Medicine to increase milk supply

sim.: salaaaam.is there any madicine or any food which will increase breast milk?im a breatfeeding mother of a 2 mnths baby(wg4.8).i feel dat i dont have milk as much as my son needs.do taking milk will increase milk?wat shell i do?wud u be able to help?thanks

Hi Sim. First of all, it is very good that you asked about these things rather then turning to formula. Let me try to tell you how (objectively) you can assess if your baby is getting enough breastmilk. A baby who is getting enough milk will pass urine a minimum of 6 times in 24 hours (if child got less than his need, then he'd pass less number of times). Please open his nappy every 2-3 hours and check if he is passing urine. Next thing: if a child is getting enough milk he would be gaining weight - 125grams a week (= 500grams a month). If on checking these two things there is evidence that your child is getting enough milk (passing urine 6 or more times in 24 hours and putting on 125g a week) then do not worry about inadequacy of breastmilk. If on assessing these there is suggestion of reduced milk volume then do consult your childs pediatrician. There are medications that could help increase milk supply (perinorm).

I must however inform you that the best way to increase milk supply is to allow child to suckle on breast more. The suckling stimulates production of chemicals (hormones) that promote milk production. Drinking more milk does not increase milk production. Mama sustagen or other such milk too DO NOT increase milk production.Gentle breast massage, back massage, confidence (that you will be able to feed your child well), night breast feeds and ensuring breast gets emptied during each feed (allow baby to feed from one side until side is emptied rather than just offering both breasts at each feed) will help increase milk production. Breast is best. Take care.

Noise while breathing

suxee: Hi Dr , Niyaf . my baby is 4m . baby breath kuraairu adu kiyaakamah faahaga kurevey. but not weezing . I shown to DR. but he said it's ok. He said it might be coz of that i had Lscs insted of normal birth. is tru?

Hi Suxee. Many babies make a bit of soft noise while breathing - sometimes. It could come from the nose or appear to come from a bit deeper inside. In many, the sounds decrease and almost disappear when baby is sleeping comfortably. If that is the situation it is unlikely to be troublesome. If the sound is always there and especially seem to increase when child is sleeping then it needs assessment. A bit of nose block could be the most common reason for noisy breathing. I do not think that by 4 months age baby born by LSCS should have any more noisy breathing than those by vaginal delivery. Sometimes, if a baby was suctioned vigorously at birth - a bit of noisy breathing maybe heard for a few months.

Avoid using pillow under the head. It could cause neck to be bent (flexed) and may cause the airway in the neck to be kinked. If the noisy breathing - or noise at breathing is loud, always present, worsens when sleeping or the root of the neck seems to get sucked in during the noise - have a second opinion from another doctor. If it is not disturbing him/her and is free of the above signs/characters then it is unlikely to be a problem.

Starting foods at 6 mnths age

XL: hi Dr. can u tel wat r the foods that i can introduce wen become 6 months . and as a first food to giv . n the quantity of food n how many times . thanks

Hi XL All fruits, vegetables, rice, mugu, wheat, oats could be introduced at 6 months of age. Mince and make the food mushy. Give meals twice a day with about min 4 hours between the meals. In the beginning kids may only take 3-5 spoonfuls but gradually they may take more (up to 10-12 spoonfuls by 6.5 to 7months. Just for an idea here is a sample meal (boil 2-3 spoons of rice and 2 spoons of mugu in a bit of extra water - don't add salt. Also boil 1x1 inch cube of pumpkin. Now mix them well to a smooth mushy consistency. The amount would be about 10-12 feeding spoon full. A useful web-resource is www.bpni.org (read complementary food / weaning food ).

Not gaining weight

saain: hi dr. my daughter will be 14 months this month and she weighs 8.4kg. im concerned about her weight as she could be under weight.when she was 11 months you have advised to give cheese and butter and all those that have fat in it. i never had any problem feeding her as she loves food. but its been a week since she's been a liitle fussy about food. may be its cox she's having cold.so how can i improve her appetite and make her gain weight? and by the way she's very active too. and all the dr.s say she's taller than most of the children her age. so could this be the reasons for her not gaining weight? should i be much worried about her weight?

