Insufficient Breast Tissue (IGT), sometimes a false diagnosis?
Two case studies
Case 1. A mother and her 3 month old baby presented at the International Breastfeeding Centre in Toronto because of?late onset sore nipples. I noted that the baby had a?tongue tie, previously undiagnosed, which was one reason that caused the baby not to latch on well. Late onset sore nipples is usually due to?late onset decreased milk supply.
There were several reasons why this mother would have had a decrease in her milk supply.
The mother, based solely on the appearance of her breasts (see photo, on left above), was diagnosed immediately after the birth as having “insufficient glandular tissue”. Based on this diagnosis, the baby was immediately, at his very first feeding, supplemented with formula with a?lactation aid?at the breast (at least was not given bottles).
The baby was on a bottle for the first 6 weeks of his life. The baby was also using a?nipple shield?starting at 2 weeks of age and was?on it for 20 days.
When we saw the baby at 3 months of age, the mother, on her own, had managed to get the baby off the bottles (except for 1 or 2 small bottles of expressed milk a week), and off the nipple shield. (I must say, I was amazed she was able to do this without help). Thus, when she and the baby presented at the clinic, the baby was exclusively breastfed and had been so for 6 weeks. The baby was growing well and drinking well at the breast despite the initial “diagnosis” of insufficient glandular tissue.
We released the tongue tie, only one of the causes of her late onset sore nipples.
As for the mother and baby on the right above, her other breast looked even more IGT than the breast pictured. Yet with treatment of her sore nipples by improving the latch, she was able to breastfeed exclusively for 4 months when she had late onset decreased milk supply At the time I had no notion of late onset decreasing milk supply and flow. I suggested she start domperidone, but she preferred solids, so we agreed that she take that route.
Insufficient glandular tissue is a diagnosis that should be avoided. For several reasons:
It is a “diagnosis” which essentially tells the mother that there is no hope she will ever breastfeed exclusively.
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As these two cases show, nobody can look at a woman’s breasts and nipples and predict her ability to breastfeed exclusively. In fact, we have had other such cases where the diagnosis of insufficient glandular tissue had been made and the mothers were able to breastfeed exclusively.
As in the case discussed, the baby was supplemented immediately after birth, based simply on the appearance of the mother’s nipples and breasts (see photo) even though, later on she was able to breastfeed exclusively. Given that, why would she not be able to breastfeed exclusively from birth?
Because of this false diagnosis, many interventions were imposed on this mother and baby pair (photo on left), which resulted in unnecessary supplementation, use a nipple shield (how does a nipple shield help with “insufficient milk supply” or anything for that matter?), but despite these unnecessary interventions, the mother eventually managed to breastfeed exclusively.
Instead of looking at the at the size and shape of the breast, health providers should be watching the baby at the breast, because it is quite possible to know if the baby is drinking well at the breast, or not, or something in between. See the following video. Really good drinking https://www.dropbox.com/home/Videos%20for%20conferences?preview=2a.mpg (the pause in the baby's chin as the baby's mouth opens to the widest is a sign of milk entering the baby's mouth: the longer the pause, the more milk the baby received.
Knowing when a baby is drinking at the breast or not is the key to understanding breastfeeding. Unfortunately few doctors know and depend on the scale and weight gain to decide if breastfeeding is going well or not, and that is not a good way at all as errors in weighing are made not infrequently, and comparing weights from two different scales is complete nonsense.
Please consider buying and recommending my new book: What Doctors Don’t Know About breastfeeding
Print version and ebook version on Amazon:?https://www.amazon.com/dp/B09WC2HCC6
Print version on Praeclarus site:?https://stores.praeclaruspress.com/what-doctors-dont-know-about-breastfeeding-by-jack-newman-and-andrea-polokova/?showHidden=true
Consultante en lactation DIULHAM et IBCLC et diététicienne chez cabinet paramédical Bellecour
1 年?a y est, à Toronto aussi, on voit des freins de langue partout. Peut être que ces insuffisances glandulaires ne sont un problème qu’au démarrage? Et vous ne les avez vues que quand c’était déjà en voie d’amélioration spontanée. (Enfin, Pas spontanée mais devant la demande de l’enfant)
Infant Feeding Clinical Lead at Cheshire and Wirral Partnership Starting Well 0-19 Service
1 年Please can you give me the video link for baby drinking well as I would like to share with staff and it did not work when I copied and pasted a link. Thank you for your post. I too supported a mum to exclusive breastfeeding who had been advised IGT.
International Board Certified Lactation Consultant providing education and preparation antenatally for what comes after. I help families to breastfeed on their terms and to parent with confidence.
1 年I’ve seen all shapes and sizes exclusively bf and can’t agree more. Im appalled at the number I’ve supported who have been told that they have IGT because they aren’t pumping volumes leaving the hospital and baby has a poor latch and is on bottles ??
MD, FIAP, Pediatrician, IYCF National Trainer and Child Health Advocate, President Human Milk Bank Association of India (2022 & 23)
1 年I hope u will agree that it is the decrease in fatty tissue deposition rather than glandular tissue. In such cases frequent feeding is recommended because of the less storage space in the breasts.