Illness and Breastfeeding

By Jack Newman, MD, FRCPC

Introduction

Over the years, far too many women have been wrongly told they had to stop breastfeeding. The decision about continuing breastfeeding when the mother takes a drug, for example, is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother, the baby and the family, as well as society.

And there are plenty of risks in not breastfeeding, so the question essentially boils down to: Does the addition of a small amount of medication to the mother's milk make breastfeeding more hazardous than formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping. The same consideration needs to be taken into account when the mother or the baby is sick.

Remember that stopping breastfeeding for a week or even days may result in permanent weaning since the baby may then not take the breast again. On the other hand, it should be taken into consideration that some babies may refuse to take the bottle completely, so that the advice to stop is not only wrong, but often impractical as well. On top of that it is easy to advise the mother to pump her milk while the baby is not breastfeeding, but this is not always easy in practice and the mother may end up painfully engorged.

Illness in the Mother

Very few maternal illnesses require the mother to stop breastfeeding. This is particularly true for infections the mother might have, the most common type of illness for mothers are being told they must stop. Viruses cause most infections, and most infections due to viruses are most infectious before the mother even has an idea she is sick. By the time the mother has fever (or runny nose, or diarrhoea, or cough, or rash, or vomiting etc), she has probably already passed on the infection to the baby.

However, breastfeeding protects the baby against infection, and the mother should continue breastfeeding, in order to protect the baby. If the baby does get sick, which is possible, he is likely to get less sick than if breastfeeding had stopped. But often mothers are pleasantly surprised that their babies do not get sick at all. The baby was protected by the mother’s continuing breastfeeding. Bacterial infections (such as “strep throat”) are also not of concern for the very same reasons.

See handout on Drugs and Breastfeeding with regard to continuing breastfeeding while taking medication.

The only exception to the above is HIV infection in the mother. Until we have further information, it is generally felt that the mother who is HIV positive not breastfeed, at least in the situation where the risks of artificial feeding are considered acceptable. There are, however, situations, even in Canada, where the risks of not breastfeeding are elevated enough that breastfeeding should not be automatically ruled out. The final word is not yet in. Indeed, recently information came out that exclusive breastfeeding protected the baby from acquiring HIV better than formula feeding and that the highest risk is associated with mixed feeding (breastfeeding + artificial feeding). This work needs to be confirmed.

Antibodies in the Milk

The only exception to the above is HIV infection in the mother. Until we have further information, it is generally felt that the mother who is HIV positive not breastfeed, at least in the situation where the risks of artificial feeding are considered acceptable. There are, however, situations, even in Canada, where the risks of not breastfeeding are elevated enough that breastfeeding should not be automatically ruled out. The final word is not yet in. Indeed, recently information came out that exclusive breastfeeding protected the baby from acquiring HIV better than formula feeding and that the highest risk is associated with mixed feeding (breastfeeding + artificial feeding). This work needs to be confirmed.

The antibodies that make up the vast majority of the antibodies in the milk are of the type called secretory IgA. Autoimmune diseases are not caused by secretory IgA. Even if they were, the baby does not absorb secretory IgA. There is no issue. Continue breastfeeding.