By Anne Smith, IBCLC
When you are sick, you and your baby will almost always benefit from continuing to breastfeed. There are very few illnesses that require a mother to stop nursing. Since most illnesses are caused by viruses, that are most infectious before you even realize you are sick, your baby has already been exposed before you even develop symptoms (such as fever, diarrhea, vomiting, rash, runny nose, cough, etc). Continuing to breastfeed will help protect your baby from the infection, because your body produces antibodies to the specific bug that is causing the infection, and you pass them on to the baby in your milk. Often, a breastfed baby will be the only member of the family who doesn't get sick. If he does get sick, he will usually have a much milder case than the older members of the family.
Illnesses are most often transmitted through skin contact and secretions from the mouth and nose. Be sure to wash your hands often, and try to avoid face-to-face contact (and sneezing directly on the baby).
Nursing your baby while you are sick makes it easier for you to rest. Tuck him into bed with you to nurse, then have someone take him away when you're done. I remember being so sick that my older kids would bring the baby in to nurse every couple of hours, and I was so out of it that I didn't even know when she nursed.
Weaning abruptly is never a good idea, especially when you are sick. You put yourself at risk for engorgement and mastitis, as well as the emotional trauma of sudden weaning for both you and the baby.
You do need to make sure that you get plenty of fluids when you're sick, because you don't want to become dehydrated. Often your milk supply will decrease during and immediately after your illness, but your supply will build back up when you feel better.
Here is some general information about OTC (over the counter) drugs and breastfeeding -- remember, though, that drug manufacturers often change their active ingredients, so always read the label carefully and/or consult your health care provider before taking any drug when you are nursing.
• Analgesics: avoid extra-strength formulas -- Aleve, Anacin-3 Regular Strength, Tempra, Tylenol (Acetaminophen), and Excedrin are generally safe. Motrin and Advil (Ibuprofen) are ok if the dose is 400mg or less.
• Antacids and digestive aids which are usually ok to take: Lact-Aid, Lactobacillus acidophilus, Tums and Tums E-X or Ultra, Mylanta or Mylanta extra-strength, Mylicon, Maalox, DiGel, Gaviscon, Alka-Seltzer, Phazyme, Rolaids, and Pepto-Bismol Original or Extra Strength.
• Antidiarrheal Medications: preparations containing "attapulgite" (such as Donnagel, Diasorb, Kaopectate, and Rheaban), as well as those containing "loperamide" (such as Imodium A-D, Kaopectate 1-D, and Pepto-Bismol) are usually not harmful.
• Artificial Sweeteners: Avoid saccharin (Sweet'n'Low) because we just don't know. Aspartame (Equal or NutraSweet) are ok unless your baby has PKU ( a very rare metabolic disorder which every baby should be screened for soon after birth -- ask your doctor if you're not sure).
• Cough, Cold, and Allergy Preparations: Try to use single ingredient, short acting forms of the drug.
• For sore throats, avoid lozenges and sprays which contain phenol, or hexylresorcinols. (These include Cepastat, Listerine, and Sucrets lozenges, and Vicks Chloraseptic Sore Throat Spray). Instead, choose Celestial Seasonings, Cepacol Lozenges, NICE Lozenges, and Vicks Lozenges (these contain menthol/and/or benzocaine rather than phenol. You can also use Sucrets Lozenges if they contain dyclonine rather than hexylresorcinols.
• For allergies and sinus congestion: Actifed, Benadryl, Benylin, Chlor-Trimeton, Dimetapp, Drixoral, Gualifed, Sinutab Non-Drying, Sudafed, Tavist-D, Triaminic, and Vicks Dayquil Sinus Pressure and Pain Relief are usually ok.
If you want to use a nasal spray to relieve sinus congestion, look for preparations that contain sodium chloride or phenylephrine (such as Afrin Saline Mist, Nasal Moist, and St. Joseph Nasal Decongestant, and Neo-Synephrine Spray and Drops) rather than those which contain oxymetazoline, naphazoline, or phenylephrine (such as Afrin, Dristan, Privine, or Vicks Sinex Nasal Spray or Inhaler).
Always avoid long acting forms and multiple ingredients, and watch for drowsiness in the baby or a decrease in your milk supply. Drink extra fluids, because drugs that dry up secretions in other parts of your body may decrease your milk supply as well. Your supply will build up when you feel better.
