Pitfalls of Infant Formula

Though there are many articles about the benefits of breastfeeding for babies, benefits for mothersuniqueness of breast milk, the importance of colostrum, and the amazing antibodies in breast milk it is also important to talk about the pitfalls of infant formula.

Here are 20 known and documented adverse health implications from infant formula:

    1. Cognitive Development
      Formula-fed infants have less advanced cognitive development.1 Preterm babies given formula have decreased cognitive abilities at five years of age.2
    2. IQ
      Formula-fed infants have lower mental development scores throughout adolescence, by as much as 10 points.3  4
    3. SIDS
      Formula feeding increases a baby’s risks of Sudden Infant Death Syndrome.5
    4. Allergies & Eczema
      Formula-fed infants have higher rates of allergic disease.6
    5. Asthma
      Babies who receive formula before 2 months of age have a four-fold increase than babies who are breastfed for at least four months.7
    6. Ear Infections
      Formula fed babies have 75% increase in incidence of otitis media (ear infections).8
    7. Respiratory Infections
      Formula-fed infants have higher rates of bronchitis, croup, and pneumonia.9
    8. Infectious Disease
      Formula feeding is associated with higher incidences of infectious diseases (including diarrhea, sepsis, and pneumonia) and hospitalizations for illnesses.10
    9. Necrotizing Enterocolitis
      Formula-feeding is associated with significantly higher rates of NEC.11 NEC is a serious illness that can be fatal, especially in premature infants.
    10. Gastrointestinal Illness
      Children and adults who were formula-fed have greater incidences of Chrohn’s disease, inflammatory bowel disease, ulcerative colitis, Celiac Disease, and other GI issues.12  Given that breast milk is essential for the proper development of a baby’s immature intestinal mucosa, it makes sense that coating his system with anything other than breast milk before his body is ready can cause gastrointestinal distress.
    11. Harmful bacteria
      Exclusively formula-fed babies are more likely to be colonized with pathogenic bacteria such as E-coli, Candida, and Clostridium.13
    12. Gross Motor Coordination
      Formula-fed infants are more likely to have gross motor coordination delays than babies who were exclusively breastfed at least four months.14
    13. Obesity
      Children who are formula-fed have increased rates of obesity throughout their lifetimes.15  This could be because breastfeeding has a cell programming effect in reducing overweight conditions, which formula-fed infants miss out on.  Formula-fed babies have higher insulin concentrations in their plasma which can begin fat deposition in the body at an early age. And breast milk contains the hormone leptin (which is not in formula) that helps regulate body weight.
    14. Diabetes
      Breastfeeding is protective against both Type I and Type II diabetes. Diabetes rates are higher among children and adults who were formula-fed.16
    15. Cancer
      Risks for several childhood cancers are greatly increased in formula-fed children: lymphoma, leukemia, and Hodgkin’s disease.17  Researchers have identified alpha-lactalbumin, a protein in breast milk, which causes the death of abnormal cells.  This human milk protein does not exist in formula.
    16. Diarrhea and Vomiting
      One of the leading causes of infant deaths around the world, the incidence of diarrheal disease is greatly increased in formula-fed infants. Exclusive breastfeeding for at least four months is highly protective.18
    17. Multiple Sclerosis
      The strongest link to MS is a person’s diet, especially in fatty acids.  Breast milk has the perfect makeup of essential fatty acids for humans and has not been replicated in formula.  In fact, formula destabilizes the normal development of myelin. There are higher incidences of MS in children and adults who were formula-fed.19
    18. Immunizations
      Children who are formula-fed show lower antibody responses to vaccines.  In fact, some formula-fed children show no antibody levels at all.20
    19. Neurotoxins
      Formula has much higher levels of manganese than breast milk and many times also contains MSG, toxic lead and silicon levels, nitrites, GMOs, and more. Formula is not sterile and has been recalled many times over the years.21
    20. Schizophrenia
      Exclusive formula-feeding, or breastfeeding less than two weeks, has been shown to be associated with an elevated risk of developing schizophrenia.22

 

{Note from Nursing Nurture:  One of the most controversial parenting topics is breastfeeding vs. formula feeding. Women love to hear the benefits of breastfeeding but if something is stated in the reverse it can cause great dissension. Mothers become polarized.  Some vehemently stand up for breastfeeding benefits while others say they “hate” the messenger.  

This article is not intended to upset mothers who formula-feed.  Nor is it meant to hurt them or make them feel guilty

Rather it is to help mothers have all the information and be able to make an informed decision.  Health care providers do not provide all of the negative impacts of formula and many mothers lament the fact that they were never told of the long-term, negative health implications for both mothers and babies from formula. Ultimately, all mothers must make what they feel to be the best decision for their situation.

Some mothers, when given all the information, will choose to breastfeed when they normally would not have.  Still others will persevere to find good lactation support, in spite of a health care system set up to fail those who need this additional help.  And, most importantly, understanding the pitfalls of formula may resonate so strongly with some breastfeeding mothers that they may choose to donate their breast milk.  By doing this, a day could come when no baby whose mother truly can’t produce enough milk is faced with having to give her child formula.}


Breastfeeding and Vaccines

Maternal Vaccines

Are Maternal Vaccines Safe While Breastfeeding?

