Friday, January 13, 2012

Breastfeeding & The Sick Mother

Breastfeeding during illness
Regardless of having a “Super Mom” status, no mother is immune to getting sick.  Even during illness, there are very few conditions which require a lactating mother to discontinue breastfeeding her child. 

It is recommended that infants be exclusively breastfed for the first 6 months of life.  Breastfeeding can be continued along with the addition of solid foods from 6 months to 1 year of age.  After age 1, breastfeeding may continue as desired, so long as adequate nutrition is met together with solid foods.

If I have a cold, should I continue breastfeeding?
Remember that prior to feeling the symptoms of a common cold, you have previously been exposed to the pathogen (commonly a virus) often several days prior to feeling ill.  During that time, you have probably exposed your child to the infectious pathogen (virus, bacteria, etc).  Additionally, antibodies (components made by your immune system which fight infection) being produced and recruited are passed to your infant through the breast milk to allow them to fight the infectious agent which is also causing your symptoms.  Delaying or discontinuing breastfeeding is not recommended for common colds and most other illnesses in a lactating mother.

Are there any diseases which preclude a mother from breastfeeding?
There are very few infectious medical conditions in a lactating mother which necessitate that their breast milk not be given to an infant.  The following infections have been identified by the American Academy of Pediatrics & The Report of the Committee on Infectious Diseases as capable or possibly being capable of transmission via breast milk.
·         HIV (Human Immunodeficiency Virus)
o   All pregnant women in the United States should be screened for HIV infection in order to begin treatments necessary to reduce transmission to an unborn child.
·         HTLV 1 & 2 (Human T-lymphotropic Virus)
·         Herpes Simplex Virus (HSV) Type 1 - when there are active lesions on the breast.
o   Breastfeeding may resume once the lesions have resolved. 
o   Active HSV lesions should be covered at all times to prevent infant contact.
·         Syphilis – when there are active lesions on the breast. 
o   Breastfeeding can resume 24 hours after treatment has been received by the mother.
·         Hepatitis C – while transmission of Hepatitis C via breast milk is possible, the Report of the Committee on Infectious Diseases from 2009 states that there has not been a case of Hepatitis C contracted by an infant via breastfeeding.
o   To reduce the risk of transmission - infants should not breastfeed on skin which is cracked or bleeding in a lactating mother who has hepatitis C.
·         CMV (cytomegalovirus) – may be transmitted via breastfeeding, but can be eliminated by pumping breast milk and then pasteurizing it to kill any CMV which has been transferred.
All mothers with any of the infectious etiologies above should discuss with their obstetrician and pediatrician the risks & benefits of breastfeeding vs. other methods of providing nutrition to their newborns.

If I am taking an antibiotic, can I still breastfeed?
A rule of thumb endorsed by the American Academy of Pediatrics & The Report of the Committee on Infectious Diseases is that an antibiotic is safe to use by a lactating woman if it is also known to be safe for an infant.  There are instances where certain antibiotics which are safe in adults would not be used in infants. In these cases, if there is not a safe alternative medication for a lactating mother, breastfeeding should be discontinued in favor of formula or stored frozen breast milk until the antibiotic treatment has been completed.
·         Discuss with your personal physician & pediatrician if any medication you are prescribed is safe to use while breastfeeding. 

General Tips
  • Postpartum mastitis is a common skin infection caused by entry of bacteria through a crack or break in the nipple or areola.
    • While antibiotic therapy is occasionally required, the best treatment is to continue breastfeeding or to pump the affected breast.
·         Frequent hand washing, while always important, is especially so during times when a mother or any close contact to an infant has an illness.
o   As during any illness, contact with your infant should be limited to breastfeeding if possible.
§  Tip: Wear a mask while breastfeeding if you are feeling ill to avoid excessive spread of germs.
·         Several other classes of medications, such as certain cardiac medications and chemotherapeutic agents are contraindicated during breastfeeding due to potential harm to the infant.
·         Aspirin and other aspirin-containing drugs should be avoided if possible while breastfeeding.
o   Aspirin, which has been associated with the development of a serious illness known as Reye’s syndrome, should never be given to an infant or young child for fever or pain.
·         If you are currently taking daily medications, including over-the-counter medicines or supplements, discuss with your OB/GYN their safety during pregnancy as well as safety while lactating.
·         Before starting any new medication or supplement, discuss with your child’s pediatrician the potential risks to a breastfed infant.

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1 comment:

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