Dr. Brian Donnelly wants to wish everyone a:
Happy World Breastfeeding Week!
(Always the first week in August, rain or shine)
Dr. Donnelly also wants to add some thoughts to yesterday’s PediaBlog post, “Breastfeeding On Meds”:
Thanks for posting this, Ned! As a member of the Academy of Breastfeeding Medicine, I will take the liberty of weighing in:
Question 1 : Will I pass my illness to my baby while breastfeeding?
There are a few YES answers to this. Mothers with active tuberculosis can pass their disease to their baby. (Of course, they can also pass their disease to the baby while bottlefeeding.) Once the mother is treated, she can breastfeed again. If the mother has a disease called brucellosis, she should not breastfeed, as the Brucella bacteria can potentially harm the baby. Similarly, once she has been adequately treated (usually 2 days of antibiotics), she can resume breastfeeding.
If mom has active chicken pox disease, she should avoid feeding her un-vaccinated baby. Once she is no longer contagious, breastfeeding may resume. If the mother has a herpes simplex lesion on her nipple, the baby should avoid nursing on that side until the nipple has healed.
Mothers who test positive for HIV or HTLV [Human T-cell Lymphotropic virus] I or II in the USA (or other developed countries) should not breastfeed. In under-developed countries, the advice is a little different. There, the risk of not breastfeeding is more life-threatening; bottle-feeding is considerably more dangerous. In these under-developed areas where bottle-feeding has been embraced, many more babies die from pneumonia or diarrheal illness compared to their breastfed peers. Exclusive breastfeeding for the first six months, along with the maternal use of anti-retroviral medication, seems to show the most promise in minimizing the risks to babies who are born to HIV + mothers in the Third World.
Question 2 : Does breastfeeding interfere with vaccinations?
Usually, we see the opposite result. Data show that breastfed babies generate higher antibody levels after being immunized. But, there is a YES answer here also. Studies show a slightly greater response to the rotavirus vaccine in bottlefed babies. This vaccine is live. The thinking is that breast milk, with its anti-infective components, attacks the live virus and blunts the baby’s antibody response. On the other hand, when it comes to live, wild rotavirus disease, breastfed babies do MUCH better, and are much less likely to suffer dehydration, than non-breastfed babies. The immune sword cuts both ways.
Question 3 : Can I breastfeed if I am taking medications?
As mentioned in the post, most times the answer is YES. In general, medications with high molecular weights do not even enter the breast milk. But the important thing is to base the decision on data, and not fear. All too often, doctors (anesthesiologists, I am looking at you!) tell moms to “pump and dump” for 2 days, without studies backing up that advice. I just heard of a mother who was told by her ophthalmologist to stop breastfeeding for 10 days because she had an intravitreous injection of a medication with a molecular weight of 48,000. The vitreous of the eye is a rather small space, so the actual amount injected had to be correspondingly small. The molecule itself is huge, as molecules go. (By way of comparison, salicylic acid’s molecular weight is 138.) These factors make it extremely unlikely that the medication will be absorbed into the bloodstream and cross into the breast milk.The admonition to quit nursing for 10 days is, sadly, not based on the available science.
We can serve these mothers, and their babies, better than that!
(Dr. Brian Donnelly works in the Pediatric Alliance — North Hills Division. You can read more of his contributions to The PediaBlog here.)