• For coughs: Avoid products with an alcohol content of over 20%. Benylin, Robitussin (DM, PE, and Maximum Strength), Triaminic Expectorant, and Vicks 44E and Vicks 44 Dry Hacking Cough are not harmful, but watch for infant drowsiness. Avoid multi-action formulas such as Tylenol Multi-Symptom Cough medication and Vicks Nyquil Liquid or Liquicaps.
• For constipation: Use formulations containing pysillium, docusate, methylcellulose,or magnesium hydroxide (Citrucel, Colace, Fiberall, Fibvercom, Maalox Daily Fiber, Metamucil, Mylanta, Philips' Milk of Magnesia, Serutan, or Surfak. Avoid those containing mineral oil, phenolphthalein, bisacodyl, and castor oil (Correctol, Dulcolax, Ex-Lax, Feen- a-Mint, Peri-Colace, and Senokot. These may cause stomach upset in the baby.
• Most sleep preparations, including Nytol QuickCaps, Sleep-Eze, Sominex Formala 2, and Unisom Maxium Sleepgels, are ok. Avoid those which contain doxylamine, (such as Nytol Maximum Strength, and Unisom), and always watch for excessive sleepiness in your baby.
• For nausea and vomiting: Benadryl, Emetrol, and Dramamine aren't harmful. Again, watch for drowsiness, and try to take the dose after you nurse. Avoid compounds containing meclizine or cyclizine, such as Bonine, Dramamine II, and Marezine.
• Most weight control products such as Acutrim and Dexatrim contain phenylpropanolamine and large amounts of caffeine. It is best to avoid them.
• All the major hemorrhoidal preparations, such as Americaine, Anusol, Nupercainal, Preparation H, and Tucks gel or pads are safe to use while breastfeeding.
Let's discuss specific illnesses now. First, the scariest one of all -- cancer. Cancer causes malignant blood cells to multiply rapidly and out of control. If detected early and treated promptly, many types of cancer can be cured completely. When cancer is suspected, there are several types of diagnostic tests that may be used; some affect breastfeeding more than others.
Remember to do your monthly breast exam.
Early detection is the key as most women find lumps themselves.
For more information on breast self-exam and breast health go to http://www.ama-assn.org/insight/h_focus/wom_hlth/brc.htm#p05
• X-rays: human milk is not affected by diagnostic x-rays, and you can safely nurse immediately afterward.
• MRI (magnetic resonance imaging) is a non-invasive technique that will not affect your milk. However, as part of the procedure, you will be injected with a dye that may or may not be harmful, so if you are concerned, you can discard the milk pumped after the procedure. Consult a knowledgeable health care provider for specifics on how long to wait before resuming breastfeeding.
• Ultrasound and CAT scans: these are non-invasive procedures that should not affect your milk or interfere with breastfeeding.
• Mammograms can be performed while you are nursing, without affecting your milk. Because the breast tissue is denser during lactation, it may be more difficult to read the results. Be sure to empty your breast by pumping or nursing before the procedure.
• Fine-needle aspiration cytologic study: If you have a breast lump, this is a simple, nearly painless out-patient procedure performed in your doctor's office to determine the nature of a solid mass. There should be no reason to interrupt breastfeeding.
• If you need to undergo radioactive isotope testing, you will need to wean your baby temporarily. (See article on "Drugs and Breastfeeding" for more specific information.) If you need to undergo radiation therapy, you can continue nursing unless both breasts are being radiated. The treatment will not affect the function of the un-radiated breast. If you must have chemotherapy and treatment with radioactive compounds, temporary or permanent weaning will be necessary. (See articles on "Weaning" and "Lactation Suppression").
The other really scary illness is AIDS, or HIV infection. There is evidence that the HIV virus can be transmitted through breastfeeding. The average risk for HIV transmission is 1 in 7 in children born to, and breastfed by an infected woman. This means that although the majority of cases of viral transmission occur during late pregnancy and delivery, more than one-third of infants acquire the virus through breastfeeding. The risk is real, so at least in the US, where we have access to nutritionally adequate infant formulas, and clean water and sanitation, HIV positive mothers probably should not breastfeed their babies. In developing countries, where the risk of artificially feeding the baby may outweigh the risk of transmitting the virus, the issue is not as clear.
Other illnesses in the mother include:
• Herpes Simplex I (cold sores) and Herpes Simplex II (Genital Herpes): The Herpes virus can be fatal to newborns up to three weeks of age. Genital sores can be transferred to the breast. If you are pregnant, you should talk to a doctor who is knowledgeable about the virus to decide which precautions to take. Generally, the baby can continue to nurse if he doesn't touch the sores. Until all the sores are dried, be sure to: wash your hands often, especially after touching the sores and before touching the baby; keep clean coverings over the sores; and avoid kissing your baby if you have sores on or near your mouth. If the sore is on the nipple or areola, you need to express milk from that breast until the sore heals. You can continue nursing on the unaffected breast.