Mothers often wonder if breastfeeding is compatible with medications, how drugs affect breast milk, and how medications in milk affect a baby.  Vaccines are no different; before getting a vaccine most breastfeeding mothers want to ensure it will not negatively impact their milk or baby.  While many breastfeeding mothers will never be faced with needing a vaccine while breastfeeding, others (due to international travel, endemic illness, etc.) will need one or more.

The CDC states:

“Neither inactivated nor live vaccines administered to a lactating woman affect the safety of breast-feeding for mothers or infants.  Breast-feeding does not adversely affect immunization and is not a contraindication for any vaccine. . . . Although live vaccines multiply within the mother’s body, the majority have not been demonstrated to be excreted in human milk.  Although rubella vaccine virus might be excreted in human milk, the virus usually does not infect the infant.  If infection does occur, it is well-tolerated because the viruses are attenuated.  Inactivated, recombinant, subunit, polysaccharide, conjugate vaccines and toxoids pose no risk for mothers who are breast-feeding or for their infants.” 1

Vaccines WITH Precautions for Breastfeeding

  • Smallpox – contraindicated while breastfeeding

Vaccines Without Breastfeeding Precautions

  • Immune globulins, including Rh immune globulin (RhoGAM)
  • Diphtheria
  • Tetanus
  • Hepatitis A – CDC states that no safety research is available. While it is most likely safe, consider administering the immune globulin instead of the vaccine.
  • Hepatitis B
  • Influenza (inactivated whole virus or subunit)
  • Japanese Encephalitis – No data available regarding its safety during breastfeeding
  • Measles
  • Meningococcal Meningitis
  • Mumps
  • Pneumococcal – No data available regarding its safety during breastfeeding though it is unlikely to cause any concern in breastfed baby.
  • Polio, inactivated
  • Rabies – No data available regarding its safety during breastfeeding though it is commonly given to breastfeeding mothers without observed problems in baby.
  • Rubella
  • Tuberculosis (BCG) – No data available regarding its safety while breastfeeding.
  • Typhoid (Polysaccharide & Live bacterial) – No data available regarding its safety while breastfeeding, although CDC states it should be given in breastfeeding mothers when risk of exposure is high
  • Varicella
  • Yellow fever – Avoid administering to breastfeeding mothers unless travel to endemic areas is unavoidable. 2

What’s the Bottom Line?

While it is always best to not have to take any type of drug, medication, and/or vaccine while breastfeeding, all vaccines are considered safe if necessary with the exception of Smallpox.  There are many well-documented health consequences associated with formula, even for a short duration.  Therefore, when a vaccine is necessary in a breastfeeding mother it should not be a cause of breastfeeding concern or reason for supplementation and/or early weaning.

You may also be interested in reading about infant vaccines and breastfeeding.


Medications and Breast Milk

Medications and Breast MilkIntroduction

Most breastfeeding mothers will use some sort of medication while breastfeeding whether it is prescribed from a doctor or herbal in nature.  Many doctors will suggest a mother wean when taking a drug.  However, in actual fact, this is almost always not necessary.  Though most everything which a mother ingests, including medications, will enter her milk, the amount is usually small and the impact on her baby minimal.

How does a drug pass into breast milk?

There are several avenues (passive diffusion, lipid solubility, molecular weight, ion trapping, protein binding, and/or cellular transport system) by which a drug may be able to pass into breast milk.

Passive Diffusion

The most common is passive diffusion – which means that the concentration of a drug in maternal plasma is the same as that in breast milk.  Alcohol is a prime example.  As a mother’s blood plasma levels increase, so does the amount in her milk.  As her levels decrease, the quantity in her milk does as well.  This is why “pumping and dumping” breast milk is not effective to remove alcohol.  Knowing that most drugs pass into breast milk by passive diffusion is immensely helpful in choosing a medication.  Drugs with a short half-life (rather than “long-lasting”) will clear from breast milk quicker.  In fact, many times it is possible to time feedings so that the baby will nurse when levels of a drug in breast milk are already very low for example, right before taking a dose.

Lipid Solubility

The lipid solubility of the medication is another means by which it may transfer to breast milk.  Breast milk has more lipids (fat) than plasma. Therefore, the more lipid soluble a drug, the more likely it is to be found in breast milk.  In fact, a highly lipid soluble drug may have higher concentrations in breast milk than maternal plasma. 1

Molecular Weight

A drug’s molecular weight can be a factor impacting transfer into breast milk.  Medications with a smaller weight (300 daltons or less) can pass into milk more readily that those with weights exceeding 500-800 daltons.  Thus, drugs with high molecular weights (such as insulin) rarely enter breast milk. 2

Ion Trapping

While blood plasma maintains a pH of 7.4, breast milk is slightly more acidic with a pH of 7.2.  A highly alkaline drug may change its ionic state in breast milk and then be unable to pass back out to maternal serum. Therefore it is best to select medications with a lower pKa – ie. drugs that are more acidic. 3

Protein Binding

The ability of a medication to bind to protein (albumin) in the mother’s plasma is yet another factor.  Only the portion of a drug that is unbound can transfer into breast milk.  Ibuprofen is an example of a drug that is highly bound; therefore, little transfers to breast milk. 4

Cellular Transport System

Finally, there are few drugs that seem to have their own cellular pumping system.  Some medications are transported in, and others transported out.  Iodine (especially radioactive) is the most relevant to breastfeeding as this drug is actively pumped into breast milk.  5

Is it true that there are greater concentrations of a drug in breast milk during the first few days following birth?

