。

◆让宝宝的整个身体面对并且紧贴着你的身体，这样他无需转头就能轻松吃到奶。他的嘴和鼻子应该面向你的乳头。

◆用你的乳头轻轻触摸宝宝的嘴唇，等待他自发地张开嘴。轻微重复的轻敲或轻扫的动作可引导宝宝张大嘴巴。太过用力的触摸则不行。

◆当宝宝张开嘴时，他的头应该稍微向后倾斜，他的鼻子要与你的乳头持平。当他的头向你的胸部靠近时，让他的下巴最先靠近胸部，这样有助于他的下巴比上嘴唇更多地覆盖你的乳房。

◆如果你感觉舒服，宝宝也在积极地吮吸，那么这个姿势就很好了。

新生儿无法含乳怎么办？

• 试试半躺式的姿势，让宝宝主导寻乳，妈妈可以相应移动乳房以便宝宝找到乳头。
• 尝试在宝宝睡着或非常困倦时喂奶。
• 改变哺乳姿势。有些宝宝刚出生后一段时间对某些姿势有偏好。
• 试着站起来走动或稍微摇晃一下，同时让他靠近乳房。
• 在一个没有干扰的安静的房间里喂奶。
• 尝试与宝宝肌肤接触：宝宝只穿着尿布，依偎在你裸露的胸膛上。如果房间有点冷，请在你们俩身上盖一条毯子。
• 尝试在不同场景喂奶：在肌肤接触时，用背巾背着宝宝时，一起泡热水澡，睡在宝宝的旁边。
  
  
  

  
  

  
  

  如果在刚开始第一周宝宝含乳时，你感觉除了有些压痛或轻微酸痛外还有其他不适， 请联系国际母乳会的哺乳辅导寻求帮助。

  
  

  
  

  

  
  

国际母乳会哺乳辅导联系方式

2022-09-03

国际母乳会建粉丝群啦！

2023-05-01

END

撰稿 | Victoria

审阅 | Victoria、晓璠

编辑 | 斯琦

更多阅读资料，

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您的赞赏可以让更多的妈妈和婴儿获益！

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点击上方国际母乳会LLL 设为星标，获取哺乳信息    

这是一个鸡生蛋还是蛋生鸡的事情。

不同的哺乳动物生成的不同成分乳汁会影响它们作为这一物种的哺育方式吗？还是不同的哺育方式会影响物种自身生存所需的乳汁成分呢？

各种哺乳动物乳汁中的脂肪和蛋白质含量会依据物种的需要而产生相当大的差异。乳汁中脂肪含量最高的哺乳动物，需要让它们的幼仔迅速长出一层厚厚的脂肪来御寒。

灰海豹的乳汁中含有59.8%的脂肪，蓝鲸的乳汁中含有40.9%的脂肪。人类的乳汁中只含3.8%的脂肪。乳汁中蛋白质含量最高的哺乳动物，其幼仔生长得非常迅速，而且很快就会发育成熟。老鼠乳汁的蛋白质含量为12.9%，而人乳的为0.9%。

脂肪和蛋白质的含量与动物母子之间的关系也会互为影响。公共卫生医师及袋鼠式育儿法研究专家尼尔斯·伯格曼描述了四种不同类型的哺乳动物，以及它们的乳汁成分是如何与母子关系相关的。

藏匿型哺乳动物：幼仔刚出生时就相当成熟。母亲把幼仔藏在安全的地方，大约每12个小时回来一趟给它们哺乳。藏匿型哺乳动物的乳汁中，蛋白质和脂肪含量很高，因为必须让幼仔保持长时间的饱腹和安静状态。如果幼仔饿得哇哇大哭，就会更容易受到捕食者的攻击。鹿和兔子是藏匿型哺乳动物的典型代表。

巢穴型哺乳动物：巢穴型哺乳动物的幼仔出生时还不太成熟。它们一般生在窝里。出生后的早期，它们需要巢穴的温暖并和其它幼仔共处。巢穴型哺乳动物的母亲每隔2~4个小时回到巢中给幼仔们哺乳。这种哺乳动物的乳汁中，蛋白质和脂肪含量低于藏匿型哺乳动物。狗和猫是巢穴型哺乳动物的典型代表。

跟随型哺乳动物：这类动物的幼仔出生时已经比较成熟，在出生后很短的时间内就能很好地跟随妈妈。幼仔们日日夜夜都和母亲待在一起，频繁地吃奶。这种哺乳动物的乳汁中，脂肪和蛋白质的含量低于藏匿型或巢穴型哺乳动物。牛和长颈鹿属于跟随型哺乳动物的典型代表。

携带型哺乳动物：这类动物包括猿类以及有袋类动物，例如袋鼠。携带型哺乳动物出生时是最不成熟的。它们在很长一段时间内都需要被母亲一直携带着，并且要不分昼夜、频繁地哺喂低蛋白、低脂肪的乳汁。

人类是“携带型”哺乳动物。人乳是所有哺乳动物中脂肪和蛋白质含量最低的乳汁。这提醒了我们，人类婴儿从基因上就设定为他们需要被频繁哺乳、被经常抱着。

2022年8月更新

Mammal Milk Composition and Mothering Styles

This is a chicken and egg kind of story. Did the kind of milk produced by different mammals influence their mothering style as a species? Or did the mothering style influence the kind of milk needed to support the species?

The fat and protein composition of the milk of various mammals is quite different depending on the needs of the species. Mammals who produce the highest fat content milk need their babies to grow a thick coat of blubbervery quickly to protect them from the cold. 

Gray Seals have 59.8% fat and Blue Whales have 40.9% fat in their milk. Human milk has 3.8% fat. Mammals whose milk has the highest protein content have young whose growth is very rapid and who will reach maturity very quickly. Mice have 12.9% protein compared to humans at 0.9%.

The fat and protein content also influences, or has been influenced by, the way the animal relates to its young. Nils Bergman, a public health physician and Kangaroo Mother Care researcher, describes four distinct types of mammals and how their milk composition relates to the relationship between mother and baby.

Cache mammals:The young are quite mature at birth. The mothers hide the babies in a safe place and return to feed them approximately every 12 hours. The milk of cache mammals is high in protein and fat because it has to keep the baby full and quiet for a long time. If the baby cried out in hunger, it would become more vulnerable to predators. Deer and rabbits are examples of cache mammals.

Nest mammals: The babies of nest mammals are less mature at birth. They are generally born in litters. They need the warmth of the nest location and the other young in their early days. The mothers of nest mammals return to the nest to feed every two to four hours. The milk of these mammals is lower in protein and fat than that of cache mammals. Dogs and cats are examples of nest mammals.

Follow mammals: The young of this group are also mature at birth and can walk well enough to follow their mothers within a very short time after being born. The babies stay close to their mothers and feed frequently throughout the day and night. The milk of these mammals is lower in fat and protein than that of cache or nest mammals. Cows and giraffes are examples of follow mammals.

Carry mammals:This group includes the apes as well as marsupials, such as the kangaroo. Carry mammals are the most immature at birth. They are carried constantly by the mother for an extended period of time and they are fed low protein/low fat milk frequently around the clock.

Humans are “carry” mammals. Human milk is amongst the lowest in both fat and protein levels of all mammals. This reminds us that human babies are genetically programmed to be fed often and carried a lot.

Please considersupporting LLLC.

