Dear Mirror Doctor, My problem is with my two-week-old baby girl. She was born with the breasts enlarged and sometimes a whitish fluid comes out when they are squeezed. I reported to my midwife who said I should not worry but I am dead worried. Please, why these breast swellings and when is the discharge going to stop? Is there any effect of this swelling on the injections children are to receive?
Dear Josephine, Pregnancy is sustained by certain chemicals in the mother’s body called hormones. Thus the foetus grows in an environment very rich with hormones.
In fact, newborns show signs of this exposure in a variety of ways. Newborn girls may show signs of this hormonal exposure by having whitish vaginal discharge, breast buds, which may produce colostrum, (the same initial fluid breastfeeding mums secrete) and even some vaginal bleeding.
Breast development is influenced by the sex hormone called estrogen. The levels of estrogen vary significantly at different times during life. And its effects cause changes throughout the body.
These changes include maturation of mucous membranes of the vagina, breast enlargement and bone maturation. Because the mother’s breast must mature in anticipation of breastfeeding, certain hormones are produced in high levels to bring about this change.
Unfortunately, the child also gets exposed to these same hormones as they easily pass through the placenta to the developing child’s bloodstream leading to, among the effects of this hormone, breast development.
However, these initial effects generally subside within the first few weeks after birth because these hormones, passed from mother to daughter, go away.
However, over the next few months, the infant's own hormone system begins to mature. This maturation involves the signals the brain gives the ovaries to make sex hormones. It is at this time that estrogen levels go up again, peaking at about four months of age.
This increase in levels may be enough to sustain breast development through early infancy. Over the next one and a half years, the child’s own hormonal system undergoes further maturation allowing for the inhibition of these signals leading to cessation of these hormones, and the breasts stop their development or regress.
If nothing is done to this breast, the natural cycle described above will go on and the breast will shrink to the normal levels as the child grows.
The effect of this hormone, as already mentioned above, is not limited to the breast alone. Sometimes as a result of this sudden withdrawal of these hormones, (because child is born and leaves the mother’s womb) the child suffers withdrawal symptoms.
These include some whitish discharge from the vagina, which may persist for days and in some cases, there is frank vaginal bleeding (neonatal menstruation).
These symptoms, scary as they may be, are very benign and mothers need not worry at all. In some extreme cases, estrogen cream is applied to help stop the bleeding if it is so profuse.
The only worry we as medics tend to have is this cultural practice of squeezing the fluid out of the breast. In some cases a flat object is applied to the breast to help squash the breast. These practices lead to infection of the breast, called mastitis.
It is worth noting that in some cases mastitis can develop de novo without any physical manipulations. It typically occurs in infants younger than two months of age (neonatal mastitis).
During the first two weeks of life, neonatal mastitis occurs with equal frequency in girls and boys. Thereafter, it is more common in girls, with a female:male ratio of approximately 2:1. This is thought to be related to the longer duration of physiologic breast enlargement in female than in male infants.
As stated above, manipulation of the neonatal breast to express a clear or cloudy (milk-like) nipple discharge ("witch's milk") has been considered to be a risk factor for breast abscess.
So apart from this complication of mastitis, there is absolutely no reason why you should have sleepless nights over the enlarged and discharging breast in your newborn.
All the child needs is occasional examination by the paediatrician to ensure that nothing untoward is happening to the child. Time is the only remedy you need and everything will fall in place.
There is no need to take any medications unless prescribed by a doctor, neither is there the need for any vaccines to help. These breast swellings do not in any way interfere with the childhood immunisation programme.
Please don’t give in to the persistent pressure you will come under, especially from parents, grandparents and in-laws.
Let us also cultivate the habit of seeking a paediatrician’s help when baffled with certain things about our children, especially newborns.
A member of Paediatric Society of Ghana