Yes, this is typically the case.  However, it does not mean that your baby is getting greater doses of the medication through your milk.  The reason for greater drug transfer during the first few days postpartum is due to hormones surrounding lactation.  But since a baby’s total colostrum/milk intake is small, the total amount of drug he receives is still usually negligible.

What should I consider about taking a medication while breastfeeding?

Though any medication has the potential to enter breast milk, it is almost always in small amounts that are not considered harmful to your baby.  Formula has known risks associated with it.  Breast milk is a living substance that is perfectly suited for your baby each and every day.  It is resilient enough to withstand the times a mother has a need for medication and still make milk of excellent quality.  In fact, typically when a drug does enter breast milk, it is in a dose much lower than if the baby were prescribed the medication outright!  So, here are a few things to consider about taking a medication while breastfeeding:

  • Can I delay treatment?
  • Is there an alternative medication that is still effective and would be safer for my baby than what is prescribed?
  • Can I time feeds around the medication so that my baby gets less – ie. nurse then take the medication; not taking a “long-lasting” drug; etc.
  • What is the Relative Infant Dose (RID)?  If it is less than 10% most drugs are considered safe. The RID for most drugs is less than 1%! 6
  • Talk with your doctor about choosing medications that have high protein binding, high molecular weight, poor penetration to central nervous system, short half-life and low oral bioavailability.
  • Select drugs that are commonly considered safe to use with pediatric patients.
  • Watch your baby for any side effects to see how medications affect your baby.

Marijuana and Breastfeeding

The use of marijuana (cannabis) is on the rise in the United States.  Two states – Colorado and Washington – legalized cannabis by state referenda in the 2012 elections and nearly half of the remaining 50 states have laws legalizing its use in various ways.  Whether as an illegal drug of abuse or for medical purposes, more and more people are using marijuana to varying degrees.

The National Institute on Drug Abuse has published research based on national surveys showing that 19% of 18-25 year olds have used marijuana in the past month and 4.8% of those ages 26 or older have done so in the past thirty days.1 This, coupled with the fact that up to half of all pregnancies in North America are unplanned, has lead many pregnant and lactating women to want accurate information about whether or not marijuana has negative effects on a fetus or nursing baby.2

Is marijuana safe to use while breastfeeding?

The American Academy of Pediatrics states that since marijuana can be found in breast milk and there is concern about a baby’s neurobehavioral development over the long-term, marijuana should not be used during pregnancy or breastfeeding.3 THC, the active component in marijuana, is highly lipid soluble, which means it readily passes into breast milk.  The body also stores THC for weeks to months, so babies will continue to show trace amounts of the drug in their bodies for several weeks after a breastfeeding mother no longer uses it.

While cannabis readily passes from breast milk to a baby’s system, the amounts found in breast milk are still considered insignificant to producing psychoactive affects in a baby even with mothers who are chronic users.4 The effects of THC in breastfed babies have not been well studied, though the potential for high concentrations of accumulation are possible with chronic use.5

How does marijuana impact a breastfeeding mother?

A mother’s breast milk supply may be negatively impacted by marijuana use.  Prolactin, a hormone that is responsible for both initiating and maintaining lactation, is reduced with marijuana use.6 Since prolactin is essential for milk production, a low milk supply could be yet another negative side effect.  And, while using marijuana, a mother may experience hallucinogens, euphoria, and then deep sleep – all of which could prevent her from taking care of her baby’s needs.

How does marijuana use impact a baby?

Though the impact of maternal marijuana use is greater while a baby is in utero than during breastfeeding, a newborn baby’s brain is rapidly growing and developing and there is a significant chance that marijuana can negatively impact this growth.  Not only can the THC in breast milk have a negative effect on a baby, but the environmental exposure will also impact an infant.  However, in this case, breast milk will have a more ameliorating affect with its living antibodies than manufactured formula.

Regardless, a mother who is breastfeeding and using marijuana should speak with her health care provider and seek appropriate counseling and help so she can continue to breastfeed her baby.  Breastfeeding promotes bonding and security and its unique makeup of vitamins, minerals, and immunological properties can help a baby achieve optimum growth and development – something especially important if they have been exposed to marijuana in utero.

While individual mothers may need to discuss the risks and benefits of marijuana use during pregnancy or lactation with their health care provider, the overall message to women is that marijuana use during pregnancy and lactation should be avoided.  Any woman of childbearing age should consider the potential impact of marijuana usage and either take precautions against pregnancy or discontinue its use during this time in her life.


Smoking and Breastfeeding

Is it safe to smoke while breastfeeding?

Everyone knows that smoking cigarettes is hazardous to their health.  And while the risks of smoking during pregnancy are well documented with increased incidences of preterm birth, low birth weight, and increased risk of abortion or stillbirth, much less is publicized about smoking and breastfeeding. Many mothers who smoked in the past want to make changes now that they have a baby, but change can be hard and take time.

