Cold medicine and breastfeeding

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Is it safe to take cold medicine while breastfeeding?

Becoming the proprietor of a sniffly cold or a hacking cough when you have kids to look after seems like a cruel joke, but alas, viruses don’t discriminate. And if you’re breastfeeding, the situation can feel that much bleaker, since you’re probably not sure which medications you can safely take — if any.

While some medications should be avoided entirely while breastfeeding, nursing moms aren’t completely out of relief options when they’re under the weather. In fact, some of the most beloved over-the-counter (OTC) cough and cold medicines are considered OK while nursing.

“Even though there haven’t been any studies on guaifenesin or dextromethorphan in breastfeeding mothers, they’re thought to be safe for women who are nursing, especially for mothers of older infants,” says Dr. Brandon Smith, general academic pediatrics fellow in the Department of Pediatrics at Johns Hopkins in Baltimore.

Even though taking Robitussin while breastfeeding is considered safe, there are medications nursing moms should avoid when they have a virus. Here, experts weigh in on the dos and don’ts of cold medicine while breastfeeding.

Which medicines are best while breastfeeding?

Natural remedies

When you feel the sniffles coming on or notice those first dreaded throat tickles, your initial line of defense shouldn’t necessarily be over-the-counter drugs.

“Overall, there’s not a ton of great evidence out there on cough and cold medications making symptoms any better, so it’s probably best to let the cold run its course and support your body with rest and hydration, which is good for milk supply, too,” says Smith. “Other options for a troublesome cough include honey and humidification.”

One 2010 study found that honey was equally effective in treating coughs as traditional cough syrups.

If you’re looking to beef up your natural arsenal, Leigh Anne O’Connor, a New York City-based lactation consultant, suggests a trip to the produce aisle.

“In addition to resting and staying hydrated, take extra vitamin C and drink tea with lemon, honey and ginger,” O’Connor says. “It’s great for soothing a sore throat and ginger can help open the sinuses. Also, keep nursing because the milk will have antibodies that will help baby avoid getting sick altogether or at least give them a less severe case.”

Cough syrup

According to Dr. Nick DeBlasio, a pediatrician and medical director of the Pediatric Primary Care Center at Cincinnati Children’s Hospital Medical Center in Cincinnati, cough suppressants such as guaifenesin and dextromethorphan (the main ingredients in Robitussin and Delsym) are safe to take while breastfeeding, as long as they’re taken as directed.

“Guaifenesin and dextromethorphan are generally considered safe, but like many drugs, they aren’t well studied in relation to breastfeeding,” DeBlasio says. “However, the general consensus is that these medications taken in their usual doses are not considered to have an effect on the infant or the mother’s milk supply.”

Before taking cough syrup, though, be sure to read the label in its entirety since many forms include a mix of drugs that might not always be the best for a breastfeeding mom. For instance, some cough syrups may contain a decongestant, which isn’t always recommended while nursing. (More on that in a bit.)

Cough drops

Got a nagging scratch in your throat? Go ahead and reach for a cough drop.

“Cough drops and lozenges are generally considered safe for breastfeeding moms,” O’Connor says.

Nasal sprays

Another great option for nursing moms who are under the weather, or who are suffering from seasonal allergies, is nasal spray.

“Saline nasal sprays are perfectly safe for breastfeeding moms,” says Smith. “And for those with allergies, steroid nasal sprays are OK to use, as well.”

Acetaminophen and ibuprofen

For breastfeeding moms looking to combat headaches, fever or body aches, acetaminophen (Tylenol) and Ibuprofen (Motrin) are safe to use.

“Ibuprofen and acetaminophen are great options for pain relief and fever control in breastfeeding mothers,” says Smith. “Studies looking at both medications in nursing mothers have shown very low levels in breast milk and rare side effects.”

However, if you decide to take either of these painkillers, you should probably avoid taking anything in conjunction with it.

“Look at all ingredients for OTC medications,” Smith says. “Most have more than one ingredient and usually contain acetaminophen. If you’re already taking acetaminophen by itself, you don’t want to over do it. It’s probably best and safest to take a single medication versus a product with multiple ingredients.”

Loratadine and cetirizine

Loratadine and cetirizine, the main ingredients in long-lasting allergy medications such as Claritin and Zyrtec, are considered safe while breastfeeding.

