Breastfeeding While Sick and How To Recover Your Supply

by Jessica Martin-Weber with Rene Fisher, IBCLC

This article made possible by the generous support of Ameda.

Ameda Finesse Double Electric Breast pump

*Please note, this is not intended to be health care advice or to replace or be a substitute for being seen by a qualified health care provider. 

Is it ok to breastfeed when you’re sick? Could baby get sick from your milk? From being so close to you if you’re contagious?

We often hear how great breastfeeding is for our babies’ immune systems, a highly motivating reason to  breastfeed. There’s plenty of evidence that shows this to be true and even though it’s no guarantee that our babies will never be sick (lowering risk is not eliminating risk), it can certainly be a motivating factor to breastfeed. In fact, we know that in infants, breastfeeding significantly reduces respiratory infections, gastrointestinal infections, SIDS and infant mortality, allergic disease (asthma, atopic dermatitis, and eczema), celiac disease, inflammatory bowel disease, diabetes, and childhood leukemia and lymphoma. (For more, see here and here.) There’s no doubt that breastfeeding can help reduce how often a baby is seek, the severity of their illness, and the duration of their illness. (More on that here.) Most of the time, breastfeeding is exactly what your baby needs when they are sick.

But what about when the breastfeeding parent is the one sick? Particularly with an infectious disease that baby could easily get being in close proximity to the one sick? Is breastmilk that magical it can protect our babies even then?

Not exactly but, well… kind of.

“…the immunologic components found in breast milk appear increasingly likely to play a specific immunologic role in the protection of the nursing infant.” (Mucosal immunity: the immunology of breast milk)

While it is possible your infant nursling could catch a sickness from you even with breastfeeding and since reduced risk doesn’t mean no risk, it certainly does happen, breastfeeding can reduce the duration of infectious disease in the breastfed infant and even beyond the first year of life.

The American Acadamy of Pediatrics recommendation on breastfeeding while sick:

If a mother has a cold or the flu, it is not necessary to discontinue or interrupt breastfeeding. Through breastfeeding, the infant will receive the antibodies that the mother is producing to fight the illness. Most infectious diseases are also not a cause for weaning or interruption. Generally, by the time a disease has been diagnosed, the infant has been exposed and will probably benefit more from the protection he gets from his mother’s breast milk than from weaning. However, each case must be evaluated individually.

There are times when it would be dangerous to breastfeed during an illness such as when the treatment for the illness carries a higher risk to the baby in the mother’s milk than not breastfeeding would. While this is rarely the case for infectious diseases, it is possible. It is important to speak with your health care provider and disclose that you are breastfeeding when considering treatment options. As not all health care providers are fully informed on human lactation, you may find the following resources helpful in determining treatment options that are safe for breastfeeding and to check a medication’s potential impact on breastmilk supply.

  • LactMed app to look up the compatibility of pharmaceutical treatments with breastfeeding.
  • Infant Risk the leading research for medication safety during pregnancy and breastfeeding.

Sometimes, illness can have an impact on breastfeeding. Some changes to breastfeeding that can happen during an illness of the breastfeeding parent:

  • Low milk supply
  • Milk color changes
  • Increased feedings
  • Decreased feedings
  • Sensitivity
  • Fussy baby at breast
  • Sore nipples

Decreased feeding or pumping, fever, and dehydration can lead to a lower supply of milk. Severe dehydration (such as can happen with gastrointestinal illness) can cause a sudden and drastic drop whereas a slow decrease in milk volume is more typical of illnesses such as the flu. Low supply as a result of dehydration will typically come back quickly with hydration, electrolytes, and rest. Low supply as a result of not fully emptying breasts due to fatigue and other symptoms will take time to rebuild. Low supply as a result of medication side effects usually will begin to recover when the medication is stopped and frequent emptying of the breast increases.

American Academy of Pediatrics breastfeeding through sickness

Recovering Milk Supply Following Illness

If you experience low supply as a result of illness, the best way to increase your supply to meet your baby’s needs is simply to let them breastfeed as often as they are interested in doing so. Complete and frequent draining of the breasts will signal the body to produce more milk. Keeping your baby close and doing skin-to-skin will also help encourage milk production. For lactating parents who pump, adding a 10-20 minute pumping session after several feedings or in between feedings can have the same effect. Don’t be surprise if you pump for 10 minutes immediately following a feeding or even an hour later and get nothing or just a few drops. The stimulation will tell your body to make more milk. It may take several days to see results.

Always be sure to be seen by a qualified health care provider for high fevers, prolonged illness, or severe symptoms.

For further discussion and Q&A on breastfeeding through illness and recovering breastmilk supply following illness, see this video chat with Rene Fisher, IBCLC and Jessica Martin-Weber, The Leaky Boob.

This is general information and does not replace the advice of your healthcare provider. If you have a problem you cannot solve quickly, seek help right away. Every baby is different. If in doubt, contact your physician or healthcare provider.

Mother of 4, Rene Fisher has been an IBCLC since 1998. Rene has worked in private practice before going on to be a hospital Lactation consultant for 10 years where she was responsible for nurses and patient education and hands on assistance with breastfeeding mothers. Rene got started in lactation support as a La Leche League Leader 1993 and became a member of La Leche League Area Professional Liaison Department from 2000 -2010. Today, Rene supports families in reaching their baby feeding goals working with Ameda breastfeeding products.

 

 

Drawing from a diverse background in the performing arts and midwifery, Jessica Martin-Weber supports women and families, creating spaces for open dialogue. Writer and speaker, Jessica is the creator of TheLeakyBoob.com, co-creator of BeyondMoi.com, freelance writer, and co-founder of Milk: An Infant Feeding Conference. Jessica lives with her family in the Pacific Northwest and co-parents her 7 daughters with her husband of 21 years.
 