They understand the importance of breast milk for their babies but wonder if the benefits are negated if they still use nicotine.  The bottom line is that even though nicotine does pass into breast milk, and mothers should seek to stop smoking or at least use a nicotine patch, breastfeeding is still a better option than formula feeding, for a variety of reasons.

The CDC states the following:

“Mothers who smoke are encouraged to quit, however, breast milk remains the ideal food for a baby even if the mother smokes.  Although nicotine may be present in breast milk, adverse effects on the infant during breastfeeding have not been reported.  AAP [AmericanAcademy of Pediatrics] recognizes pregnancy and lactation as two ideal times to promote smoking cessation, but does not indicate that mothers who smoke should not breastfeed.”1

What are the various forms of nicotine?

  • Cigarettes – Smoking 17/day is proportional to the 21 mg nicotine patch.  The 14 mg and 7 mg patches have significantly less nicotine than cigarette smoking.
  • Patch – This is considered a safer option than smoking.  Nicotine amounts don’t have a sharp rise and decrease as with cigarettes or gum so timing breastfeeding is less important.
  • Inhaler – Dispenses low levels of nicotine and even habitual users will typically incur less nicotine than smoking a pack of cigarettes each day.  There is minimal transfer of nicotine to breast milk.
  • Gum – Maternal serum levels fluctuate as with smoking cigarettes.  The faster the gum is chewed the greater the peak levels of nicotine.
  • E-cigarette – Considered safer than smoking a cigarette. Peak blood nicotine levels similar to the nicotine inhaler and minimal in breast milk.2

How can I reduce the levels of nicotine my baby is exposed to?

Smoking (or using gum, inhaler, etc.) immediately following breastfeeding and then waiting a couple of hours before nursing again allows the nicotine in breast milk to decrease before each breastfeeding.  The half-life of nicotine is 95 minutes – that means it reaches its peak in the maternal blood stream at this time.  It takes 5 half-lives to clear a drug completely.  (You can read more about this on how medications affect baby.)

Smoking and then breastfeeding right afterwards greatly increases the amount of nicotine in breast milk.  However, if your baby wants to nurse after smoking it is better to breastfeed than give formula.

It is important to smoke away from your baby.  Smoking in a separate, well ventilated room can greatly reduce the amount of second hand smoke your baby is exposed to.  Decreasing the number of cigarettes a mother smokes or switching to a nicotine patch is also beneficial.

What effect does smoking have on a mother’s breast milk?

Smoking cigarettes can have a detrimental effect on a mother’s milk supply, milk ejection reflex, and a baby’s weight gain.3  In a mother with an ample supply of milk this may not be as much of a concern, but with a mother with smaller breasts or less glandular tissue (breast size does not equal breast milk capacity) this could mean the difference of being able to provide enough milk for her baby versus having to supplement.  Slow weight gain in a baby could lead to failure to thrive, a very serious diagnosis.  Babies of mothers who smoke should have their weight watched diligently to ensure adequate growth.

The fat content of breast milk in mothers who use nicotine is also lower.4  Fat in breast milk is something that is affected by maternal diet and mothers who smoke not only have lower fat content but the fat has nicotine in it.  Fat is important for infant growth and brain development.  But, just because nicotine affects the fat content of breast milk does not mean the alternative – formula – is superior; it’s not.

What are the infant concerns when a mother smokes?

Mother’s who smoke are less likely to breastfeed.  Those that do breastfeed are more likely to breastfeed for a shorter duration than mothers who don’t smoke.5  Breastfeeding has tremendous health benefits for mothers and benefits for babies so anything that decreases the duration of a mother-baby breastfeeding relationship is significant.

Maternal smoking also exposes a baby to the dangers of second-hand smoke.  This can cause increased allergies and respiratory illness as well as unsafe carbon monoxide levels.6

These infant concerns continue to exist when a mother formula feeds her baby while smoking.  In fact, formula feeding while smoking is even more harmful than breastfeeding and smoking.  A baby receives the vast majority of smoking side effects from second-hand smoke rather than nicotine in breast milk.  In fact, the nicotine that does pass through breast milk is easily outweighed by the living, changing, and unique qualities of breast milk that impart antibodies and immunities to a baby to help him fight disease, infection, and illness, as well as equipping his immune system to maturity so it will be strong and prepared to work to its full potential over the course of a lifetime.

A baby who is regularly exposed to second-hand smoke especially needs the benefits of breast milk!

So, while it is important for a mother to try to decrease or cease smoking, it is far better for a mother to smoke and breastfeed than to stop breastfeeding in order to continue smoking.


Mixed Feeding with Multiples

Many mothers of multiples want to breastfeed their babies but are unsure about committing to exclusive breastfeeding.  While it is completely possible for a mother’s body to make enough breast milk to nurse twins, triplets, and even quadruplets without supplementation there are many factors a mother must consider.  Weighing the pros and cons of breastfeeding multiples is important, but it is also not an all or nothing situation.  Mothers may also choose to do partial or mixed feeding with multiples. This means that some of their babies’ nutrition comes from breast milk and some from formula.