Updated August 2022

资料来源：

www.lllc.ca/mammal-milk-composition-and-mothering-styles

END

翻译：Lynn

审稿：传艳、楠楠 

编辑：斯琦

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国际母乳会感谢您支持我们的公益事业！

正如我们的志愿者在内部会议中提到，投身公益事业后才知道做公益也是有成本的！你的支持和赞赏可以让更多的妈妈获益！

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点击上方国际母乳会LLL 设为星标，获取哺乳信息

母乳喂养 科普手册系列

#

当然，本手册只是提供资讯，无论妈妈选择哪种喂养方式，我们都尊重你们的选择。

以下是母乳喂养对妈妈和宝宝都很重要的几个主要原因：

• 即使母乳喂养几天也能减少产后问题，让妈妈产后恢复更快，瘦身更快，体内激素更均衡，并给宝宝的肾脏、肠道和肝脏一个更健康的开始。早期的乳汁充满了保护因子，宝宝在未来数月都会依赖这些保护。它具有任何配方奶都无法提供的特别定制的免疫因子。

• 研究表明，如果母乳喂养超过几个月，与配方奶喂养的母亲相比，妈妈会降低乳腺癌、子宫癌、宫颈癌、卵巢癌、糖尿病、骨质疏松症和泌尿道感染的发病率。

• 在出生后的头六个月纯母乳喂养有助于确保宝宝拥有正常的免疫系统，并保护他免受配方奶喂养可能引起的许多疾病。这意味着妈妈将拥有一个更健康快乐的宝宝，很少需要请假去照顾他。

• 母乳喂养不但是婴儿食物的来源，同样重要的这是他们舒适和安全感的来源。大多数母乳喂养的婴儿哭得少是因为他们被抱得多。

• 哺乳时间越长，宝宝的智商越高，身体越健康，降低包括癌症、心脏病、糖尿病和肥胖等长期健康风险。

• 纯母乳喂养的母亲排卵和月经的恢复可能会延迟至产后六个月或更长时间。

• 母乳喂养会消耗额外的热量，所以妈妈无需节食就能逐渐减轻体重。

• 与配方奶喂养相比，母乳喂养可以节省大量的时间、精力和金钱。

• 母乳喂养的婴儿往往拥有丝滑柔软的皮肤。配方奶喂养的婴儿更容易患湿疹，他们还更可能患哮喘和过敏。

  
  

  
  

END

撰稿 | Victoria

审阅 | Victoria, 晓璠

编辑 | 斯琦

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蛀牙这个锅，母乳该不该背？一文理清母乳喂养与牙齿健康 Breastfeeding and Dental Health

国际母乳会上面这篇母乳与牙齿健康的文章发表后，引起了广泛的讨论。

针对妈妈们关心的问题，我们特地采访了两位牙科医生：广州的mtk和武汉的乐乐妈，她们都是母乳妈妈。

以下是访谈详情：

1. 乳牙什么时候开始清洁，乳牙保健注意事项

宝宝长第一颗牙齿的时候就可以开始清洁牙齿了。刚长出来的牙齿矿化程度低，很容易龋坏，因此帮宝宝刷牙十分的重要。给宝宝刷牙需要选用儿童牙刷，刷头小巧圆钝，刷毛软硬适中。牙膏选用氟含量500-1100ppm的儿童牙膏，3岁以下的小孩无法有效地吐出牙膏和漱口，牙膏最终会被吞下肚子，所以选择合适的牙膏用量也很重要，3岁以下每次刷牙使用米粒大小的牙膏，3岁以上使用豌豆大小的牙膏。

刷牙的频率是每天早晚各一次，由父母来帮小朋友刷牙，直到至少六岁。小朋友牙缝容易嵌塞食物，父母亦应该每天帮小朋友使用牙线。定期的口腔检查也是十分重要，频率一般为每年两次。

 

2. 为什么换牙好多都长歪了，如果需要做正畸，几岁做比较好？

家长经常会发现孩子牙齿萌出之后长歪了，十分担心。但是实际上大部分随着时间推移，都能慢慢调整过来。但如果是多生牙压迫导致的上前牙间隙或者扭转，需要及时处理；如果门牙扭转阻碍了下颌发育也需要及时处理。

三岁的时候可以到正畸医生处就诊，若有骨性问题可及早干预，若非骨性问题可待替牙完成再进行干预。 

3. 蛀牙和遗传有关吗？

引起蛀牙的原因包括致龋菌、食物、宿主、时间这四个因素。虽然有些与龋病相关的疾病是可以遗传的，如釉质发育不全，但这些疾病发病率极低。大部分的龋齿在同一个家庭里面“扎堆”出现的情况，往往是因为家长把不良的口腔卫生习惯及生活习惯带给了宝宝，或者宝宝照顾者通过密切的接触把口腔中的细菌传播给了宝宝。   

4.孩子乳牙总是要换的，那护理与不护理有啥区别

乳牙龋齿会影响咀嚼，影响孩子吃饭。发生在前牙的乳牙龋齿可能会影响发音功能。乳牙龋齿不美观，小孩子可能会在社交过程中不敢笑，缺乏自信，乳牙龋齿还可能会影响继承的恒牙，造成萌出的异常或者釉质发育不良。乳牙因为龋齿过早的脱落，后方的牙齿会前移，继承的恒牙萌出的时候没有位置，牙齿会不整齐。基于以上种种危害，对于乳牙龋齿需要尽早的干预和治疗。

5.门牙缝大 有必要去一下唇系带吗？

门牙缝大不一定是唇系带导致，有可能是因为旁边侧切牙的牙胚压迫导致，这种待牙萌出后会自己调整。如果是因为唇系带导致，建议在乳牙期及时处理。如果已替换为恒牙，建议先行正畸治疗关闭门缝后再行唇系带手术。

6.有必要定期带孩子涂氟吗？如果有必要的话是从几岁开始？

有。建议6个月长第一颗牙就可以带孩子去看牙医，评估患龋齿的风险决定要不要涂氟。对于高龋风险的孩子，越早开始涂氟越好。每3-6个月涂氟一次可以有效地预防龋齿。一直到12-14岁孩子换牙结束。

无论是否涂氟，尽早地开展定期口腔检查，都可以使孩子获益。

7. 夜奶会不会造成龋齿？    

母乳喂养并不会导致龋齿，WHO的报告中显示，出生第一年，母乳喂养的婴儿，龋病发病率低于配方奶喂养的婴儿。更应该引起我们注意的是，加工食物中过多的游离糖及精制碳水。为了降低低龄儿童龋齿的发生率，我们更应该限制高含糖量的食物，形成良好的口腔卫生习惯。   

本文作者

乐乐妈

END

审稿：Victoria、mtk、乐乐妈

编辑：斯琦

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接下来我们将继续深入探讨关于母乳喂养期间饮酒的一系列问题，涵盖诸如“一杯酒”的定义以及一些至关重要的注意事项。包括在饮用酒精饮料后是否需要泵奶并丢弃乳汁，以及在发生醉酒情况时应该如何处理。还将详细讨论酒精依赖或利用酒精进行自我治疗对母乳喂养婴儿可能产生的影响，如何在权衡风险和收益时做出明智的选择。

Next, we will continue to delve into a series of issues regarding alcohol consumption during breastfeeding, covering topics such as the definition of “one drink” and some crucial considerations. This includes whether it is necessary to pump and discard breast milk after consuming alcoholic beverages and how to handle situations of intoxication. We will also discuss in detail the potential impact of alcohol dependence or using alcohol for self-treatment on infants during breastfeeding, as well as how to make informed decisions when balancing risks and benefits.

Par6

“一杯酒”是指多少？

在不同国家，一个“标准杯”的衡量标准会有差异。如果您选择了在母乳喂养期间饮酒，了解什么是“标准杯”很重要。

请查询当地的卫生部或其他相关政府资源，以获取您所在国家/地区的正确信息。

举几个例子：

欧洲

想要了解欧洲的标准杯衡量方法，请参阅欧洲标准饮酒准则 。在英国，国家医疗保健服务（NHS）建议使用以下这个酒精单位计算器：https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator

美国

在美国，国立卫生研究院（NIH）的定义如下：

一个“标准杯”的酒（或同等的酒精饮料）大约含14克纯酒精，相当于：

12盎司（约等于360ml）普通啤酒，其酒精含量通常约为5%

5盎司（约等于150ml）葡萄酒，其酒精含量通常约为12%

1.5盎司（约等于45ml）蒸馏酒，其酒精含量通常约为40%

中国（译者注）

《中国居民膳食指南2022》（https://www.cnsoc.org/notice/442220200.html）建议孕妇、乳母不应饮酒。成年人如饮酒，一天饮用的酒精量不超过15g。

15g酒精相当于

啤酒（4%计）：450ml

葡萄酒（12%计）：150ml

白酒（38%计）：50ml

高度白酒（52%计）：30ml

注册药剂师托马斯.W.黑尔博士在其《药物与母乳喂养》（第17版，2019年）一书中这样写道：      

“酒精很容易进入人乳，平均血浆/乳汁比值约为1。这并不一定意味着人乳中的酒精剂量很高，只是说血浆中的酒精含量与人乳中的酒精含量密切相关。转移到人乳中的酒精的绝对量（剂量）通常较低，并与母体血浆中的酒精水平相似。早期的研究（有些是动物试验）表明，啤酒(或更有可能是啤酒里的麦芽)可能会刺激泌乳素的分泌。有不少酒精会进入了人乳，但如果酒精的量和持续时间有限，则认为对婴儿无害。转移到人乳中的酒精的绝对量通常较低。   