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Medications and Breastfeeding

by Star Rodriguez, IBCLC 

This post made possible in part by the generous support of Rumina Nursingwear.

 

It can be really confusing taking medications or having procedures done while you are breastfeeding.  Most of the time, if you look at the package insert or online, most medications simply say that you should ask your doctor or not take them while breastfeeding.  Then you might hear something completely different from friends, or relatives, pharmacist, or from your doctor.  So what do you do?

Well, luckily, there are a bunch of fantastic resources for breastfeeding moms.

First, I want to tell you that research on breastfeeding and medications has come a long way in the past few years.  So your doctor, nurse practitioner, or pharmacist may have outdated information.  I am not trying to say that you shouldn’t respect your provider or that they don’t know what they are talking about.  That’s absolutely not true.  However, the amount of breastfeeding patients or customers that they see is probably relatively small, so their continuing education is often focused elsewhere.  If you are wondering if information that you were given is correct, you have every right to research that yourself and then bring that information back to your provider so you can make an informed decision together.

Medications moving into milk depend on several things, and, sometimes, even if they do, they do not enter the bloodstream of the baby.  Describing the hows and whys of that could literally take me twenty (probably boring to most people) pages, so I’ll cut to the more important things: how to tell what your medication is ranked, taking you baby’s age into account, resources for information, and supply issues from medications.

Drugs are typically ranked in L categories.  These categories are, as per Dr. Thomas Hale:

L1 – Safest.  These drugs either don’t reach the baby at all or have been proven to be safe in large studies.

L2 – Safer.  These drugs have either been studied to a lesser degree with little to no side effects on the baby, or, after taking the evidence into account, the likelihood of this drug being problematic to your baby is pretty remote.

L3 – Moderate.  This category is where most drugs start.  L3 drugs either have no studies done, or studies have been done showing minimal problems to the infant if the mom is taking it.  This is the category where it’s really a risk/benefit situation.  What are the risks of the drug in your breast milk versus the risks of feeding formula?

L4 – Possibly Hazardous.  We know that this drug can have adverse effects on the baby.  However, there might be some situations where use of this drug is justified.  For instance, if someone is in a life-threatening situation.  For the most part, though, we want to avoid these medications.

L5 – Contradicted.  You can’t use these while breastfeeding.  We know that they have significant, documented, negative impacts on babies.  If you have to take a L5, you cannot breastfeed while it is present in your milk.

 

Sometimes the classification of medications can vary based on where you are in your breastfeeding relationship.  In the first week of breastfeeding, due to the difference in colostrum versus mature milk, it can be a little easier for medications to pass into milk in greater quantity.  If you can avoid a drug during that time, you should.  However, maintenance medications, pain relievers used for surgical deliveries or painful vaginal deliveries don’t need to be avoided.

In the later stages of breastfeeding, after solids are introduced, most babies begin to take in a little less milk – and in the toddler stage, that often lowers again.  So if you are nursing in a later stage, some medications that were once not ok can be acceptable again.

So now that you have a basic idea about how drugs are coded, where do you find this all out? 

LactMed is a website that has a bunch of information about drugs and breastfeeding.  It doesn’t have the L classification, but it does talk about the drug’s potential effect on lactation.  For instance, if you look up Sudafed, it talks about how it might lower production of milk.  LactMed also has a free Android and iPhone app.  I haven’t tried out the app itself yet, though, so I’m not certain what, if any, differences there are.

Medications and Mother’s Milk  is a book that is updated every 2 years.  Many libraries have it, as do most pharmacies, hospitals, WIC clinics, and doctor’s offices.  It is written by Dr. Thomas Hale, and has a wealth of information on drugs and breastmilk, including the L classification.

Infant Risk Center is a website that has a bunch of information regarding pregnancy, breastfeeding, and the risks to infants of various things.  It is directly connected to Dr. Hale, who is the foremost authority on breastfeeding and medications.  The site itself can sometimes be a little difficult to find the specific information that you’d like.  However, Dr. Hale also has an app (it is a paid app, but it has a HUGE amount of information, so if you’re a provider, or you regularly work with breastfeeding moms, I can’t endorse it enough.  For the mom who is occasionally taking medication, it’s probably not necessary, though.)  The Infant Risk Center is also staffed Monday – Friday 8am – 5pm CST to answer questions about breastfeeding (and pregnancy) and medications, and the people working it are knowledgeable, helpful, and generally wonderful.

When looking at medications, it is important to consider whether they can impact supply.  For instance, as I mentioned, Sudafed can be problematic in that area.  Generally, if a medication is meant to dry something up, or impacts your hormones (like birth control), you should exercise caution in using it.  Before anyone worries, you can still take birth control.  You may want to use an IUD, the mini pill, or Depo Provera if you are not planning to use barrier methods.  With Depo or the Mirena IUD, I usually tell moms to ask to be on a month of the mini-pill first; some moms just have sensitivities to hormones, and those sensitivities can impact supply.  Depo can’t be removed once injected, and Mirena is expensive to place and uncomfortable to remove, so it is good to have an idea if you will react that way.  Also, hormonal birth control should not be started until at least 6 weeks postpartum after milk supply is established.

I hope this information helps you work with your health care provider to determine the best choice for you when you need medication.

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Did you have to take medications while breastfeeding?  Was it easy for you to find good information on them?

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 Star Rodriguiz, IBCLC, began her career helping women breastfeed as a breastfeeding peer counselor for a WIC in the Midwest.  Today she is a hospital based lactation consultant who also does private practice work through Lactastic Services.  She recently moved to the northern US with her two daughters and they are learning to cope with early October snowfalls (her Facebook page is here, go “like” for great support). 
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