Breast milk is unique and unlike any other mammalian milk or infant formula.  Any amount of breast milk a mother is able to provide is a wonderful gift and should be celebrated.  There are multiple health benefits for both a mother and baby.  Breastfeeding will help with maternal-infant bonding – something that can be a challenge when there are multiple babies! Breastfeeding will also decrease feeding costs, visits to the doctor, time off work for illness, allergies, and health care costs both in the short and long term.

How does mixed feeding work with multiple babies?

There are several methods of giving mixed feeds with multiples:

  • Combination breastfeeding and bottle feeding
  • Combination breastfeeding and formula given via syringe, cup, finger feeding, etc.
  • Combination bottle feeding of expressed breast milk and formula
  • Exclusive nursing at the breast with an at-breast tube feeding device to supplement with formula
  • Breastfeeding with an at-breast tube feeding device and bottle top ups with formula or expressed breast milk

There are also several ways of supplementing breast milk:

  • Breastfeeding babies first then topping off with formula
  • Offering bottle as an “appetizer” then giving “meal and dessert” at the breast
  • Offering the breast to one (or more) and a bottle to one (or more) at a feed; then rotating who breastfeeds each time
  • Breastfeeding during the day (or night) and bottles the other times

There are different percentages of formula and breast milk given to babies:

  • Some mothers may start off giving majority formula but later build a strong milk supply and the majority becomes breast milk
  • Some mothers begin with a strong milk supply but allow it to decrease as they increase the percentage of formula given to babies
  • Some mothers give the majority or even all breast milk to a weaker or sick baby(s) and give formula to the stronger or healthier babies

There is no right or wrong way to provide mixed feeds to your babies.  One size does not fit all and the way a mother does this may change over time.  In fact, as her babies grow, one (or more) may take to breastfeeding more than another so a mother continues to nurse one and bottle feed another.

What are the risks of mixed feeding babies?

There are several risks to be aware of, as follows:

  • Decreased milk supply – Whenever a mother supplements her milk there is a risk of her milk supply decreasing.  This can be a slippery slope – as her milk supply decreases a baby receives increased supplementation, which cause her milk supply to further decrease until there is no more milk.
  • Nipple confusion – Babies may develop a preference for a certain feeding method – many times it is the fast flow of a bottle.  The flow of a bottle nipple is continuous whereas a baby at the breast must suck-suck-suck to have a let-down which lasts a minute or two and then there’s a pause before another let-down. Once a baby experiences the faster flow of a bottle they may get frustrated at the breast and begin to reject breastfeeding.
  • Health risks – While any amount of breast milk is a precious gift and wonderful for your baby, there are also well known and documented risks of formula.  Any amount of formula will change your babies’ intestinal flora to that of a formula-fed baby.  Any amount of formula will increase a baby’s chance of infection and illness. The more formula a baby receives the greater the chance of contracting infectious illnesses.  And, with multiples, if one baby gets sick it usually spreads to each baby.
  • Breast milk can be convenientWithout help, it can be easier and more convenient to breastfeed than give formula.  Breast milk doesn’t require mixing, heating, cleaning bottles, etc. so if mother is going to be feeding her babies it just makes sense to feed them in the most convenient way possible.  It is also a great way to multitask because breastfeeding requires touch and bonding that babies also need.  Even if mother does have help, it is many times easier for mother to breastfeed her babies and allow others to serve the breastfeeding mother.

Breastfeeding and Acute Illness

Breastfeeding & Acute Illness

Is it safe to breastfeed when I’m sick?

Most mothers will come down with some sort of acute illness while breastfeeding.  Whether it’s the common cold, influenza, food poisoning, or an infection that requires antibiotics, it can be a scary thought worrying about whether it is still safe to breastfeed.  The good news is that in ALL of these scenarios it is not only safe to breastfeed, but also provides the greatest level of immune protection for your baby.

What happens to my breast milk when I’m sick?

When a breastfeeding mother comes into contact with any germ (whether she comes down with the illness or not) her body immediately begins to produce IgA antibodies specific to exactly what she has come into contact with. This antigen response travels to the mammary glands where antibody protection will be present in the breast milk a baby consumes. 1  Secretory IgA lines your baby’s immature intestinal and urinary tracts and oral pharynx to help fight these invader pathogens.

A mother’s body will make this antibody response in her breast milk when she comes in contact with any germ or bacteria, as well as if her baby does (since she will come into contact with the germs by touching her baby).  A mother’s breast milk does NOT contain the contagious germs passing them along to the baby.  Rather, the opposite happens: the antibodies to fight the germs pass through breast milk to a nursing child.

Why is it important to breastfeed when I am acutely ill?

By the time a mother comes down with symptoms of an acute illness that is contagious, she has already come into contact with the specific germs and is passing them to others.  Her baby has already been exposed to the germs as well.  Though complete at birth, a baby’s immune system is still immature and cannot make its own antibody response to help fight the invaders.  But breast milk has the antibody response already in it, to help a baby’s body fight the germs.  Breast milk is the best defense to help protect her baby from also getting sick.  Stopping breastfeeding while a mother is acutely ill will not only have a deleterious impact on her milk supply but also put her baby at greater risk of getting sick.  Even in a situation where a breastfeeding mother could quarantine herself and not see her baby during the duration of the time she is ill, continuing to breastfeed and coming in close contact with her baby will still provide her infant better protection than any alternative. Not only does breast milk provide immunological protection, it also provides comfort to a baby, as well as protecting him from the plethora of documented harms of formula.