酒精过量可能导致婴儿嗜睡、深度睡眠、虚弱和生长迟缓。母亲血液中的酒精含量必须达到3克/升，才会对婴儿产生明显的副作用。喷乳反射的减少显然与剂量有关，需要饮酒量达到1.5-1.9克/公斤体重才会发生。其他研究表明，中度饮酒者（每天喝2杯以上酒精饮料）的婴儿精神运动发育会落后。在饮酒期间和饮酒后 2-3 小时内应避免母乳喂养。酗酒者则应等待更长的时间。 

在一项观察酒精如何影响婴儿摄入母乳的有趣的研究中，12位母亲在接触酒精（0.3 g/kg）后4小时内，婴儿的吃奶量明显减少。随后在母亲停止饮酒后8-16小时内观察到吃奶量有代偿性的增加。

成人在3小时内大约能代谢1盎司（约等于30ml）的酒精，因此适量摄入酒精的母亲通常在神经方面感觉正常后可立即恢复母乳喂养。长期或重度饮酒者不应母乳喂养。”    

Part7

重要的注意事项  

宝宝的年龄

• 新生儿的肝脏发育不成熟，受酒精的影响更大
• 直到大约三个月大的时候，婴儿代谢酒精的速度约为成年人的一半
• 年龄较大的婴儿比年幼婴儿能更快地代谢酒精，但仍然不如成人

  
  

您的体重

• 一个人的体型会影响他们代谢酒精的速度
• 体重较重的人比体重轻的人代谢酒精更快
  
  

酒精的量

• 了解什么叫“一个标准杯的酒精饮料”

酒精对婴儿的影响与饮酒量直接相关

• 饮酒越多，身体就需要越长的时间来清除酒精。

（CDC指出，“喝了1杯酒精饮料后大约2-3小时内可以在母乳中检测到酒精，喝了2杯酒精饮料后大约4-5小时内可以在母乳中检测到酒精，喝了3杯酒精饮料后大约6-8小时内可以在母乳中检测到酒精，依此类推。”）   

Part8

喝了酒精饮料后我必须吸奶并丢弃乳汁吗？  

当酒精从血液中清除后，它也同时从母乳中消失。酒精不会以固定的量存在于母乳中（当血液中的酒精含量下降时，母乳中的酒精会回到血液），因此吸奶并丢弃乳汁并不能去除酒精。吸奶并丢弃乳汁、大量喝水、休息或喝咖啡都不会加快体内酒精的清除速度。             

Part9

如果我喝醉了怎么办？  

如果您喝醉了，就不应该母乳喂养，直到您完全清醒、大部分酒精离开身体之后才能再喂奶。已经证实，喝醉酒或纵酒会影响婴儿的睡眠方式。在母亲摄入大量酒精（0.3克/公斤体重）后一小时，婴儿通过母乳接触到的酒精含量就足以对睡眠产生负面影响。

Part10

酒精依赖/使用酒精来自我治疗会影响母乳喂养的婴儿吗？  

是的。哺乳期母亲如果有酒精依赖或使用酒精来自我治疗（译者注：有些妈妈会喝酒来缓解压力、抑郁或焦虑）可能导致婴儿体重增加缓慢或生长迟缓。如前面所说，即使是少量到中等量的酒精也会对喷乳反射产生负面影响，并减少婴儿的母乳摄入量。婴儿的睡眠可能会受到严重干扰，或者可能无法有效吸吮，从而导致乳汁摄入量减少。婴儿甚至可能发生运动发育迟缓。如果您担心自己或您认识的人过量饮酒，请联系医疗保健专业人员或靠谱的专业机构组织，为那些正在与酒精使用作斗争的人提供支持。

Part11

权衡风险和获益  

生活中经常会出现需要喝酒的情况。也许您要和家人一起出门、有约会，或者您好不容易熬过了极度紧张的一周而有人提议去喝杯啤酒放松一下。无论出于什么原因，您可能会担心饮酒可能对宝宝产生的任何影响。最好权衡一下母乳喂养的好处与饮酒的好处和可能的风险。以下建议可能会对您有帮助。

未雨绸缪    

• 如果您选择喝酒，请尽可能好好计划，尽量减少宝宝接触酒精的机会；如果可能，提前挤出一些母乳并预存起来。

• 在饮用任何酒精饮料之前立即母乳喂养，然后等待大约三小时后再次哺乳，这样将有助于确保宝宝从母乳中喝到的酒精很少。

• 如果您在等待酒精从你体内清除的过程中开始涨奶，可以用手挤奶或者用吸奶器吸奶，并丢弃挤出的乳汁。

其他备选方案

• 如果您打算大量喝酒，请确保找到一个负责任的看护人来代替您照顾好宝宝。

• 如果您真的不想去参加家庭或职场的社交活动，请与值得信赖的朋友或当地的国际母乳会哺乳辅导(获取国际母乳会哺乳辅导联系方式)讨论去参加活动的利弊。

• 您可以坚持喝不含酒精的饮料。

• 在其他人都在喝酒的场合中，可以给值得信赖的朋友发消息或在线联系国际母乳会哺乳辅导。

• 如果情况允许，就寻求并接受帮助，让您从哺乳育儿中缓口气休息一下，专注做一些您喜欢做的事情。

         

Drinking Alcohol and Breastfeeding

HOW IS ONE DRINK DEFINED?

A ‘standard drink’ is measured differently in different countries. It is important to understand what a ‘standard drink’ is if you choose to drink alcohol and breastfeed.

Please check with your Ministry of Health or other pertinent government resource for appropriate information in your country.

Some examples:

▏To determine standard drink measures in Europe, please refer to Standard Drink Measures in Europe.

In the UK, the NHS suggest using this unit calculator:  https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator. 

▏In the United States, it is defined by the National Institutes of Health (NIH) this way:

In the United States, one “standard” drink (or one alcoholic drink equivalent) contains roughly 14 grams of pure alcohol, which is found in:

• 12 ounces of regular beer, which is usually about 5% alcohol
• 5 ounces of wine, which is typically about 12% alcohol
• 1.5 ounces of distilled spirits, which is about 40% alcohol

Thomas W. Hale, R.Ph. Ph.D, says this in his book Medications and Mothers’ Milk (17th ed., 2019):

“Alcohol transfers into human milk readily, with an average plasma/milk of about 1. This does not necessarily mean the dose of alcohol in milk is high, only that the levels in plasma correspond closely with those in milk. The absolute amount (dose) of alcohol transferred into milk is generally low and is a function of the maternal level. Older studies, some in animals, suggested that beer (or more likely barley) may stimulate prolactin levels. Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.

Excess levels may lead to drowsiness, deep sleep, weakness, and decreased linear growth in the infant. Maternal blood alcohol levels must attain 300 mg/dl before significant side effects are reported in the infant. Reduction of letdown is apparently dose-dependent and requires alcohol consumption of 1.5 to 1.9 gm/kg body weight. Other studies have suggested psychomotor delay in infants of moderate drinkers (2+ drinks daily). Avoid breastfeeding during and for 2–3 hours after drinking alcohol. Heavy drinkers should wait longer.

In an interesting study of the effect of alcohol on milk ingestion by infants, the rate of milk consumption by infants during the 4 hours immediately after exposure to alcohol (0.3 g/kg) in 12 mothers was significantly less. Compensatory increases in intake were then observed during the 8–16 hours after exposure when mothers refrained from drinking.

Adult metabolism of alcohol is approximately 1 ounce in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. Chronic or heavy consumers of alcohol should not breastfeed.”

IMPORTANT CONSIDERATIONS

Your baby’s age

• A newborn has an immature liver, and will be more affected by alcohol
• Up until around three months of age, infants metabolize alcohol at about half the rate of adults
• An older baby can metabolize alcohol more quickly than a young infant but still not as well as an adult

Your weight

• A person’s size has an impact on how quickly they metabolize alcohol

• A heavier person can metabolize alcohol more quickly than a lighter person

Amount of alcohol

• Know what constitutes a “standard drink”

The effect of alcohol on the baby is directly related to the amount of alcohol that is consumed

• The more alcohol consumed, the longer it takes to clear the body. The CDC state “Alcohol from 1 drink can be detected in breast milk for about 2-3 hours, alcohol from 2 drinks can be detected for about 4-5 hours, and alcohol from 3 drinks can be detected for about 6-8 hours, and so on.”

DO I HAVE TO PUMP AND DUMP AFTER DRINKING AN ALCOHOLIC BEVERAGE?

As alcohol leaves your bloodstream, it leaves your breastmilk. Since alcohol is not “trapped” in breastmilk (it returns to the bloodstream as your blood alcohol level declines), pumping and dumping will not remove it. Pumping and dumping, drinking a lot of water, resting, or drinking coffee will not speed up the rate of the elimination of alcohol from your body.

