title: Infants' fussiness on the breast; a window to salvage breastfeeding before breast rejection.
abstract: BACKGROUND
  Infants' fussiness on the breast is a common lactation problem that can proceed to complete breastfeeding refusal if not professionally handled.
  
  
  OBJECTIVE
  To study the factors associated with infants' fussiness while breastfeeding and the effect of proper lactation counselling on the breastfeeding outcome.
  
  
  METHODS
  This is an interventional study conducted in the breastfeeding clinic of the Cairo university children's hospital. Forty-six fussy infants were recruited. Personal interview together with assessment of the act of breastfeeding were done for each mother-infant dyad. The mothers' milk letdown was assessed by manual expression. Intervention was done by proper lactation counselling, guided by the WHO/UNICEF breastfeeding counselling training course.
  
  
  RESULTS
  28 (61%) of the mothers had forceful milk letdown versus 9 (19.5%) having average letdown and 9 (19.5%) having inhibited letdown (p<0.01). 13 infants were using pacifiers, which was stopped in 10 of them (p=0.01), 8 infants received formula and 5 mothers were smokers and all couldn't stop smoking. Upon counselling, 37 infants continued breastfeeding without fussiness and 9 stopped it (p<0.01). The greatest success was accomplished in mothers having forceful letdown (p=0.0001) and average letdown (p=0.01), rather than those having inhibited letdown (p=0.57).  19 of the 37 mothers having acceptable let down were presenting with perceived low milk supply and only 3 remained unconvinced (p<0.01). 46.2% of pacifier users, 100% of formula users and 80% of infants of smoker mothers quitted breastfeeding. Conclusion & Recommendations: Forceful milk letdown is commonly associated with fussiness on the breast with good outcome if properly managed. Inhibited letdown, smoking, bottle-feeding and pacifier use are associated with breastfeeding rejection. Low milk supply is a commonly "perceived" problem that should be properly assessed and handled by lactation consultants. Medical professionals should be oriented about the common breastfeeding problems, their prophylaxis and management and their role should go beyond just "motivating" mothers to breastfeed without practical guidance.
authors: Paediatrics and Neonatology, Dept. of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt. raniatomerak@yahoo.com.
authors: Rania H
authors: RH
authors: Tomerak