“If a nursing mother needs to take an antihistamine, I would recommend a long-acting, non-sedating one, such as loratadine (Claritin), as opposed to one that wears off quickly, such as Benadryl,” says DeBlasio.

Which medicines should you avoid while breastfeeding?

Pseudoephedrine and phenylephrine

Seriously stuffed up? You may want to wait it out if you’re nursing. Decongestants, such as pseudoephedrine and phenylephrine, aren’t recommended for women who are breastfeeding.

“Nursing moms should avoid medications that contain decongestants, such as pseudoephedrine and phenylephrine,” says DeBlasio. “These medications can decrease milk supply and can sometimes make babies fussy, as well.”

In one study that examined the effects pseudoephedrine had on breastfed babies, 20% of nursing moms reported having babies that were “irritable” after taking a dose — a possible reason being that pseudoephedrine, which is excreted in breast milk in small amounts, affects the central nervous system, sometimes making people jittery or anxious. Another study involving eight nursing mothers found a mean 24% decrease in milk production the 24 hours following 60 mg of pseudoephedrine. Researchers found that the drug didn’t affect breast blood flow, but instead had the ability to cause a “depression of prolactin secretion.” (Prolactin is the protein that enables women to breastfeed.)

Diphenhydramine

While diphenhydramine, the main ingredient in Benadryl, is generally thought to be safe if used on occasion in breastfeeding moms, doctors don’t usually recommend it. In addition to it causing drowsiness and small amounts getting in breast milk, continued use can reduce milk supply.

“An occasional dose of diphenhydramine should not cause any adverse effects — specifically if it’s a single bedtime dose after the last breastfeeding,” says DeBlasio. “However, repeated, consistent use of diphenhydramine can potentially cause decreased milk production and may make some infants fussy or drowsy.”

While the relationship between breast milk production and diphenhydramine isn’t completely clear, researchers do know that histamine is a neurotransmitter that helps stimulate prolactin. Diphenhydramine, which is an antihistamine, has been found to decrease prolactin, particularly in early postpartum women who have not yet established a solid breastfeeding routine.

Codeine

“Any cough medication with codeine should be avoided because it can cause problems, such as excess sleepiness in the baby,” says Smith.

Additionally, in rare cases, mothers may be “codeine hyper-metabolizers,” which, according to the American Academy of Pediatrics (AAP), can be associated with apnea (when a baby stops breathing), which, in one case, according to the Food and Drug Administration (FDA), resulted in the death of a breastfed baby. In some cases, codeine, when used over a period of four or more days, has been associated with the depression of the central nervous system in babies.

Aspirin

While only small amounts of low dose aspirin enter the breast milk, it shouldn’t be the pain reliever of choice for breastfeeding moms, as, in very rare cases, it has been associated with Reye’s syndrome, a disorder that causes brain and liver damage. Any connection between breastfeeding and Reye’s syndrome is likely a result of long-term, high-dose use, but across the board, experts advise nursing moms to avoid it.

“Women who are breastfeeding should avoid aspirin,” says Smith. “It can cause severe reactions in babies and children.”

If you’re not sure which medications are OK while breastfeeding and which ones to avoid, DeBlasio recommends consulting with your doctor and checking LactMed, which has a ton of information on how medications affect nursing moms.

“Overall, there isn’t a lot of great data for many common medications and breastfeeding,” he says. “Because of this, it’s always important to speak with your pediatrician before taking something.”

Is It Safe to Take Cold Medicine While Breastfeeding?

When you already have a baby tugging at your chest to nurse 12 times a day, a coughing fit that travels deep into your core—and the cold that comes with it—is the last thing your body needs. And when the congestion, headaches, and chills won’t seem to quit, the bottle of DayQuil under the bathroom sink starts to look more and more appealing.

But Is It Safe to Take Cold Medicine While Breastfeeding?