WHAT IF I GET DRUNK?

If you are intoxicated, you should not breastfeed until you are completely sober, at which time most of the alcohol will have left your body. Drinking to the point of intoxication, or binge drinking, has been shown to impact the way infants sleep. The negative impact on sleep occurs when the infants are exposed to alcohol through milk containing alcohol at the level it would be found in human milk one hour after a mother consumed a significant amount of alcohol (0.3 grams per kilogram of their body weight).

CAN ALCOHOL DEPENDENCY/SELF-MEDICATING WITH ALCOHOL AFFECT A BREASTFED BABY?

Yes. Alcohol dependence or self-medicating with alcohol by the mother/lactating parent can result in slow weight gain or failure to thrive in their baby. As noted earlier, even a small to moderate amount of alcohol negatively affects the milk ejection reflex (let-down) and reduces the baby’s milk intake. The baby can suffer significant disruption to their sleep or may not suck effectively leading to decreased milk intake. The baby may even suffer from delayed motor development. If you are concerned that you or someone you know is self-medicating with alcohol excessively, contact your healthcare professional or a reputable organisation supporting people who are struggling with alcohol use.

WEIGHING THE RISKS AND BENEFITS

Often, situations in which alcohol is being offered arise. Maybe you are going out with family, or on a date, or you have had an incredibly stressful week and someone suggests a beer. No matter the reason, you may have concerns about drinking and any possible effects on your baby. It is a good idea to weigh the benefits of breastfeeding against the benefits and possible risks of consuming alcohol. You might find the following suggestions helpful.

Plan Ahead

• If you choose to drink alcohol, plan as well as you can to reduce your baby’s exposure to alcohol; If possible, store some expressed breastmilk in advance. 
• Breastfeeding immediately before consuming any alcoholic beverage, then waiting to nurse again for about three hours, will help ensure that your baby gets very little alcohol from you.
• If your breasts become full while waiting for the alcohol to clear, you can hand express or pump, discarding the milk that you express. 

Alternatives

• If you plan to drink more than a moderate amount of alcohol, ensure that your baby has a responsible alternative caregiver.
• If you don’t really want to go to a family or work event talk to a trusted friend or with your local La Leche League Leader about the pros and cons of going. 
• You might prefer to stick to non-alcoholic drinks.
• Have a trusted friend or an online La Leche League group on hand to message when at an event where everyone else is drinking.
• Whenever possible, ask for and take up offers of help that allow you to have a short break from mothering and parenting to focus on something else you enjoy doing.

参考资源References: 

1.Centers for Disease Control (CDC).https://www.cdc.gov/alcohol/faqs.htm#excessivealcohol

2.LactMed. Retrieved 11 May 2020 from 

https://www.ncbi.nlm.nih.gov/books/NBK501469/

3.Mennella, J. A., & Garcia-Gomez, P. L. (2001). Sleep disturbances after acute exposure to alcohol in mothers’ milk. Alcohol 25(3) pp. 153-158. DOI: 10.1016/s0741-8329(01)00175-6

4.Koletzko, B., & Lehner, F. (2000). Beer and breastfeeding. 

Advances in Experimental Medicine and Biology 478 pp. 23-8. doi: 10.1007/0-306-46830-1_2. PMID: 11065057    

5.Mennella, J. A., Pepino, M. Y., & Teff, K. L. (2005). Acute alcohol consumption disrupts the hormonal milieu of lactating women. The Journal of Clinical Endocrinology & Metabolism 90(4) pp. 1979-1985. doi: 10.1210/jc.2004-1593.

6.Mennella, J. A., & Pepino, M. Y. (2008). Biphasic effects of moderate drinking on prolactin during lactation. Alcoholism: Clinical and Experimental Research 32(11) pp. 1899-1908. Doi: 10.1111/j.1530-0277.2008.00774.x.

7.Mennella, J. A., & Beauchamp, G. K. (1993). Beer, breast feeding, and folklore. Developmental Psychobiology, 26(8) pp. 459-466. doi: 10.1002/dev.420260804

8.Haastrup, M. B., Pottegård, A., & Damkier, P. (2013). Alcohol and breastfeeding. Basic & Clinical Pharmacology & Toxicology 114 pp. 168-173. doi: 10.1111/bcpt.12149 

9.Mennella, J. A. (2001). Regulation of milk intake after exposure to alcohol in mothers’ milk. Alcoholism: Clinical and Experimental Research 25(4) pp. 590-593.

10.Mennella, J. A. (1998). Short-term effects of maternal alcohol consumption on lactational performance. Alcoholism: Clinical and Experimental Research 22(7) pp 1389-1392. doi: 10.1111/j.1530-0277.1998.tb03924.x

11.Brown, R. A., Dakkak, H., & Seabrook, J. A. (2018). Is breast best? Examining the effects of alcohol and cannabis use during lactation. Journal of Neonatal-Perinatal Medicine, 11(4) pp. 345-356. Doi: 10.3233/NPM-17125.

12.Reece-Stremtan, S., Marinelli, K. A., & The Academy of Breastfeeding Medicine. (2015). ABM Clinical Protocol #21: Guidelines for breastfeeding and substance use or substance use disorder, Revised 2015. Breastfeeding Medicine 10(3) pp. 135-141. doi: 10.1089/bfm.2015.9992     

13.Anderson, P. O. (2018). Alcohol Use During Breastfeeding. Breastfeeding Medicine 13(5) pp. 315-317. DOI: 10.1089/bfm2018.0053.

14.Nonacs, R. (2018). Alcohol and breastfeeding: What are the risks? Contemporary OBGYN Net December 2018 24-28.

15.Oei, J-L. (2019). Risky maternal alcohol consumption during lactation decreases childhood abstract reasoning at school age. Evidence-based Nursing 22(10 p. 25. doi: 10.1136/ebnurs-2018-102999.

16.Gibson, L., & Porter, M. (2018). Drinking or smoking while breastfeeding and later cognition in children. Pediatrics 142(2). doi: https://doi.org/10.1542/peds.2017-4266.

17.Gibson, L., & Porter, M. (2020). Drinking or smoking while breastfeeding and later developmental health outcomes in children. BMC Res Notes 13:232. doi.org/10.1186/s13104-020-05072-8.

18.Pepino, M. Y., Steinmeyer, A. L., & Mennella, J. A. (2007). Lactational state modifies alcohol pharmacokinetics in women. Alcoholism: Clinical and Experimental Research 31(6) pp. 909-918. doi: 10.1111/j.1530-0277.2007.00387.x. 

19.Tay, R. Y., Wilson, J. McCormack, C., et al. (2017) Alcohol consumption by breastfeeding mothers: Frequence, correlates and infant outcomes. Drug and Alcohol Review 36 pp. 667-676. doi: 10.1111/dar.12473.

20.Standard Drink Measures in Europe (2015). Published by RARHA (Reducing Alcohol Related Harm). Accessed 4 Dec 2020 from http://www.rarha.eu/Resources/Deliverables/Lists/Deliverables/Attachments/14/WP5%20Background%20paper%20Standard%20drink%20measures%20HRB.pdf 

21.National Institutes of Health. What Is a Standard Drink? Accessed 4 Dec 2020 from 

https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink

22.Drugs and Lactation Database (LactMed), Alcohol, May 11 2020 https://www.ncbi.nlm.nih.gov/books/NBK501469/          
Accessed 27 October 2020

Reviewed and revised December 2020, with minor language changes March 2021.