Hi Saain. 8.4kg at 14 months is less. If he has been "eating well" and not gaining weight it is quite likely that the food he is getting is less in calories than he needs. This must have been one reason I might have asked you to add oil/butter/cheese to meals. I do not recommend arbitrary use of Vitamin syrups or tonics for increasing appetite. It would only help if there is a Vitamin deficiency status (which in itself is not uncommon). If the weight is not improving and there is a reduced appetite, perhaps there is a need for Vitamin and calorie supplementation. I would suggest that you discuss this with a doctor while you have her assessed. I will not be recommending medications over the internet. I do not think that activity or height is a reason for low weight. Increase in height should be accompanied by growth of body - and so weight should increase. It is not about kids being thin, but being under-weight (they are not always inter-related).

In terms of diet: she needs more quantity and more calories that would translate to body growth. I think the best way forward would be to discuss these very aspects during a consultation.

Not sleeping, always wanting to breast feed.

leela: my daughter is 14 months old. at night she takes in her meal at around 7:15 and goes to sleep at 8. she wakes up every night around 11 to have her feeds. i have tried to feed her cows milk and formula too at that time as she keeps getting hungry a lot in the night.she wont drink any of those and i will have to feed her through out the night which is very painful to me as i have to sleep by her side.is it advisable to feed something light to her at that time? and if she wont eat anything what can i do to make her sleep alone in her bed without being fed all throuht the night and sleep by my side.

Hi Leela. One thing that you could do is to give her a meal about an hour before she goes to sleep. Make the meal in such a way that it is made up of items that take a while to digest. Very commonly kids that age, in Maldives, are still given Nestum, Cerelac, or some other "mushy" baby food. I would recommend using home made food that is more like bits and pieces (chewable). Include meat, chicken, fish, egg in those meals. These meals would make the child feel less hungry in between meals! I do not recommend discontinuing night feeds altogether. Getting kids to sleep on their own is not always easy.

Prevent your child from using your breast as a soother, try not to offer him the breast everytime he wakes up or cries. See if he would go to sleep without suckling. Many a time, he'd wake up (or even cry) from another cause than hunger! Try to teach your baby to go to sleep without needing to suckle. This is easier said than done. It is likely to take many days of difficult effort.

I think it takes time for kids to learn to fall asleep without such "sleep aids". Rocking to sleep (not recommended) if at all to be practiced has to be really gentle. A special pillow, teddy bear or lullaby might help too.

Other things that might help: Using dim-light in the bed room and not switching on bright lights when kids wake up (theoretically trying to reduce the biological clock in the baby by reducing exposure to "daylight" during the night). Try not to carry him/her around when he wakes up. Trying to put the baby with least amount of stimulation, as possible, may help. Don't just offer the breast because child wakes up. They can get used to falling asleep on the breast. It is a difficult habit to stop. If you have to keep the child by your side to get him to sleep, put him back to his bed once he falls asleep rather than keeping him at your side. This might be difficult if he keeps waking up several time but it could help over the longer run. These are just some ideas. It is likely to be difficult to apply some of these in some kids, use them as a guide only. I hope they helped.

Eating very little.

Amana: Hi, My 4 year old daughter doesn't seem to be eating well. She is a thumb sucker. I wonder whether she gets hungry. Dring meal times she takes very little. When I say little its like 2 to 3 spoons. She takes in milk. I am worried cause she's very thin as well

Hi Amana. I wonder if she is drinking a lot of milk and juices! Many kids fill themselves with fluids (like milk, juices) during or in between meal times. This will make them feel less hungry during meals. And they may therefore eat very little. The way to help kids in these situations is to reduce the amount of milk and juices they are given. Some times parents worry that I am asking them to stop or reduce the only thing that the kid is "eating well". But if the excessive milk (and filling effect from it) is responsible for poor appetite then the only way to help is to reduce amount of milk offered and replace that with food. I am not particularly worried about "thin" kids if their weight is appropriate for age. For a 4 yr old I expect 16kg and if she is thin but of good weight it is still fine! Thin and good weight is better than plump and higher weight!

Fever and teething?

marion: my baby is 13 months old and still no sign of teething.he drools alot too.physically and mentally he seems fine for a baby of his age as he;s already dancing, climbing stairs and uttering short words. ppl keep commenting that it might be a problem that he is not teething by now.could u plz tell me if this is a problem or not? another thing is that he has been having on and off fever for the past 3 days. today his fever was at a constant 38.2 which with panadol syrup went down to 38. he is refusing to eat and only wants liquids which i guess is normal for a sick baby. my concern is is this persisting on and off fever anything to do with his teething or something else. thanks

Hi Marion The timing of eruption of teeth is quite variable. I am not overtly concerned if teeth eruption has not occurred by 1 year. It could happen as late as at about 18 months (although this is not common). I think what you could do for now is to ensure that your baby is getting the needed amount of Calcium. Give him whole cream milk, rehi or sardines. Allow her to chew and bit on food. It is a stimulus for teething. The fever is more likely to be related to something other than teething. Unless there is swelling of gum teething is unlikely to cause significant fever. If the fever is persisting for 3 days then I think you should seek consultation.