“Many medications can pass from the mother to baby during breastfeeding,” says Sherry A. Ross, M.D., ob-gyn and author of She-ology and She-ology: The She-quel. “However, most are considered safe to use.” (Related: The Best Cold Medicines for Every Symptom)

On that list of cold medicines safe for breastfeeding? Antihistamines, nasal decongestants, cough suppressants, and expectorants. If your sniffles are paired with a fever and headache, you can also try a pain-relieving medication with ibuprofen, acetaminophen, and naproxen sodium—ingredients that are generally safe for breastfeeding mothers to consume, says Dr. Ross. The American Academy of Pediatrics (AAP) has also given its stamp of approval to these active ingredients for short-term use, as small amounts of ibuprofen and less than 1 percent of naproxen are passed into breast milk. (On that note, you might want to consider how much sugary food affects your breastmilk.)

Every Medication Should Be Considered On a Case-by-Case Basis.

Even if it’s generally safe to take a particular cold medicine while breastfeeding, there’s still a chance of side effects. Drugs containing phenylephrine and pseudoephedrine—common decongestants found in meds like Sudafed Congestion PE and Mucinex D—can decrease breast milk production, according to the U.S. National Library of Medicine (NLM). In a small study, eight nursing mothers who took four 60-mg doses of pseudoephedrine daily saw a 24-percent decline in the amount of milk they produced. So, if you’re a new mom whose lactation “is not yet well established” or have difficulties producing enough milk for your little one, your best bet is to steer clear of these ingredients, per the NLM. (Yep, the breastfeeding struggles are real—just take it from Hilary Duff.)

Some antihistamines containing diphenhydramine and chlorpheniramine could make both you and your baby sleepy and sluggish, says Dr. Ross. She recommends finding non-drowsy alternatives to these medications, as well as avoiding medicines with a high alcohol content, which can have similar effects. (For example, liquid Nyquil contains 10-percent alcohol. Ask a pharmacist or your doctor to confirm if the medicine you’re taking is alcohol-free, considering it’s not recommended to consume alcohol while breastfeeding.) If you choose to take a cold medication with these active ingredients, consider using a small dose of 2 to 4 mg after your last feeding of the day and before bed to minimize any side effects, according to the NLM. TL;DR: be sure to examine the ingredient label before dropping anything into your cart.

And, need not forget, the child’s age also plays a role in a drug’s safety while nursing too. Research has found that babies younger than two months old who were exposed to medications via lactation experienced more adverse reactions than infants older than six months.

The Bottom Line

Although some women may avoid taking medications out of fear of harmful side effects, the benefits of breastfeeding outweigh the risk of exposure to most medications through breast milk, notes the AAP. When in doubt about a particular drug’s safety, Dr. Ross recommends talking to your healthcare provider about taking cold medicine while breastfeeding and don’t consume a larger dose than advised. “Overmedicating with cold medications can be harmful, even for those approved to be safe while breastfeeding,” she says. (Instead, you might want to try out some of these natural cold remedies.)

To get back to bringing your parenting A-game, use these medications designed to silence your cough and sniffles. If the medication is non-drowsy, try taking it at the time of breastfeeding or immediately after to minimize your baby’s exposure and consult your doctor if your baby is showing any unusual symptoms like sleepiness or irritability, per the AAP.

Cold Medicines Generally Safe to Take While Breastfeeding

  • Acetaminophen: Tylenol, Excedrin (Excedrin also contains aspirin, which the AAP considers to be safe for breastfeeding mothers in low doses.)
  • Chlorpheniramine: Coricidin
  • Dextromethorphan: Alka-Seltzer Plus Mucus and Congestion, Tylenol Cough and Cold, Vicks DayQuil Cough, Vicks NyQuil Cold and Flu Relief, Zicam Cough MAX
  • Fexofenadine: Allegra
  • Guaifenesin: Robitussin, Mucinex
  • Ibuprofen: Advil, Motrin
  • Loratadine: Claritin, Alavert
  • Naproxen
  • Throat lozenges

Pseudoephedrine use while Breastfeeding

Medically reviewed by Drugs.com. Last updated on Mar 14, 2019.

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Pseudoephedrine Levels and Effects while Breastfeeding

Summary of Use during Lactation

Although the small amounts of pseudoephedrine in breastmilk are unlikely to harm the nursing infant, it may cause irritability occasionally. A single dose of pseudoephedrine decreases milk production acutely and repeated use seems to interfere with lactation. Mothers with newborns whose lactation is not yet well established or in mothers who are having difficulties producing sufficient milk should not receive pseudoephedrine. A treatment scheme has been reported for mothers with hypergalactia that uses pseudoephedrine to decrease milk supply.