2020年12月审阅修订，2021年3月略作语言微调。

资料来源：https://llli.org/breastfeeding-info/alcohol/

END

翻译：许悦

审稿：Lynn、Marien 

编辑：斯琦

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°睡眠障碍，包括睡眠时间缩短，更频繁醒来，以及在饮酒后3小时内总的浅睡眠时间和快眼动睡眠时间减少

°哭吵增加

°惊跳增加

°觉醒增加

°暴露于酒精后3.5小时至24小时内，快眼动睡眠增加

°婴儿的乳汁摄入量减少

°生长迟缓

°免疫功能受损

°运动发育落后

°认知发育可能受损

°学龄期(6-7岁)抽象推理能力下降 

母乳喂养医学会临床指南#21指出，在哺乳期饮酒会产生一些负面影响，程度从轻微到严重不等。这取决于母亲的饮酒量，以及与身体处理酒精的速度相关的其他因素。

酒精能完全溶于水和脂肪，因此很容易进入血液和乳汁。喝了一杯标准杯酒之后，母乳中的酒精含量约为母亲血液中酒精含量的 95%。

另一篇由Nonacs撰写的综述显示，经常从母乳中接触酒精的婴儿，运动发育会更差或落后。婴儿通过母乳摄入的酒精越多，婴儿在运动发育指标上的得分就越低。因为婴儿不能像成人那样快速地代谢酒精；新生儿代谢酒精的速度甚至仅为成人的25%-50%。

基于动物研究中的发现，人们担心酒精也会对婴儿发育中的大脑产生负面影响。Oei指出，“可靠的来自动物研究的数据”表明“酒精可能对发育中的大脑有毒性，特别是在大脑快速发育的时期”，比如在出生后的第一年。婴儿饮酒也可能导致记忆力和抑制反应的损害。

尽管研究仍在继续，但Haastrup，Pottegård和Damkier表示，“母乳中的酒精可能产生的长期影响仍然未知”。

Part4

在决定是否以及何时饮酒时，我还要考虑哪些其他影响？

根据您的饮酒量，除了影响乳汁分泌和喷乳反射之外，您可能发现饮酒对您自身也会产生一定程度的其他影响。

酒精会产生镇静作用以及一些兴奋作用。有证据表明，哺乳期妈妈可能比非哺乳者更快代谢酒精。有明确的证据表明，喝酒时吃点东西也会降低饮酒后血液里的酒精含量。空腹饮酒会增加酒精对泌乳素和催产素以及身体的影响。如果您经常喝酒，就不要和宝宝一起睡觉，因为您的反应能力会大大下降。         
         
关于母婴同床和酒精的信息，请查阅以下资讯：如何保证母乳宝宝在睡眠中的安全？Safer Sleep & the Breastfed Baby

酒精可能会通过干扰喷乳反射，进一步减少您的奶量：没有喷乳反射，您的宝宝就无法有效地吃奶并排空乳房。当乳汁滞留在乳房中时，它会“通知”您的身体减少产奶量。

Part5

在给宝宝喂奶期间，我可以偶尔喝点酒吗？

以下资讯提供了在母乳喂养期间饮酒时需要考虑的安全建议。

请注意，新生儿不能很好地代谢酒精；尽可能至少在宝宝8周龄大之前避免饮酒。

■如果可能的话，在喝任何酒精饮料之前立即母乳喂养宝宝，或者吸出并保存乳汁。

■酒精摄入量不要超过两杯葡萄酒（共8盎司，约相当于240ml）或一两杯啤酒，最好不要超过一杯。

■喝了一标准杯酒精饮料后，至少等2小时后再给宝宝喂奶。

■请注意，您喝得越多，清除酒精所需的时间就越长。

■如果您的宝宝等不及两个多小时就需要喂奶，请用您之前挤出的乳汁喂养宝宝。

■饮酒时喝点果汁。

■饮酒时吃点东西——它会减慢酒精进入血液的速度。

■仅在涨奶不舒服时才“吸奶并丢弃”。只要您的血液里有酒精，您的乳汁里就会含有酒精。

在接下来的文章中，我们将继续给大家带来关于酒精在母乳喂养中的一系列问题。

包括“一杯酒“是指多少？以及一些重要的注意事项，包括喝了酒精饮料后是否必须吸奶并丢弃乳汁，以及如果发生醉酒情况应该如何处理。我们还会深入讨论酒精依赖或使用酒精进行自我治疗是否会对母乳喂养的婴儿产生影响。最后，我们将探讨如何在权衡风险和获益之间做出明智的选择。

这些内容旨在为您提供关于母乳喂养和酒精相关问题的全面信息，帮助您做出正确的决策。

尽请期待

Drinking Alcohol and Breastfeeding

Can I drink alcohol and breastfeed? No harmful effects to babies have been from drinking no more than one drink a day. Our evidence-based article on Drinking Alcohol and Breastfeeding answers many questions you may have.

●Overview

●Can Drinking an Alcoholic Beverage Help Me Relax and Stimulate Milk Production?

●What are the Risks To My Baby?

●What Other Effects Should I Consider When Deciding Whether and When To Drink? 

●Can I Nurse My Baby and Still Drink Occasionally?

●How Is One Drink Defined? 

●Important Considerations

●Do I Have To Pump And Dump After Drinking an Alcoholic Beverage?

●What if I Get Drunk 

●Can Alcohol Dependency/Self-medicating With Alcohol Affect A Breastfed Baby? 

●Weighing The Risks And Benefits

●References

●Further resources

Overview

Breastfeeding mothers and lactating parents often receive conflicting advice about whether alcohol consumption can have an effect on their baby. While warnings are often given not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding have not received as much research attention. A number of studies have focused on the effects of alcohol on lactation and the infant, but long-term outcomes are still unknown.

Especially when it is consumed in large amounts, alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant. There is also the possibility of decreased milk-ejection reflex in the mother. No harmful effects to babies have been found when breastfeeding mothers drink no more than one drink a day.

Depending on how much alcohol you consume before you nurse your baby, they may experience a number of effects from the alcohol in your milk. Even a small to moderate amount of alcohol may impair milk production and the milk ejection reflex. Some of the negative effects in the baby may be:

• Sleep disturbances
• Increased crying
• Increased startling
• Increased arousal
• Increased REM sleep in the period from 3.5 hours to 24 hours after exposure to alcohol
• Decreased milk intake by baby
• Decreased weight gain

Potentially, depending on how much you drink and when you nurse your baby after drinking, there may be other, more severe effects on your baby as well. As a result, the guidance on drinking and nursing is changing. According to the CDC, “moderate alcohol consumption is defined as having up to 1 drink per day for women and up to 2 drinks per day for men”. We go into more detail below.

In brief, LactMed®, a database that contains information on drugs and other chemicals to which those who are breastfeeding may be exposed, offers the following information: 

“Breastmilk alcohol levels closely parallel blood alcohol levels. The highest alcohol levels in milk occur 30 to 60 minutes after an alcoholic beverage, but food delays the time of peak milk alcohol levels. Nursing after 1 or 2 drinks (including beer) can decrease the infant’s milk intake by 20 to 23% and cause infant agitation and poor sleep patterns. Nursing or pumping within 1 hour before ingesting alcohol may slightly reduce the subsequent amounts of alcohol in breastmilk.”          

Infants exposed to a significant amount of alcohol (0.3 g/kg parent’s body weight) through drinking human milk, spend significantly less time in both active and total sleep. REM sleep is also disrupted.  As infants are less able to process alcohol than adults due to their immature systems, some researchers believe that the dosage they receive through their mother’s/lactating parent’s milk may be stronger than it would be in an adult. In research conducted by Mennella and Garcia-Gomez, when an infant’s exposure occurred within 3.5 hours of a mother consuming a significant amount of alcohol, the effects were stronger. In the following 24-hour period, sleep patterns continued to be disrupted as the infant makes up for the earlier disruption. In addition, the research showed that during times when the infants were awake, they were less active.

Here are some common questions people ask with recommendations supported by the evidence available. Below, we will answer these questions and look at the possible impacts of drinking alcohol while breastfeeding in more detail. We will end with some tips for increasing safety if you want to drink alcohol while breastfeeding/chestfeeding/nursing (see How Can I Nurse My Baby and Still Drink Occasionally?). Pumping and dumping will not remove the alcohol from your bloodstream, so it will not affect the alcohol level in your milk.                 

Can drinking an alcoholic beverage help me relax and stimulate milk production?  

Along-standing “old wives’ tale” regarding consumption of alcohol, particularly beer, while breastfeeding, is that it can help boost milk production. While a barley component in beer–not the alcohol–does boost prolactin production, alcohol alone does so as well. However, in one study, milk production was actually decreased. In addition, in their research on alcohol consumption in lactating women (www.ncbi.nlm.nih.gov/pmc/articles/PMC1351273/)Menellaetal found alcohol also inhibits the milk ejection reflex and thus reduces the baby’s milk intake.

The research shows that nursing infants actually consumed less milk in the three-to-four-hour period after mothers consumed a small to moderate amount of alcohol. When a mother/lactating parent drinks alcohol and then breastfeeds their baby, their perception is that the baby nurses normally and for a normal time, so they do not realize that their baby is not getting as much milk. According to Menella, who conducted this research on this over a period of years, “infants consumed approximately 20% less breast milk”. This was the case even though the infants nursed a “similar number of times during the first 4 hr after exposure to alcohol in mothers’ milk” compared with nursing infants not exposed to alcohol in their mother’s milk. Similarly, additional research conducted by Mennella and Beauchamp showed that infants consumed about 23% less milk. Mennella also found that when pumping milk two hours after drinking alcohol, mothers obtained significantly less milk.