Is there anything else I can do to protect my baby from acute illness?

Breastfeeding is the best protection.  In addition, taking common health precautions such as washing your hands frequently (especially after blowing your nose and before touching baby) and not kissing him on his mouth are important sanitary measures.  In a highly contagious situation, a mother could even wear a face mask to help ensure she doesn’t breathe directly on her baby.  Even if your baby does get sick, he will have a milder case and/or it last for a shorter duration than if you had not been breastfeeding.

Specific Conditions

Food Poisoning

Though food poisoning can leave a mother feeling like death warmed over, her milk continues to be safe for her baby. 2  Typical symptoms include diarrhea and vomiting, exhaustion and abdominal cramps.  If the poisoning is severe, she may lose a considerable amount of weight in a few days’ time.  Food poisoning is usually self-limiting, lasting 24-72 hours.  If it requires antibiotics or other medications, make sure to mention to your doctor that you are breastfeeding so he can prescribe a drug(s) that is compatible with breastfeeding.  You can also search for medications that are compatible with breastfeeding on the LactMed link on the right sidebar of this page.

Common Cold

The common cold can leave a breastfeeding mother feeling absolutely miserable.  Sore throat, congestion, cough, aches and pains…though antibiotics are usually not warranted, over-the-counter cold relievers might be.  When a mother has a cold, her milk has antibodies to this virus that will help to protect her baby from getting sick, or lessen the severity.  It is best to try natural remedies before turning to OTC medications, though most OTC drugs are compatible with nursing and any potential harm is still less than the known dangers of formula.  Search the LactMed link on the right sidebar of this page to check on a specific OTC remedy.  Some natural remedies for a cold include the following:

  • Drinking plenty of liquids and getting lots of rest
  • Steam pots  to loosen congestion in the sinuses and lungs
  • Chicken soup made from rich bone broth
  • Fresh lemon and raw honey in hot water for sore throat
  • Gargling salt water for sore throat
  • Remember that fever is your body’s way of fighting infection so allowing it to rise significantly before taking a fever reducer will allow your body to learn to fight the infection

Influenza

Along with many symptoms of a common cold, the flu also leaves a person with a fever, chills, and body aches.  Though it may be viral, secondary bacterial infections can arise that may require antibiotics. There are many natural remedies that can help alleviate symptoms (see above section), but, like with a cold, many medications are compatible with breastfeeding and it is better to continue breastfeeding while exposing your baby to small amounts of medicine than to switch to the well-documented harms of formula. Search the LactMed link on the right sidebar of this page to check on specific over-the-counter and antibiotic remedies.

Along with continuing to breastfeed so the baby receives antibodies to fight the flu, it is important to implement basic sanitation principles – hand washing, no kissing/breathing directly on baby, possibly use a face mask, etc.

Acute Illness Requiring Antibiotics

There are many illnesses that require a breastfeeding mom to take a round of antibiotics: mastitis, upper respiratory infection, urinary tract infection, tonsillitis, and so forth.  Whatever the acute illness, finding an antibiotic that will treat the illness and is compatible with breastfeeding is almost always possible.  However, many health care providers are not educated on this topic and simply read the drug manufacturers’ insert (which provides no helpful information about breastfeeding and drug usage).  Make sure to inform your doctor you are breastfeeding and wish to continue.  Inform yourself and share information with your doctor/pharmacist about breast milk compatibility and medications, how medications affect breast milk, and how medications affect your breastfed baby. Search the LactMed link on the right sidebar for information about a specific medication. Working together you will be able to find a medication that is compatible with breastfeeding.


Alcohol and Breastfeeding

Alcohol and Breastfeeding

Is it safe to breastfeed while drinking alcohol?

Many moms want to know if it is safe to breastfeed while consuming alcohol. While the dangers of drinking while pregnant are well documented, risks of drinking while breastfeeding are less clear.  A “safe” level of alcohol in breast milk has not been established.  In general, the maternal blood plasma level of alcohol is the same as the alcohol content in breast milk.  As levels rise in maternal plasma, they rise in breast milk as well.  It is not possible to “pump and dump” or drink extra water to make the alcohol go away.  Rather, as blood alcohol levels decrease, so do the levels in breast milk.  Knowing how alcohol moves into and out of breast milk can help a mother time an occasional drink around when she breastfeeds so she can enjoy both alcohol and breastfeeding.

The American Academy of Pediatrics’ Policy Statement says, “Ingestion of alcoholic beverages should be minimized and limited to an occasional intake but no more than 0.5g alcohol per kg body weight, which for a 60 kg mother is approximately 2 oz liquor, 8 oz wine, or 2 beers. Nursing should take place 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk.” 1

What influences the level of alcohol in breast milk?

Breast milk levels of alcohol are similar to maternal blood plasma levels.  As plasma levels increase, so do breast milk levels.  As plasma levels decrease, so do breast milk levels.  However, just as there are a number of factors that determine how much alcohol a person can tolerate, these same factors can affect breast milk levels:  how fast and how much is consumed; mother’s weight and adipose body tissue; as well as stomach contents.   Of the concentration of alcohol in breast milk, a nursing baby is only exposed to a fraction of the amount.  However, a baby’s body metabolizes alcohol at a much slower pace than an adult, so the potential for build-up of alcohol toxicity is always a possibility.