Drug Levels

Maternal Levels. A single oral dose of 60 mg of pseudoephedrine in 3 women resulted in peak milk levels of less than 1 mg/L 1 hour after the dose. Other authors used data from this study to calculate the amount excreted in milk to be 5.5% of the weight-adjusted maternal dosage.

After a 60 mg oral dose of immediate-release pseudoephedrine, peak milk levels averaging 698 mcg/L occurred 1.7 hours after the dose and half-life in milk was 5.5 hours. A fully breast-fed infant would receive a dose of 4.3% (range 2.2 to 6.7%) of the maternal weight-adjusted dose.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Mothers reported irritability was reported in 20% of infants exposed to pseudoephedrine in one study of breastfeeding mothers.

All adverse reactions in breastfed infants reported in France between January 1985 and June 2011 were compiled by a French pharmacovigilance center. Of 174 reports, pseudoephedrine was reported to cause adverse reactions in 4 infants, primarily agitation.

Effects on Lactation and Breastmilk

After a single dose of pseudoephedrine 60 mg orally in 8 nursing mothers, there was a mean 24% decrease in milk production over the following 24 hours. No change in blood flow to the breast was detected that could explain the decreased milk production; there was a 13.5% decrease in serum prolactin after pseudoephedrine, but this change did not achieve statistical significance. Oxytocin levels were not measured.

Alternate Drugs to Consider

Oxymetazoline

1. Eglash A. Treatment of maternal hypergalactia. Breastfeed Med. 2014;9:423-5. PMID: 25361472

2. Findlay JW, Butz RF et al. Pseudoephedrine and triprolidine in plasma and breast milk of nursing mothers. Br J Clin Pharmacol. 1984;18:901-6. PMID: 6529531

3. Aljazaf K, Hale TW et al. Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk. Br J Clin Pharmacol. 2003;56:18-24. PMID: 12848771

4. Ito S, Blajchman A et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: 8498418

5. Soussan C, Gouraud A, Portolan G et al. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014;70:1361-6. PMID: 25183382

Pseudoephedrine Identification

Substance Name

Pseudoephedrine

CAS Registry Number

Drug Class

Breast Feeding

Lactation

Adrenergic Agents

Adrenergic Alpha-Agonists

Central Nervous System Stimulants

Sympathomimetics

Vasoconstrictor Agents

Administrative Information

LactMed Record Number

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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When a Nursing Mother Gets Sick

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.

Since most illnesses are caused by viruses that are most contagious before you even realize you are sick, your baby has already been exposed before you even develop symptoms (such as fever, diarrhea, vomiting, rash, runny nose, cough, etc). Continuing to breastfeed will help protect your little one, because your body produces antibodies to the specific bug that is causing the infection, and you pass them on to the baby in your breast 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. Illnesses are most often transmitted through skin contact and secretions from the mouth and nose. Be sure to wash your hands often, and try to avoid face-to-face contact, and sneezing near the baby.

Breastfeeding your baby while you are sick makes it easier for you to rest. Tuck him into bed with you to nurse, then have someone take him away when you’re done. I remember being so sick that my older kids would bring the baby in to nurse every couple of hours, and I was so out of it that I didn’t even know when she nursed.

Weaning abruptly is never a good idea, especially when you are sick. You put yourself at risk for engorgement and mastitis, as well as the emotional distress of sudden weaning for both you and the baby.

You need to make sure that you get plenty of fluids when you’re sick, because you don’t want to become dehydrated. Your milk supply may decrease during and immediately after your illness, but it will quickly build back up when you feel better.

Every year, over 4.3 million women in the U.S. have babies. Nearly all of these moms will use at least one drug while they are pregnant or nursing, and they are just fine. You must always consider the risk/benefit ratio when making decisions regarding whether or not to take a medication while pregnant or lactating, weighing the very unlikely (for the vast majority of drugs) risk of the medication versus the very real benefits that breast milk provides for your baby.

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 doctor before taking any drug when you are nursing. The article Drugs and Breastfeeding has more information to share with your health care provider.

