When a Nursing Mother Gets Sick
By: Anne Smith
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. 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.
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.
- 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.
Let's discuss specific illnesses now. First, the scariest one of all – cancer. 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.
- 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. 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.
- 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. There should be no reason to interrupt breastfeeding.
- If you need to undergo radioactive isotope testing, you will need to wean your baby temporarily. If you must have chemotherapy and treatment with radioactive compounds, temporary or permanent weaning will be necessary.
- The other really scary illness is AIDS, or HIV infection. There is evidence that the HIV virus can be transmitted through breastfeeding.
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. If you are pregnant, you should talk to a doctor who is knowledgeable about the virus to decide which precautions to take.
- 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, 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.
- If you get chickenpox, 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 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 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. Insulin is compatible with breastfeeding, because it doesn't transfer into human milk. Your insulin requirements may be significantly less than before you became pregnant.
- Mothers with Epilepsy can nurse. 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 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 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, you can resume complete breastfeeding. 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 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. If you have a history of thyroid problems, ask your doctor to monitor your levels regularly so your medication can be adjusted. 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.
NOTE: The text of this article was reduced for this publication. For more information on this topic, click here.
To find out about cold medicines that are compatible with breastfeeding, go to http://www.geocities.com/Heartland/Prairie/3490/cold-remedy.html
To check out theAAP's list, go to http://www.aap.org/policy/00026.html
Here's a site that lists some common drugs: http://www.parentsplace.com/expert/lactation/medications
Anne Smith is an IBCLC – International Board Certified Lactation Consultant and La Leche Leader since 1978. More importantly, she is a mother to 6 breast fed kids with twenty plus years experience of counseling nursing mothers. Her site, www.BreastfeedingBasics.com , provides expert advice and solutions to breast-feeding problems and gives basic information on how to breast feed. Anne also features her recommended breast feeding products and breast pumps.