Medicine for fussy eating?

ummu: hi dr. ppl uesd giv some madicines to the fussy eaters. wats ur opinion abt that? whats cyp-l drops? wil fusy eaters make this to eat? and also the gripe water?

Hi Ummu. Fussy eating is a huge problem in Maldives. It happens everywhere, but perhaps it is more common in Maldives. We need good data collection and analysis to see if that is the case or not but it is my observation. There are some possible reasons too: [1]parent put in too much of an effort to feed kids. Perhaps parent fussing too much about feeding could make kids fussy about eating. [2] Force feeding: this is much too common I have observed. Kids are more likely to resist when food is forced. More force = more resistance. Force feeding will not lead to kids giving up resisting and starting to eat better. On the contrary it is likely to ensure that the fussy eating is unduly extended for many many months. [3] Baby food given beyond early "weaning" age: many parent, with a view to giving more quantity, continue to mash and blend food while feeding bigger kids. Blended food is only recommended from 6-8 months. Increased consistency is recommended above 8-9 months.

[4] Using distractions at meal time: TV, games, etc are used by parents to distract kids during meal times while food it being offered. Kids eat while their attention is diverted. This does not help in getting kids to learn importance of meals and meal times. Meal times should be meal times. Get kids to sit and have meals without distractions. [5]Family meals may help: kids love to imitate and they learn from adults. If older kids and adults eat with the child (and eat well) a positive influence could be felt in the child. [6] Variety in texture and taste: kids (as adults) may not like to eat food that look, taste and feel the same at every meal! Variety in terms of appearance, taste and texture would help make the meal interesting.......I hope these pointers help.

I do not believe that medicines should be used to treat poor appetite on a routine basis. I understand that in some dire situations clinicians may try these measures.Ummu I don't kow if you were trying to write Cefo L. If that is the case - it is an antibiotic. I do not know a Cyp -l (perhaps Ciplactin: something commonly used to improve appetite, but effect not very clear in many). Gripe water: I do not recommend. I don't think there is adequate evidence that it helps!

Sound from knee

leesh: hello Dr. my baby is 4mnths old. My concern is .. I feel some sound or movement ( i dont knoe the exact word use for that) from joints while i lift the baby mostly knee jiont and wrist . is this problem ?

Hi Leesh. The sound you describe, is it like (kashi govvaa adu) that people make from their fingers? Well, if it is that, then it could be normal. However, it might be a good idea to have him shown just to be on the safe side. Some sound maybe heard normally as the fluid within the joint shifts from one side to the other within the joint, as the joint moves.

leesh: mmm. that sounds is not exactly ( kashigovva adu ) and now i notice that leg ga hifahattafa kudakoh dhe faraathah move kurevykan . is it problem??

Hi Leesh. A bit f lateral (side to side) movement at the knee maybe possible is smaller kids. However, I think it is better to have it shown and an opinion sought. I am unable to give you a clear opinion without having an opportunity to examine.

Pacifiers

Een: I started giving my son a pacifier when he was about 4 months old. I started using it bcoz he used to cry a lot and it soothes him. Now he is 9 months old and i have minimised the use of pacifier now for only times when he is very very fussy. I have heard people say that use of pacifiers can delay tooth development and can deform the gums and lips. Is this true? Is it ok for me to continue the use of a pacifier? If so when is the best time to stop using it?

Hi Een. There is concern that pacifiers may contribute to those problems. It is perhaps more to do with misdirected teeth in that respect. Statistically there is an association with increased infections too. It is very habit forming and my suggestion would be to try to gently get him to let go of the pacifier. It may not be easy.

When to give Full cream milk

Mum M: Hi Dr.Niyaf, my baby is 11 months old now and she hates formula milk. But she likes flavoured full cream milk, is it ok to give her this? I am still breastfeeding her and she eats rice, buiscuits, bread and sometimes cereals too. Hoever she is still underweight for her age but her habits are very healthy.