  • Analgesics: avoid using extra-strength formula when regular strength will do. Aleve, Anacin-3 Regular Strength, Tempra, Tylenol (acetaminophen), and Motrin or Advil (Ibuprofen) are also considered safe. Ibupropen is the preferred analgesic in breastfeeding mothers as only very small amounts get into milk (0.6% of maternal dose)
    Aspirin (salicylate) is not recommended for use during pregnancy or lactation due to the small risk of Reye’s syndrome in infants. For that reason, Excederin isn’t recommended. It contains a combination of acetaminophen, caffeine, and aspirin. The caffeine and acetaminophen aren’t considered harmful, but the aspirin carries a very small risk of Reye’s syndrome, and while it is very unlikely that its occasional use would cause a problem, it’s better to avoid if if possible.
  • Antacids and digestive aids which are usually safe to take: Lact-Aid, Lactobacillus acidophilus, Tums (also a good source of calcium), and Tums E-X or Ultra, Mylanta or Mylanta extra-strength, Mylicon, Maalox, DiGel, Gaviscon, Alka-Seltzer, Phazyme, Rolaids, and Tagamet.
  • Artificial Sweeteners: Saccharin and Splenda (sucralose) are not known to cause any problems in nursing moms. Aspartame (Equal or NutraSweet) is safe unless your baby has PKU, a very rare metabolic disorder which every baby should be screened for soon after birth – ask your doctor if you’re not sure.
  • 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.
  • Sinus congestion: Pseudoehpedrine is a nasal decongestant which is considered safe, as very little of it is excreted into breastmilk. Nearly all OTC cold medications include pseudoehpedrine. New research shows that it may decrease milk supply, especially in moms who are nursing babies older than eight months. If a mother’s milk supply is low to begin with, she needs to be especially cautious when using medications containing pseudoephpredrine. These meds not been shown to be harmful to babies, but may decrease milk supply, especially if used by a mom with an older baby for long periods of time.
  • If you want to use a nasal spray to relieve sinus congestion, the majority of them are safe. Look for preparations that contain sodium chloride, oxymetazoline, or phenylephrine (such as Afrin, Breathe Free, or Dristan, or Neo-Synephrine). Avoid those containing propyhlexedrine (Benedrex). desoxyephedrine (Vicks Vapor Inhaler), or Lemetamfetamine (Nuprin Cold Relief Inhalor).
  • Most non-sedating antihistamines used for treating allergies are considered safe. Brand names include Claritin, Actifed, Zyrtec, and Allegra. You may find that sedating antihistamines like Benadryl make your baby sleepy and cause him to nurse less effectively.
  • Try to 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%. Robitussin, Mucinex, Triaminic Expectorant, and Vicks Nyquil are not known to be harmful, but watch for infant drowsiness. Expectorants like Guaifenesin(the main ingredient in Mucinex, Robitussin, Benylin) don’t suppress coughs. They loosen up the mucus in the respiratory tract to make it easier to cough up. They haven’t been known to cause any adverse effects in nursing babies, but they also don’t seem to be very effective. Avoid multi-action formulas such as Tylenol Multi-Symptom Cough medication and Vicks Nyquil Liquid or Liquicaps.

Dextromethorphan is an antitussive/cough preparation that seems to work by elevating the cough threshold in the brain. It’s the main ingredient in Benylin and Robitussin DM. It’s considered to be the safest of the antitussives, and the one least likely to transfer into milk. As with other cold meds, watch your baby for drowsiness.

  • 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.
  • Antidiarrheal preparations containing ‘loperamide’ (such as Imodium, Immodium A-D, Maalox Antiarrheal, Pepto Diarrhea Control, and Kaopectate II Caplets are usually considered safe However, antacids containing bismuth subsalicylate (Pepto-Bismol and Kaopectate) aren’t recommended for regular use by nursing moms because they have (rarely) been associated with Reye’s Syndrome in children.
  • 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 are usually safe. 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.
  • All the major hemorrhoid preparations, such as Americaine, Anusol, Nupercainal, Preparation H, and Tucks gel or pads are safe to use while breastfeeding.

Let’s discuss specific illnesses now. First, the scariest one of all – cancer. Cancer causes malignant blood cells to multiply rapidly and out of control. 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.

Early detection is the key. Remember to do your monthly breast exam, and have regular mammograms as recommended by your health care provider.