Current evidence shows that, rather than producing more milk for your baby by drinking alcohol, the effects of alcohol on your body actually mean your baby will get less of your valuable milk. Why is this?

Mennella, Pepino, and Teff found that alcohol significantly reduces oxytocin levels while also increasing prolactin levels. Both hormones influence the milk ejection reflex. The lower the level of oxytocin, the longer the delay in ejection of milk. The higher the level of prolactin, the longer the delay. The combination of alcohol’s effect on the two hormones leads to a significant delay in milk ejection. 

What are the risks to my baby?  

Depending on the amount of alcohol consumed by the mother/lactating parent, and depending on when the baby is breastfed after alcohol consumption, various researchers have found the most common negative outcomes for the baby to be:

• Sleep disturbances, including shorter sleep periods, more frequent wakefulness, and less total active and REM sleep in the three-hour-period after consuming alcohol
• Increased crying
• Increased startling
• Increased arousal
• Increased REM sleep in the period from 3.5 hours to 24 hours after exposure to alcohol
• Decreased milk intake by the baby
• Growth retardation
• Impaired immune function
• Delay of motor development
• Potential impairment of cognitive development
• Reduction in ability for abstract reasoning at school age (6-7 years)

The Academy of Breastfeeding Medicine state in Clinical Protocol #21 that consuming alcohol during lactation has several negative effects ranging from mild to severe. This is dependent on the amount of alcohol the mother/lactating parent has consumed and other factors related to how quickly their body processes alcohol.

As alcohol is completely water- and fat-soluble, it enters the bloodstream and human milk very easily. The amount of alcohol in human milk after consumption of one standard drink is about 95% that of the amount of alcohol in the mother/lactating parent’s bloodstream.

Another review, conducted by Nonacs, showed that motor development of infants who were exposed to alcohol in human milk regularly was decreased or delayed. The more alcohol the infants consumed through breast milk, the lower the infants scored on indices of motor development. Infants cannot metabolize alcohol as quickly as adults can; newborns can only metabolize alcohol at 25% to 50% of the rate at which adults can.

Concerns about negative effects on the infant’s developing brain are based on animal research. Oei notes that “robust animal data” indicate that “alcohol may be toxic to the developing brain, especially during periods of rapid brain development” such as occur in the first year after birth. Impairments to memory and inhibitory responses may also occur as a result of an infant’s consumption of alcohol.

Though research continues, Haastrup, Pottegård, and Damkier stated that “the possible long-term effects of alcohol in mother’s milk are unknown”.         

What other effects should I consider when deciding whether and when to drink？

Depending on how much you drink, in addition to the effects on your milk production and ejection reflex, you can expect some degree of other effects on yourself.

Alcohol produces sedative effects as well as some stimulant effects. There is some evidence that suggests that people who are currently lactating may metabolize alcohol more quickly than non-lactating people. There is clear evidence that eating food while consuming alcohol also reduces blood alcohol levels after consumption. Drinking alcohol on an empty stomach increases the effects of alcohol on prolactin and oxytocin as well as on your body. You should not sleep with your baby if you have been drinking alcohol, as your natural reflexes have been impaired.    

Information about bed-sharing and alcohol here:Safer Sleep & the Breastfed Baby

By interfering with your milk ejection reflex, alcohol may further reduce your milk production: without this reflex, your baby cannot nurse and empty the breast effectively. When milk stays in the breasts, it tells your body to reduce production.  

            

Can I nurse my baby and still drink occasionally ?   

Several sources offer safety suggestions to consider when breastfeeding and drinking alcohol.    

• Be aware that newborns cannot metabolize alcohol well; if possible avoid drinking alcohol until your baby is at least 8 weeks old or older.
• Breastfeed your baby immediately before drinking any alcoholic beverage, if possible, or pump and save your milk.
• Limit your alcohol intake to one (preferably) or two glasses of wine (8 ounces total) or one or two beers.
• Wait at least 2 hours after drinking one standard drink before breastfeeding your baby.
• Be aware that the more you drink, the longer it takes for the alcohol to clear your system.If your baby needs to be nursed before two hours or more is up, use your previously expressed milk to feed your baby.
• Drink juice when drinking alcohol.
• Eat food when drinking alcohol–it will slow the rate at which alcohol enters your bloodstream.
• “Pump and dump” only if needed for comfort. As long as there is alcohol in your bloodstream, there will be alcohol in your milk.

            

 

In the upcoming article, we will continue to provide you with a series of questions regarding alcohol consumption during breastfeeding.

This includes addressing the question, “What does one drink mean?” We will also cover important considerations, such as whether it is necessary to pump and discard breast milk after consuming alcoholic beverages and how to handle situations where intoxication occurs. Additionally, we will delve into the impact of alcohol dependence or using alcohol as a form of self-treatment on infants during breastfeeding. Finally, we will explore how to make informed decisions by balancing risks and benefits.

These contents are designed to offer you comprehensive information on breastfeeding and alcohol-related concerns, aiding you in making well-informed decisions.

 

参考资源References: 

1.Centers for Disease Control (CDC).https://www.cdc.gov/alcohol/faqs.htm#excessivealcohol

2.LactMed. Retrieved 11 May 2020 from 

https://www.ncbi.nlm.nih.gov/books/NBK501469/

3.Mennella, J. A., & Garcia-Gomez, P. L. (2001). Sleep disturbances after acute exposure to alcohol in mothers’ milk. Alcohol 25(3) pp. 153-158. DOI: 10.1016/s0741-8329(01)00175-6

4.Koletzko, B., & Lehner, F. (2000). Beer and breastfeeding. 

Advances in Experimental Medicine and Biology 478 pp. 23-8. doi: 10.1007/0-306-46830-1_2. PMID: 11065057    

5.Mennella, J. A., Pepino, M. Y., & Teff, K. L. (2005). Acute alcohol consumption disrupts the hormonal milieu of lactating women. The Journal of Clinical Endocrinology & Metabolism 90(4) pp. 1979-1985. doi: 10.1210/jc.2004-1593.

6.Mennella, J. A., & Pepino, M. Y. (2008). Biphasic effects of moderate drinking on prolactin during lactation. Alcoholism: Clinical and Experimental Research 32(11) pp. 1899-1908. Doi: 10.1111/j.1530-0277.2008.00774.x.

7.Mennella, J. A., & Beauchamp, G. K. (1993). Beer, breast feeding, and folklore. Developmental Psychobiology, 26(8) pp. 459-466. doi: 10.1002/dev.420260804

8.Haastrup, M. B., Pottegård, A., & Damkier, P. (2013). Alcohol and breastfeeding. Basic & Clinical Pharmacology & Toxicology 114 pp. 168-173. doi: 10.1111/bcpt.12149 

9.Mennella, J. A. (2001). Regulation of milk intake after exposure to alcohol in mothers’ milk. Alcoholism: Clinical and Experimental Research 25(4) pp. 590-593.

10.Mennella, J. A. (1998). Short-term effects of maternal alcohol consumption on lactational performance. Alcoholism: Clinical and Experimental Research 22(7) pp 1389-1392. doi: 10.1111/j.1530-0277.1998.tb03924.x

11.Brown, R. A., Dakkak, H., & Seabrook, J. A. (2018). Is breast best? Examining the effects of alcohol and cannabis use during lactation. Journal of Neonatal-Perinatal Medicine, 11(4) pp. 345-356. Doi: 10.3233/NPM-17125.

12.Reece-Stremtan, S., Marinelli, K. A., & The Academy of Breastfeeding Medicine. (2015). ABM Clinical Protocol #21: Guidelines for breastfeeding and substance use or substance use disorder, Revised 2015. Breastfeeding Medicine 10(3) pp. 135-141. doi: 10.1089/bfm.2015.9992     

13.Anderson, P. O. (2018). Alcohol Use During Breastfeeding. Breastfeeding Medicine 13(5) pp. 315-317. DOI: 10.1089/bfm2018.0053.

14.Nonacs, R. (2018). Alcohol and breastfeeding: What are the risks? Contemporary OBGYN Net December 2018 24-28.

15.Oei, J-L. (2019). Risky maternal alcohol consumption during lactation decreases childhood abstract reasoning at school age. Evidence-based Nursing 22(10 p. 25. doi: 10.1136/ebnurs-2018-102999.

16.Gibson, L., & Porter, M. (2018). Drinking or smoking while breastfeeding and later cognition in children. Pediatrics 142(2). doi: https://doi.org/10.1542/peds.2017-4266.