Hi Mum M. Full creak milk could be given at that age. Flavoured milk - I don't recommend. Cming to your concern about weight gain: more milk is not the solution. The nutrients kids that age need to grow are not all available in milk (even those available are not in the required quantity). To improve weight you will have to give more comlementary foods (like rice, roshi, fish, chicken, beef, potatoes, mugu, beans, peas, maize, cheese, eggs...etc). Giving more milk could be counter productive as the filling effect from more milk might make the child less hungry and eat even less! Don't stop milk altogether though. Continue breastfeeds. If she does not drink milk but eats yogurt it is still fine. I hope that helps.

Refusing food, taking only milk.

naz: hi Dr. My baby is 15month old , he was on regular diet since he started taking solid food, but suddenly he refuses to take any food now . it has been 3 days that he has not taken a meal, THE ONLY THING HE IS DEPENDENT ON IS BREAST milk and few small biscuits, since I am at office in the day time he gets only one fed till evening 5.30pm. im very much concern of this problem. One more thing he has got only 4 teeth, 2 in upper and 2 in lower. He don’t take bottle , but he takes very little (2- 3 onz) enfagrow (MILK) what should I do?

Hi Naz. Please also read previous post. Sometimes kids may come off food for no apparent reason. They may take comfort from drinking mostly milk and eating a few "choice" foods that they especially like. It could be, at times, an early sign of a common viral illness like cold, flu or viral fever. If it is an early sign of an illness, then the illness would declare itself in the next few days. Meanwhile try to make his meal times more appealing by usingthe different strategies described (scroll up to read them). The teeth sound fine for his age. More will likely erupt soon. If he remains off food for more than just a few days then do have him shown to a pediatrician for an assessment.

Not eating. What do I do?

me: dr,i am very concerned my daughter is not eating well,she is 14months,pls give me some ideas of a healthy meal plan for my child.she is 10 kg.

Hi Me. I wouldn't recommend a strict "diet plan". It is usually counter productive, especially in this situation. A plan that you could follow is to try different means of increasing food appeal to a child. At that age kids may go n apparently without eating anything at all. Nonetheless, they still find energy to be active and remain full of energy! In most of these kid; they do eat just about enough to meet these energy requirements, maybe not enough to show much growth in terms of weight gain and chubby cheeks and all. 10kg at 14 months isn't bad. Not at all. I think one think that you could try is to get her to eat normal adult food as much as possible (I don't mean spicy and chilly-hot food though). Try not to mash food any more. Try variety in taste, texture, colour etc. Make the food appealing on the eye (and attractive).

Just for a visual: a plate with a couple of table spoons of white rice, yellow maize (boiled is OK), orange carrots, some chicken/fish (fried perhaps), some green peas and a bit of thelli muraga fai. I will try not mix everything together. Maybe mix a few of them a bit (but allowing for the different ingredients to be seen). A kid at that age could be allowed to attempt partial self feeding (yes, allowing her to play with food a bit too). She is unlikely to eat all of it, perhaps might pick out some that she doesn't like from the ingredients. And it might take a few attempts to get her to enjoy the new presentation too. Keep changing the variety too.

Other things that might help: making meal times meal-times (and not use distractions as TV, books etc), having family meals (kids imitate people - and eating with family could help), not forcing food on child (forcing only brings out more rebellion from child), not filling her with juices and fluids (filling food takes hunger away), ..

Cold going on for long

Lubaa: hi dr.niyaf, my son who is 2 years old now has been having a cold and low grade fever for a week now .. he's tolerating his food quite well till now .. he used to vomit a lot whenever he had cold earlier .. but he has been losing wt and i can feel his lymph node swollen near his jaw .. i couldn't get an appt to show him to a paediatrician .. what shall i do?

Hi Lubaa It sounds like the cold has been going on for some time now. The fever and swollen neck glands suggest that it could be more than just a simple cold. I think you must have him shown. If you can't get an appointment for a pediatrician then do show to a general practitioner.

Eating well and not growing.

 

zaana: hi dr.  my son's 14 months and he weighs 8.6kg. but he eats well and i read the answer you have given to saain regarding the weight problems. i have the same problem too. one of my friends told me that "ginaiin kaan dhinyma gohoru boduvaaneyo" i just dont wanna believe it cox i think its like one of these old sayings. i wanna know if theres any truth in it. and my son takes in his meals well.