Click here, to explore more about the compatibility of breast milk and drugs as well as how drugs affect breast milk.

When does breast milk contain the highest levels of alcohol?

When a mother consumes a drink on an empty stomach, peak levels usually occur 30-60 minutes later.  When consumed with food, peak levels occur slightly later: 60-90 minutes. 2  Alcohol passes freely into and out of breast milk based on alcohol levels in maternal plasma.  In adults, it takes roughly 1 ½ – 2 hours to metabolize one alcoholic beverage. 3  As with most medications’ impact on children, alcohol takes longer to metabolize in a baby than an adult.  Newborns in the first four weeks can process alcohol at half the rate of an adult; preterm babies are at even higher risk for alcohol toxicity. 4

What is the safest way to breastfeed when drinking alcohol?

For a mother who wants to enjoy an occasional drink or two, this can usually be done safely while breastfeeding.  Especially after the very early days when most newborns seem to nurse all the time, there are some great strategies that can eliminate your baby’s exposure to alcohol.  If, for example, you want to consume one drink, it is best to nurse your baby immediately beforehand.  Then, if your baby were to go several hours before his next feed, the alcohol should be gone from your blood stream and therefore eliminated from breast milk as well.  But what should you do if your baby wants to nurse unexpectedly and you have just had a drink?  If your baby is under six months, it may be wise to have some expressed breast milk ready in case of this scenario.  If your baby is over six months and has already started solids, she could have a snack until you are prepared to breastfeed.  If your baby is a newborn or still nurses very frequently where there is not window of a few hours in the evening for you to enjoy a drink, it is best to prepare beforehand by expressing enough breast milk for her to have during the time your milk will have alcohol in it.

What impact does alcohol have on a baby?

Excessive alcohol consumption can have many negative impacts on a baby’s health including neurodevelopmental delays, growth retardation, and changes in sleep patterns.  Maternal blood plasma levels typically need to reach 300 mg/dL for significant side effects to be noted in baby. 5  However, drinking alcohol can also impair a mother’s ability to take care of her baby, regardless of breastfeeding or not.  Consuming alcohol is contraindicated to bed sharing as well.

How does alcohol impact milk supply?

Despite rumors that alcohol is a galactagogue and increases a mother’s milk supply, research shows the opposite to be true. Julie Mennella’s research (2001) has shown that oxytocin levels are lower after ingesting alcohol with a slowed milk ejection and frequent drinking can cause lowered milk production. 6 7  Overall, the presence of alcohol in breast milk decreases the amount of milk a baby consumes.


Breast Surgery

Breastfeeding Mother

Most every mother will be able to lactate following breast surgery, though whether lactation is full or partial depends on several factors.

More and more women are having babies after having breast surgery. Many of these women have a lot of anxiety wondering if they will be able to breastfeed following surgery.

Most every mother will be able to lactate, though whether lactation is full or partial depends largely on the type of incision(s), how much functional breast tissue remains, and the extent of damage to the nerves in the breast. The greater the time between surgery and lactation and the more lactation experiences the higher the likelihood of full lactation.

Excellent lactation management is also critical in maximizing breast milk supply. Even if a full supply is not possible, mothers who desire to breastfeed are usually able to develop a very satisfying relationship by supplementing in ways that maximize their milk supply and a baby’s time spent at the breast.1

Augmentation Mammoplasty

Breast augmentation surgery is done for a variety of reasons – small or asymmetric breasts, reconstruction after an accident or surgery, or for cosmetic reasons.  It is important to note the reason why a mother has had a breast augmentation because if the breasts were small and hypoplastic to begin with it may be that there wasn’t much glandular tissue (which is necessary for lactation).

However, the amount of glandular tissue in a breast is not always evident just by looking at the size or shape of a woman’s breasts and even small-busted women can have a full milk supply.  Excellent lactation support is critical though, with lots and lots of skin-to-skin time following birth and unrestricted access to the breast for the baby.  In the early days, mothers will often need to pump or hand express in addition to breastfeeding to help build as strong of a milk supply as possible.

As with all types of breast surgery, the type of incision can have a profound impact on a woman’s ability to breastfeed.  Periareolar incisions have a greater chance of damaging nerve tissues which are essential for breastfeeding, though implant size can also have a large impact no matter the type of incision.2  Many women have complications, which necessitate revision surgery. The more surgeries a woman has on her breasts, the greater the likelihood that functional breast tissue or nerves will be damaged in a way that will negatively impact lactation.

Silicone Implants

Silicone implants have had a lot of publicity with women believing that they cannot breastfeed because too much silicone will leak into their breast milk.  Actually, this is not the case at all.  Silicone is not readily absorbed in a baby’s body and is considered to pose little threat to a baby’s safety.3 Actually, studies have shown that silicon levels are vastly higher in infant formula than the breast milk of mothers with silicone implants.4

Breast Reduction Mammoplasty

There are a variety of reasons women have breast reduction surgery, including their physical and mental health, lifestyle, and/or cosmetic reasons. Very large breasts can cause chronic back pain, circulation and breathing problems, headaches, postural problems, and make an active lifestyle extremely difficult.  As with other types of breast surgery, the type of incision used and amount of functional breast tissue removed will have a direct bearing on future lactation ability.