17.Gibson, L., & Porter, M. (2020). Drinking or smoking while breastfeeding and later developmental health outcomes in children. BMC Res Notes 13:232. doi.org/10.1186/s13104-020-05072-8.

18.Pepino, M. Y., Steinmeyer, A. L., & Mennella, J. A. (2007). Lactational state modifies alcohol pharmacokinetics in women. Alcoholism: Clinical and Experimental Research 31(6) pp. 909-918. doi: 10.1111/j.1530-0277.2007.00387.x. 

19.Tay, R. Y., Wilson, J. McCormack, C., et al. (2017) Alcohol consumption by breastfeeding mothers: Frequence, correlates and infant outcomes. Drug and Alcohol Review 36 pp. 667-676. doi: 10.1111/dar.12473.

20.Standard Drink Measures in Europe (2015). Published by RARHA (Reducing Alcohol Related Harm). Accessed 4 Dec 2020 from http://www.rarha.eu/Resources/Deliverables/Lists/Deliverables/Attachments/14/WP5%20Background%20paper%20Standard%20drink%20measures%20HRB.pdf 

21.National Institutes of Health. What Is a Standard Drink? Accessed 4 Dec 2020 from 

https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink

22.Drugs and Lactation Database (LactMed), Alcohol, May 11 2020 https://www.ncbi.nlm.nih.gov/books/NBK501469/          
Accessed 27 October 2020

Reviewed and revised December 2020, with minor language changes March 2021.

2020年12月审阅修订，2021年3月略作语言微调。

资料来源：https://llli.org/breastfeeding-info/alcohol/

END

翻译：许悦

审稿：Lynn、Marien 

编辑：斯琦

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什么是正常的婴儿黄疸 ？

黄疸

即皮肤、巩膜(俗称“眼白”）、牙龈和嘴唇内侧发黄，在母乳宝宝中很常见也很正常。

发黄：是由于婴儿血液中的胆红素过多引起的。

而胆红素是由红细胞破坏时产生的。在子宫里，胎儿需要有较多的红细胞，才能把氧气从胎盘输送到全身。

婴儿一出生，就开始用肺呼吸来获得氧气，不再需要体内这些多余的红细胞了。它们分解后在婴儿体内循环，其中一个代谢产物是一种黄色色素，叫做胆红素，它可以通过粪便自然地从婴儿体内清除。

第一次的排便（即胎便）含有大量胆红素，所以它是黑色的。出生后的头几天婴儿吃得越多，胆红素从婴儿体内排出的速度就越快。大部分胆红素(98%)会通过婴儿早期的排便清除掉。肤色较深的婴儿可能不会显现黄疸引起的发黄，所以更应该仔细观察。

正常、轻度的黄疸一般要在出生几天后才会出现。

胆红素值上升缓慢，通常在出生后第3~5天达到峰值，不超过12毫克/分升 (你的奶量通常也会在产后第3~5天急剧增加。如果婴儿吃奶很好，就会更频繁、大量地排便)。

除了频繁有效地哺乳之外，轻度黄疸通常不需要治疗，可自行消退。摄入足够奶量就有助于婴儿清除体内的胆红素。胆红素水平的轻度升高，在有些婴儿中可能会持续15周或更长时间。

01

什么是喂养不足型黄疸？

01

喂养不足型黄疸：

当婴儿没有吃到足够的初乳/母乳来清除胆红素时，就会产生喂养不足型黄疸。

02

如果母乳摄入不足：

胆红素就无法尽快被清除掉，它会被婴儿的肠道吸收，重新回到血液中，使它达到更高的水平。这会导致婴儿的皮肤和眼睛更黄。

03

如何识别：

皮肤颜色较深的婴儿可能无法识别出发黄的加重。检查牙龈和嘴唇内侧有助于识别。

婴儿可能会越来越嗜睡，使得喂奶变得更难。 医护人员会监测婴儿的胆红素水平。让婴儿多吃奶至关重要！黄疸较重时，通常需要照蓝光来辅助解决问题。

02

什么是延迟性(母乳性)黄疸？

01

延迟性（母乳性）黄疸：

有时黄疸会一直持续到出生两周以后。这通常被称为延迟性、迟发性或母乳性黄疸。

02

表征：

中度升高的胆红素水平有时会在婴儿体内维持数周时间。这在出生后早期胆红素水平较高的婴儿中更为常见。迟发性黄疸的婴儿通常反应和吃奶都很好、体重增长和发育也正常。

03

处理方法：

只要胆红素水平不超过20毫克/分升，延迟性黄疸无需任何治疗就会在12~15周左右消退。

一些医疗保健人员会建议暂停母乳，但这既没有好处，也没有必要。(请参阅下列关于黄疸管理的母乳喂养医学会第22号临床指南，这是可以分享给医疗保健人员的相关信息)。

英文版本：www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/22-jaundice-protocol-english.pdf

中文（繁体字）版本：www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/22-Jaundice-17-1.pdf

黄疸危险吗？

有时是。但轻中度的黄疸并不危险。胆红素是一种强效抗氧化剂，在保护新生儿健康方面起着重要而有益的作用。

然而如果胆红素水平过高，就会损伤婴儿的大脑（译者注：Kernicterus或核黄疸）。安全的胆红素水平要根据胎龄、体重以及婴儿整体的健康状况来综合确定。较小的婴儿或早产儿所能耐受的胆红素水平比足月儿还低，所以更有脑损伤的风险。

如果足月儿在出生后的第一个24小时内就出现黄疸、快速上升，并超过17毫克/分升，说明存在更严重的问题。有时这被称为病理性黄疸，这通常不是母乳不足的缘故，而是由其它因素引起的。需要在不中断母乳喂养的情况下及时进行评估和治疗。

新生儿黄疸的危险因素：

• 产后泌乳延迟。

  母乳喂养启动很慢有很多原因。剖宫产和初产是两种常见的情形，这时需要额外的照护来帮助建立起母乳喂养。

• 早产

• 38周之前分娩

• 小于胎龄儿

• 婴儿出生时出现头部淤伤

• 母亲患有糖尿病

• Rh血型不合引起的溶血

• 有婴儿黄疸的家族史

男孩比女孩更容易发生黄疸。亚洲婴儿出现黄疸的可能性最大，其次是北美土著婴儿、白种人婴儿、最后是美籍非裔婴儿。O型血和RH阴性血母亲的婴儿更可能有黄疸。

如何预防黄疸过高

*尽早、频繁地母乳喂养。

分娩后尽快开始母乳喂养。良好的含乳对于有效排出乳汁非常重要。请参阅哺乳姿势和含乳姿势这两篇文章。尽早哺乳可以帮助婴儿早点排出胎便（也就是第一次大便）。

*用舒服的半躺姿势。

垫好你的腰背，抱着婴儿皮肤贴着皮肤、胸贴着胸。半躺式哺乳姿势可以让婴儿用他天生的反射找到乳房并含乳，这也解放了你的双手，便于你在需要时帮助他。你和宝宝可以用这种姿势哺喂很多日子，这有助于你们彼此了解，并学会如何含好乳房。产后初期要持续频繁地把婴儿抱到你的胸前，并对所有的哺乳信号做出回应。

*避免给婴儿喝水或葡萄糖水。

这不仅不会预防黄疸或降低胆红素水平，反而会妨碍婴儿吃到足够的母乳。 

*婴儿出院后的两天内，安排一次医疗保健人员的家访。

*如果婴儿出现以下情况，请咨询医护人员：

– 嗜睡

– 吃奶不好

– 排便少于预期

PS：嗜睡和吃奶不好是黄疸值增高的征兆。

黄疸的治疗

胆红素水平可通过验血测得。如果婴儿存在下列情况，医护人员可能会要求验血：

• 婴儿嗜睡，并且吃奶不好 

• 婴儿身体的很多部位看起来很黄

• 婴儿的皮肤和眼睛在出生后24小时内就开始发黄

治疗严重的黄疸可能需要婴儿照一段时间蓝光。这种特殊的光有助于分解胆红素，然后通过婴儿的尿液和大便排出体外。

照蓝光时，需要遮住婴儿的眼睛。治疗过程中母婴分离会令人不安。你可以和婴儿待在一起，大多数情况下，也可以把婴儿从蓝光箱中抱出来哺乳（译者注：目前国内也有一些开展蓝光治疗而不需要母婴分离的医疗机构）。喂奶时和婴儿做肌肤接触可以激发出他本能的哺乳行为，也能让你自己平静下来。

婴儿也可能需要添加挤出的母乳、捐赠的母乳或配方奶。如果他嗜睡且吃奶不好，补充喂养就很有必要。如果你的泌乳量增长缓慢，也有必要补充喂养。婴儿得靠进食才能清除胆红素。如果婴儿在乳房上吃不到足够的母乳，就需要添加奶以清除体内的胆红素。你可以用杯子、勺子、乳旁加奶或奶瓶来添加。

高胆红素血症的治疗通常需要几天时间。重要的是在这段时间里要挤奶，这样你才能为婴儿提供自己的母乳，并建立起充足的奶量。请参阅建立奶量和如何挤奶。胆红素水平一旦下降，婴儿就会变得更机警、哺乳也会改善。

如果你有任何关于母乳喂养的问题或担忧，请联系当地的国际母乳会中国的哺乳辅导，她们可以为你提供支持和相关信息。

更新于2022年

Jaundice and Breastfeeding

What is normal infant jaundice?