• If you have cardiac problems, you can and should continue nursing. The release of prolactin has a relaxing effect, and can benefit women with cardiac problems.
• If you have high blood pressure, the relaxing effects of prolactin are also beneficial. Low-dose diuretics (often used to treat hypertension) are compatible with breastfeeding, but high doses may decrease your milk supply. Many beta-blockers used for cardiovascular treatment are also compatible with breastfeeding.
• If you have carpal tunnel syndrome, it usually clears up within a couple of months of giving birth. Treatments such as wearing splints, elevating the hand, and the use of low-dose diuretic drugs, are preferable to more aggressive treatments. If steroid treatments are necessary, consult your health care provider to discuss the lowest possible doses (see article on "Drugs and Breastfeeding").
• If you get chickenpox, (and this is rare because most women of child-bearing age were exposed during childhood) it can be a serious concern, because it can be fatal in a baby who catches it in utero, or a very premature baby. If you are pregnant and have been exposed, your doctor can do a blood test to determine if you have immunity to the disease. If you are diagnosed with chickenpox within five days before giving birth, you may need to be separated from your newborn for a few days to minimize the chance of infection. If this happens, express your milk and give it to your baby. If you have the virus, your baby will be given a ZIG shot. Most babies who catch it after birth will have a very mild case. Chickenpox is no longer considered contagious when you have had no new eruptions for 72 hours, and all the lesions have become crusted. If you have older children when the baby is born, keep them away from the baby. If you have had it yourself and have immunities, the risk of the baby catching it is greatly reduced.
• IF you eat a food that is contaminated with botulism, salmonella, E.coli, or other bacterias or toxins, you may develop acute intestinal symptoms such as vomiting, diarrhea, or cramps. Usually, these toxins stay localized in your intestinal tract and don't pass into your milk. Make sure you drink enough fluids to avoid becoming dehydrated, but continue nursing your baby.
• Hepatitis A is a viral infection of the liver, which causes jaundice in the mother. It is transmitted through contact with infected blood or fecal matter. There is no reason to discontinue nursing if you have Hepatitis A.
• Hepatitis B is a virus that causes symptoms similar to Hepatitis A, but they last longer. It is transmitted by contact with body fluids such as blood, saliva, and mucus, and can also be transmitted sexually. If you contract it during pregnancy, your baby will be give several doses of the Hepatitis B vaccine within the first 12 hours of life, and breastfeeding can continue. If you get it after the baby's birth, he will be vaccinated and you can continue nursing.
• Hepatitis C is a virus that begins with a mild infection, but then progresses to jaundice. Half of those who contract it will develop chronic liver disease. It is transmitted through blood, needles, and sexual contact. The risk of transmission is minimal. If you are in the acute phases of the illness, you may need to stop nursing temporarily until your symptoms subside. Discuss this with your doctor.
• If you have infectious diseases such as Leprosy, Lyme Disease, Malaria, or Rubella (German Measles) you can continue nursing. If you contract measles, it can be fatal in an unborn or newborn baby (congenital measles). The chances of you contracting measles before birth is rare, because almost everyone has been vaccinated during childhood. If you have been exposed, and aren't sure if you are immunized, your doctor can order a blood test to determine if you have immunity to the disease. If you do contract measles and are contagious at the tine of birth, you may need to be separated from your baby for a few days to reduce the chance of infection. If this is necessary, express your milk and feed it to your baby until you are no longer contagious and can resume nursing.
• If you have an STD (sexually transmitted disease) during pregnancy, you may infect your newborn during delivery, and will require treatment immediately postpartum. STDs such as Chlamydia, Gonorrhea, Syphllis, and Trichomonas do not require the discontinuation of breastfeeding. With Syphllis, follow the same precautions as you would with Herpes. With Trichomonas (a common vaginal infection) you will probably be prescribed Flagyl. According to Dr. Jack Newman, MD. FRCPC, there is no need to stop breastfeeding during either short or long term treatment while taking this drug.
• Women with chronic illnesses can almost always breastfeed. If you have Cystic Fibrosis, you can produce normal breastmilk, but must monitor your nutrition carefully. If the disease is stabilized, and your weight gain is adequate, you should be able to continue nursing.