Hi Zaana. If yur kid is eating well and not gaining weight the most common problem would be that he is not getting adequate calories via the meal. Increase caloric content of meals by using higher calorie foods or adding a bit of oil/ butter, cheese or nuts to meals. I do not believe that gohoru boduvun" is valid. But do note: I am not just asking to increase meal size, more to increase caloric content of food.

If his weight remains a problem despite increasing caloric intake or you are concerned that there is some other problem, please do have him seen by a pediatrician to see if there is another explanation.

Not tolerating coarse food

Flower: salaam doctor, Alva is goin to be 11 months on te 25th of this month, i have a tiny concern about her eating, she seems tos till eat almost fully pureed, and rarely coarsly pureed food, some days it has to be as thinly pureed as her first meals, otherwise she gags n throws up, she has jus one tooth, cud this be the reason she is not chewing? can u let me know how i can make her start takin less pureed food pls. thank u

Hi Flower. Wa-alaikumussalam. I don't think the it has anything to do with the tooth (or the lack of them). The chewing teeth (the premolars and molars - the side teeth) only appear much later. You might have to get her used to the feel of rougher food in her mouth. Here is something that has been tried. Get pop corn (don't give pop corn as it is though). Get little bits of the white part from the pop corn. Place a tiny bit of it in her mouth. It "dissolves" fairly quickly. Keep giving her bits and pieces to get her mouth used to handling textures. Alternatively, give her bits of corn-flakes. The longer we continue to mash and puree all food, the longer the natural adaptation to textured food would take. The only way to help her get used to texture is to give textured food. It may take time in some kids. Give feed in smaller aliquots to minimise gagging.

Juices before 6 months age

mee: Dr.I'v to be back to office next month.So now Im going to give milk bottle. Now my baby is 2 months .Is it Ok to give n even can I give some fresh juice like pomegranate n apple juice.

Hi Mee. Let me start my with these messages. Exclusive breastfeeding is recommended for first 6 months of line. That is to say nothing other than breast milk is to be given until 6 months age. If for any reason breast milk cannot be given, then (safely and appropriately prepared) formula milk is recommended as a replacement. No juices or other food is to be given before 6 months of age! If formula milk needs to be given, it is better to give by cup or cup and spoon. Bottle with teat is not recommended.You could express breast milk (by hand or by pump) and have someone feed your baby with that while you are at work. To learn more about expressing breast milk please talk to a counselor at RHC (Reproductive Health Center) at IGMH. Info is also available at bpni.org

MMR is Thimerosal free!

muna: my son is going to 18 months this month. i would like to inquire whether MMR free of Thimerosal is available in Male', if so where, if not which country (from nearby) is the safest to give MMR. thanks

Hi Muna. The MMR vaccine in Male' is from Serum Institute of India. Last time I checked, which was when I was in Maldives, that was the case. The information sheet that comes with the vaccine does NOT say anything about Thimerosal. The way MMR is prepared it should not have any Thimerosal. Thimerosal is present in some DTwP, Tetanus Toxoid, Influenza and Meningococcal vaccines. 

So the MMR should not have it. But I would be happier if there was a label on it to that effect. If you are not happy with the vaccine available in Male', MMR II ( from Merk ) is an alternative. I don't think it is available for purchase in Male' though.

MMR Vaccine

Aaisha: My daugther is 22 months now, and i havent given her the MMR vaccine yet. Earlier i had refused to give it because of the fear linked to MMR and Autism. but i have read so many stuff which says it isnt the cause of autism. Therfore i would like to know whether it is okay to give MMR even if she older now. It should be given when the the child is 12-15 months right?? Thank you

Hi Aaisha. MMR vaccine could be given even if she is 22 months old. I think the issue of a link between MMR and Autism is one that has polarized the medical community. The medical evidence so far weights against a cause-effect link. However more information needs to be obtained and studies are underway into causes of Autism. My kids have had MMR vaccine because I am personally satisfied with the evidence available to me. I can still understand others being concerned.

MMR is commonly given between 12  and 18 months of age in different countries. It could be used later as well.

Another vaccine related concern is of Thimerosal (Mercury containing preservative used in vaccines). I would like to urge parents, authorities and practitioners in Maldives to ensure that the vaccines are free of Thimerosal! US FDA had banned use of Thimerosal containing vaccines in US because of concerns about safety! We should not be made to accept something that is unsuitable for kids in US to be used for our kids!!

MMR vaccine should not have Thimerosal. Thimerosal is not used as a preservative in MMR.