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Mastectomy. Women who have had a breast removed and are not on cytotoxic drugs can breast feed their babies successfully from the unaffected breast.

Mammaplasty. Mammaplasty for the enlargement (augmentation) of the breasts makes breast feeding difficult because only a little milk is usually produced, but colostrum at least should be given, and partial breast feeding is possible. However, some women produce sufficient milk so it is worth giving it a good try.

Breast reduction. Having an operation to decrease the size of the breasts does not mean you cannot breast feed. Although you may not produce a lot of milk with your first child, with your second child, milk production is usually perfectly adequate.

Tuberculosis. The BCG injection should be given to the baby soon after birth, and if the mother is being treated for tuberculosis, but is no longer considered infectious or has been free of the disease for two years, she can breast feed.

Lactose intolerance. Primary lactose intolerance is a very rare congenital disorder caused by the absence of the enzyme lactase in the gut. Lactase is used to convert lactose (the sugar in milk) into glucose and galactose. Because it is absent, lactose passes unconverted into the gut where it causes smelly frothy stools with the release of carbon dioxide gas. Diarrhoea develops in the first week and the baby fails to gain mass. Stool tests confirm the diagnosis and the child is put on a lactose-free diet for at least the first two years of life. A special lactose-free modified cow’s milk or soya milk is necessary and breast feeding is not possible.

Acquired lactose intolerance. This is a relatively common after-effect of severe diarrhoea when the production of lactase enzyme has been temporarily affected. The symptoms are the same as for primary lactose intolerance except that they may occur at any time that there has been severe diarrhoea.

The child is taken off the breast or bottle and fed soya milk or one of the new lactose-free cow’s milks. Depending on the severity of the case, the child can be returned to the breast gradually. A few weeks on a lactose-free regime is usually sufficient for the gut to recover and start producing lactase. While the baby is off the breast you should express and dispose of the milk or, better still, donate it to a milk bank.

Galactosaemia. This is a rare condition in which the child’s body lacks the enzyme necessary to convert lactose, the sugar in milk, into glucose. The child fails to thrive on breast or formula and suffers from jaundice, vomiting and listlessness in the first weeks. The condition is diagnosed by urine tests and the infant is on a galactose-free diet for life, so breast feeding is not possible.

Teeth. Occasionally a baby may be born with one or two teeth. If they are superficial and the doctor is sure there are other teeth below them they may be removed. The presence of teeth does not mean that you cannot breast feed.

When your baby normally gets her teeth, at about six months, she may try a few bites, especially at the end of a feed. Biting the gland that feeds her is ungracious and she will have to be discouraged firmly. Because of swelling and pain in the gums a baby may not be keen to suck when she is teething. Rub some teething jelly on her gums before a feed to ease any pain.

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