Women who have the free nipple graft technique (the nipple is severed completely from the ducts and nerves and then grafted back in) have decreased chances of successful lactation compared with other surgical types.  Women having pedicled reduction mammoplasty usually have greater success in lactation.  It is important to note that complete loss of all sensation in a woman’s nipple and areola can prohibit lactation completely.5

Full lactation is not always possible following breast reduction surgery.  However, excellent lactation support from the very beginning can maximize a woman’s milk supply.  Skin-to-skin contact following birth and continuing as often as possible in the early days is important.  Nursing often and on demand following your baby’s early feeding cues is a must.  Pumping or hand expressing in addition to breastfeeding is important to help ensure an optimum milk supply.  Many times mothers find they need to supplement and the best way to continue bonding and encouraging their milk supply is to use an at-breast tube feeding device. With this babies are latched onto the breast, breastfeeding, stimulating a mother’s supply, and receiving additional supplementation through a thin tube taped to the breast.

No matter how much breast milk a mother is able to give her baby following breast surgery, any amount she produces should be celebrated!  There are many methods that can help increase production and, even if supplementation is necessary, most mothers can have a satisfying breastfeeding relationship with their babies.


How Medications Affect Baby

Introduction

Knowledge of how a drug enters breast milk is important to understanding how a particular medication can affect your baby, but it is only part of the picture.  It is also critical to evaluate how a baby’s body metabolizes the drug.  Some medications, though they enter the baby’s system via breast milk, are still not able to circulate throughout his body.  Others, though only small amounts may be ingested, are fully utilized and should be used with greater caution.  Therefore, understanding what happens in a baby’s body once the drug enters via breast milk will help in selecting the best medication with the least risk to your baby.  Understanding a drug’s oral bioavailability and half live, as well as evaluating the amount of breast milk consumed and age of baby are all important factors.

What is oral bioavailability?

A drug’s ability to pass into breast milk is only part of the picture.  It is also important to know what happens to the medication once it enters the baby’s system.  A drug’s oral bioavailability is the amount of medication that can reach a baby’s systemic circulation.  This is the only amount of a drug that will usually have an impact.  Some drugs are so poorly absorbed in the infant they are unlikely to cause any problems what so ever.  Therefore, choosing drugs with poor bioavailability is a good strategy.  (Others, though not well absorbed, can become concentrated in the gastrointestinal system and can cause diarrhea, thrush, etc.)

What drugs have poor bioavailability in infants?

According to Breastfeeding and Human Lactation, 4th ed. by Riordan and Wambach, there are a variety of medications with poor bioavailability, thus having a low risk in babies.  These medications are as follows:

  • Heparin
  • Insulin
  • Large molecular weight proteins
  • Interferons
  • Infliximab
  • Etanercept
  • Omeprazole
  • Lansoprazole
  • Aminoglycoside antibiotics
  • Third generation cephalosporins
  • Inhaled beta agonists
  • Inhaled steroids
  • Most topical preparations
  • One-time injection of local anesthetic
  • Acute use of medications (as the overall dose transferred to infant over time is so low)

Half Life

A drug’s “half life” is the time it takes a drug to reduce its plasma concentration by half. So, from the time of ingestion, how long does it take the drug to reduce by half?  Some drugs have a short half life, just a few minutes or hours.  Others have a much longer half life – a few days even.  With breastfeeding, drugs with a shorter half life are better.  It takes five half lives to fully clear a drug from maternal plasma – reducing 50% each time.

A drug with a short half life of say 1-3 hours, could be strategically taken between feeds.  Nursing your baby and then taking the medication could mean the drug is already reduced by half before your baby nurses again.  (Think:  even at the maximum amount of the drug in maternal serum it is probably less than 1% that the baby will ingest via breast milk.  Add to this the ability to time feedings and the amount ingested by the baby will be even less.)

If given the choice between a medication that you take every few hours versus a long-lasting dose ingested less frequently, select the dose you can take more often.

Age and Stage of Baby

The ability of a baby to metabolize a drug is different based on his age. Newborns generally metabolize a drug more slowly than a six month old.  Older infants, 6-18 months, can usually metabolize and handle drugs much more efficiently.  Caffeine is a good example.  It’s half-life in a newborn is 97.5 hours, but 2.6 hours by the time a baby reaches 6 months.

Not only is the age of the baby important, but the quantity of breast milk ingested.  Though more of a medication is able to pass into breast milk during the first few days postpartum, the amount of milk a baby is able to drink is so small he is not ingesting a greater volume of a medication.  Also, a toddler who is only drinking milk a couple times a day is receiving much less of a medication via breast milk than a two month old solely fed on breast milk.

How much of a drug is considered safe?

For most drugs, ingesting 10% of the maternal dose is considered safe. 1  With some drugs (for example, fluconazole and metronidazole) the dose can be much higher than this.  And usually, the dose ingested is less than 1%.  Thus, most medications truly are compatible to take while breastfeeding.  This is especially true in light of the 1000s of studies that show the detrimental side effects of formula.