Jaundice, yellowing of the skin, eyes, gums and inner lips, is common and normal in breastfeeding infants. The yellow colour is caused by extra bilirubin in the baby’s blood. Bilirubin is produced when red blood cells break down. In the womb, your baby has extra red blood cells to bring oxygen from the placenta. Once your baby is born, he uses his lungs to get oxygen. These extra blood cells are no longer needed.

They break down to be recycled in your baby’s body. One byproduct is a yellow pigment called bilirubin. It is removed naturally from your baby’s body in the stools (poops). The first stool, meconium, has a large amount of bilirubin. This is why it is black in colour. The more your baby feeds in the early days, the quicker the bilirubin leaves your baby’s body. Most of the bilirubin (98%) will be eliminated in your baby’s early stools. Babies with darker skin tones may not show the yellowing effect of jaundice, so they should be observed carefully.

Normal, mild jaundice generally takes a few days to appear. The level rises slowly, usually peaking between days 3 and 5 at less than 12 mg/dl. (Between days 3 and 5 is also when your milk production should increase dramatically. When your baby is feeding well, this results in more frequent and larger poops.) Mild jaundice usually resolves without treatment other than frequent and effective feeding. Adequate milk intake is what helps your baby clear the bilirubin from his body. Some babies will have mildly elevated bilirubin levels for as long as 15 weeks or longer.

What is suboptimal intake jaundice?

Suboptimal intake jaundice occurs when a baby is not getting enough colostrum/milk to eliminate the bilirubin. When there is not enough milk intake, bilirubin is not eliminated as quickly as it should be. If the bilirubin is not eliminated quickly, it is absorbed from your baby’s gut back into the blood at higher levels. This causes more yellowing of your baby’s skin and eyes. This increase in yellowing may not be recognized in a baby with darker skin colour. It’s helpful to check the gums and inner lips. Your baby may become more and more sleepy, making feeding even more challenging. Your baby’s bilirubin levels will be monitored by your healthcare provider. It is essential that your baby gets more to eat. Phototherapy treatment is often required to help settle things down.

What is prolonged (late-onset) jaundice?

Sometimes jaundice lasts beyond the first two weeks of life. This is often called prolonged, late-onset, or breast milk jaundice. Bilirubin can sometimes remain in your baby’s body at moderate levels for many weeks. This is more common in babies who had higher bilirubin levels earlier. Babies with late-onset jaundice are alert, feeding well, gaining weight and growing. As long as bilirubin levels stay below about 20 mg/dL, prolonged jaundice resolves without any treatment by about 12 to 15 weeks. Some healthcare professionals may recommend temporary weaning, but this is not beneficial or necessary. (For information to share with your healthcare provider, see Academy of Breastfeeding Medicine Protocol #22 Jaundice: www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/22-jaundice-protocol-english.pdf).

Is jaundice dangerous?

Sometimes it is. But mild to moderate jaundice is not dangerous. Bilirubin is a powerful antioxidant and can play an important and beneficial role in protecting newborn health.

However, if bilirubin reaches too high a level, it can cause injury to a baby’s brain. Safe bilirubin levels are determined individually based on gestational age, weight and your baby’s overall health. Small or premature babies are at risk of brain injury from a lower level of bilirubin than can be tolerated by a full-term baby.

Jaundice that appears within the first 24 hours, rises quickly, and reaches higher than 17 mg/dl in a full term baby is indicative of a more serious problem. This is sometimes called pathological jaundice. This is often caused by other factors, not a lack of milk. It needs to be assessed and treated promptly without interrupting breastfeeding.

Risk factors for jaundice in newborns

· Delayed milk production. There are many reasons why breastfeeding might get off to a slow start. Cesarean section birth and first time pregnancy are two common situations where it helps to take extra care with getting breastfeeding established.

· Premature birth.

· Birth earlier than 38 weeks.

· Small for the baby’s gestational age.

· Bruises in the baby’s head from the birth.

· Maternal diabetes.

· Rh sensitization.

· Family history of jaundiced infants.

Boys are more likely to be jaundiced than girls. Asian babies are most likely to be jaundiced, followed by Indigenous North American babies, Caucasian babies and finally African American babies. O blood type and RH negative mothers are also more likely to have jaundiced babies.

Preventing high jaundice levels

· Breastfeed early and frequently. Start as soon after birth as possible. A good latch is important for effective milk removal. See Positioning and Latching. Early feedings help your baby pass the meconium or first stool quickly.

· Lie-back in a comfortable, reclined position that supports your back. Hold your baby skin to skin and chest to chest. The laid-back position allows your baby to use her inborn reflexes to find the breast and latch. It also frees your hands so you can help, as needed. You and your baby can feed like this for many days. It will help you get to know each other and learn how to get a good latch. Continue putting your baby to breast frequently in the early days. Respond to all feeding cues.

· Avoid giving your baby water or glucose. This will not prevent jaundice or bring down bilirubin levels. It will interfere with your baby getting enough milk.

· Arrange a visit with your baby’s healthcare provider within two days of discharge from a hospital birth.

· Consult your baby’s healthcare provider if your baby is:

Ø sleepy.

Ø not feeding well.

Ø not pooping as expected.

Sleepiness and poor feeding are signs of high jaundice levels.

Treatment for jaundice

Bilirubin levels are checked by a blood test. Your baby’s healthcare provider may order a blood test if:

· your baby is sleepy and not feeding well.

· much of your baby’s body looks yellow.

· your baby’s skin and eyes started turning yellow within the first 24 hours.

Treatment of severe jaundice may require your baby to spend time under phototherapy lights. These special lights help break down the bilirubin so it can be removed in your baby’s urine as well as the stool. Your baby’s eyes are covered while under these lights. Separation during this treatment can be upsetting. You can stay with your baby, and in most cases, take your baby out from under the lights to feed. Placing your baby skin to skin during these feedings encourages instinctive feeding behaviours. Holding your baby skin to skin also calms you.

Your baby may also require supplementation with expressed milk, donor milk or formula. This may be necessary if your baby is sleepy and not feeding well. It may also be necessary if your milk production is slow to increase. Your baby needs food to eliminate the bilirubin. If your baby is not getting enough milk at breast, supplementation is needed to remove the bilirubin from your baby’s body. You could supplement with a cup, spoon, at-breast supplementer or bottle. See How to Protect Breastfeeding while Supplementing (https://www.lllc.ca/how-protect-breastfeeding-while-supplementing) .

Treatment of high bilirubin levels usually takes a few days. It is important to express your milk during this time so that you can provide your own milk for your baby and establish a plentiful milk supply. See Establishing Your Milk Supply and Expressing Your Milk. Once your baby’s bilirubin levels are dropping, your baby will be more alert and will feed better.

If you have any breastfeeding questions or concerns, contact your local La Leche League China Leader who can provide you with support and information.

Updated 2022

参考文献References

Flaherman, V.J., Maisels, M.J. and the Academy of Breastfeeding Medicine. (2017). ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation—Revised 2017, Volume 12, Number 5, 2017. DOI: 10.1089/bfm.2017.29042.vjf

Mohrbacher, Nancy. (2020). Breastfeeding Answers: A Guide for Helping Families, Second Edition. Nancy Mohrbacher Solutions, Inc., 245-246.

资料来源Source

https://www.lllc.ca/jaundice-and-breastfeeding

END

作者：加拿大母乳会

    翻译：传艳   

   审核： Lynn 、Marien、楠楠

  编辑：沐凡

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搜索关键字“国际母乳会LLL”

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国际母乳会感谢您支持我们的公益事业！

正如我们的志愿者在内部会议中提到，投身公益事业后才知道做公益也是有成本的！你的支持和赞赏可以让更多的妈妈获益！

本篇文章来源于微信公众号: 国际母乳会LLL