• If you are diabetic, breastfeeding offers many advantages. It reduces your stress level, reduces the risk of the baby developing diabetes, and makes the diseases more manageable because your body's natural response to the hormones responsible for lactation are helpful. You will need to monitor your blood-glucose levels carefully because the hormonal changes of pregnancy and childbirth can cause changes in the levels. If you are diabetic, your baby is more likely to become jaundiced after birth. (see article on "Jaundice"). Insulin is compatible with breastfeeding, because it doesn't transfer into human milk. Your milk may come in a day or two later if you are diabetic, so monitor your baby's intake carefully. (See article "How To Tell If Your Baby Is Getting Enough Milk"). Many diabetic mothers experience a partial or total remission from their diabetes as long as they nurse. Your insulin requirements may be significantly less than before you became pregnant. Some mothers need to decrease their insulin requirements by as much as 27% while they are lactating. Monitor levels closely, and discuss adjusting your medication with your doctor. Diabetes makes you more susceptible to all sorts of infections, including yeast and mastitis. See articles on "Breast Infections and Plugged Ducts" and "Yeast Infections" for information on how to diagnose, prevent, and treat these problems.
• Mothers with Epilepsy can nurse. At least half of all epileptics are able to completely control their seizures with medication, and most of the rest achieve at least partial control. There are two major concerns: that you remain seizure free and able to care for your infant, and that the medications you take to control the seizures don't adversely your baby. The medications needed to control the seizures may cause sedation and poor sucking in your baby, so you may need to offer occasional bottles of formula if he seems to be sedated by the medication. You must monitor weight gain carefully, and work closely with your doctor to ensure that you remain seizure free and your baby gains weight adequately. Often mixed feedings are necessary in the early postpartum period, and once his metabolism increases, your can resume complete breastfeeding. Often you need to pump to ensure an adequate milk supply. In case of seizure activity, consider practical tips such as: nursing in a padded chair, elevate your feet with a small stool, use guardrails or pillows if you nurse in bed, have a playpen on each floor of the house so you can lay the baby down if you feel a seizure coming on, and when you go out with your baby, attach a tag to your stroller explaining that you have epilepsy and listing the name of a friend or relative who can take care of the baby in an emergency situation.
• If you have Multiple Sclerosis, a degenerative muscle disease, you can still breastfeed. Your baby can't contract it through nursing. There is evidence that the risk of contracting MS is lower in individuals nursed for more than six months as opposed to babies never nursed or nursed for less than six months.
• Thyroid levels can change during pregnancy and lactation, even with mothers who never had thyroid irregularities before. If you have a history of thyroid problems, ask your doctor to monitor your levels regularly so your medication can be adjusted. An under active thyroid can cause fatigue, poor appetite, and depression. Thyroid supplements taken during lactation will not hurt your baby, because they just bring the levels up to where they should normally be.
• An overactive thyroid can cause serious health problems. If you need to take a thyroid suppressant, you need to work closely with your doctor to make sure the baby's levels aren't lowered as well. An alternative to weaning would be to give the baby a thyroid supplement if his levels fall below normal. Let your doctor know how important nursing is to you so he will work with you on adjusting your medication so you can continue to nurse. If radioactive therapy is recommended, temporary weaning may be necessary. (See article on "Drugs and Breastfeeding"). Find a doctor who is willing to work with you on maintaining your milk supply and resuming nursing after the radiation is eliminated from your body.
It is almost always possible for a mother to continue nursing, even if temporary weaning is necessary. Remember how important breastfeeding is to you and your baby, and try to find a supportive health care provider who believes that nursing is as important as you do. Please feel free to contact me if I can help in any way with providing information about specific drugs, or just moral support for your decision to continue nursing, or to wean if that becomes necessary.
Anne Smith, IBCLC has breastfed a total of six children (three boys, three girls). She feels that her first hand experience plus her more than twenty years experience of counseling nursing mothers are among her most important credentials. Anne has been a La Leche Leader since 1978 and IBCLC since 1990. As a nursing mother, LLL Leader, and IBCLC, Anne has worked in many areas over the years. She has led support group meetings, taught breastfeeding classes, trained breastfeeding peer counselors to work with low income mothers, worked one-on-one with mothers to solve breastfeeding problems, helped thousands of mothers with breastfeeding questions over the phone, held workshops for health professionals on various breastfeeding topics, taught OB, Pediatric, and Family Practice Residents breastfeeding at Bowman Gray School of Medicine, and run a breast pump rental station with over 100 pumps, scales, and nursing bras for the past eleven years. We invite you to visit Anne's website.
Copyright © Anne Smith. Permission to publish granted to Pregnancy.org, LLC.