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 breast milk. However, as part of the procedure, you may 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. Consult a knowledgeable health care provider for specifics on how long to wait before resuming breastfeeding.
  • Ultrasound and CAT scans: these are non-invasive procedures that should not affect your breast milk or interfere with breastfeeding.
  • Mammograms can be performed while you are nursing, without affecting your breast 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 cystologic study: If you have a breast lump, this is a simple, nearly painless out-patient procedure performed in your doctor’s office to determine the nature of a solid mass. 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 need to undergo radiation therapy, you can continue nursing unless both breasts are being radiated. The treatment will not affect the function of the un-radiated breast. 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. The average risk for HIV transmission is 1 in 7 in children born to, and breastfed by an infected woman. This means that although the majority of cases of viral transmission occur during late pregnancy and delivery, more than one-third of infants acquire the virus through breastfeeding. The risk is real, so at least in the US, where we have access to nutritionally adequate infant formulas, and clean water and sanitation, HIV positive mothers probably should not breastfeed their babies. In developing countries, where the risk of artificially feeding the baby may outweigh the risk of transmitting the virus, the issue is not as clear. New antiviral therapies are showing great promise in preventing the transmission of the HIV virus when given to women during pregnancy, and researchers continue to work toward reducing the incidence of this devastating disease.

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. Genital sores can be transferred to the breast. If you are pregnant, you should talk to a doctor who is knowledgeable about the virus to decide which precautions to take. Generally, the baby can continue to nurse if he doesn’t touch the sores. Until all the sores are dried, be sure to: wash your hands often, especially after touching the sores and before touching the baby; keep clean coverings over the sores; and avoid kissing your baby if you have sores on or near your mouth. If the sore is on the nipple or areola, you need to express milk from that breast until the sore heals. You can continue nursing on the unaffected breast.
  • 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, it usually clears up within a couple of months of giving birth. 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, (and this is rare because most women of child-bearing age were exposed during childhood) 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 have the virus, your baby will be given a ZIG shot. Most babies who catch it after birth will have a very mild case. Chickenpox is no longer considered contagious when you have had no new eruptions for 72 hours, and all the lesions have become crusted. If you have older children when the baby is born, keep them away from the baby. If you have had it yourself and have immunities, the risk of the baby catching it is greatly reduced.
  • If you eat a food that is contaminated with botulism, salmonella, E.coli, or other bacterias or toxins, you may develop acute intestinal symptoms (“food poisoning”) 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 contract measles, it can be fatal in an unborn or newborn baby (congenital measles). The chances of you contracting measles before birth is rare, because almost everyone has been vaccinated during childhood. If you have been exposed, and aren’t sure if you are immunized, your doctor can order a blood test to determine if you have immunity to the disease. 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, 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 breast milk, but must monitor your diet carefully to make sure you get the nutrients you need. 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 is 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. If you are diabetic, your baby is more likely to become jaundiced after birth. Insulin is compatible with breastfeeding, because it doesn’t transfer into human milk. Your milk may come in a day or two later if you are diabetic, so monitor your baby’s intake carefully. Many diabetic mothers experience a partial or total remission from their diabetes as long as they nurse. Your insulin requirements may be significantly less than before you became pregnant. Some mothers need to decrease their insulin requirements by as much as 27% while they are lactating. Monitor levels closely, and discuss adjusting your medication with your doctor. Diabetes makes you more susceptible to all sorts of infections, including yeast and mastitis. See articles on Breast Infections and Plugged Ducts and Yeast Infections for information on how to diagnose, prevent, and treat these problems.
  • Mothers with epilepsy can nurse. At least half of all epileptics are able to completely control their seizures with medication, and most of the rest achieve at least partial control. 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 needed to control the seizures 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 monitor his weight gain carefully, and 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, your can resume complete breastfeeding. Often you need to pump to ensure an adequate milk supply. In case of seizure activity, consider practical tips such as: nursing in a padded chair; elevating your feet with a small stool; using guardrails or pillows if you nurse in bed; or placing a playpen on each floor of the house so you can put him down in a safe place if you feel a seizure coming on. When you go out with your baby, attach a name tag with your name , medical condition, and contact information on it.
  • If you have Multiple Sclerosis (MS), a degenerative muscle disease, 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, even with mothers who never had thyroid irregularities before. A low milk supply may be the only symptom of a low thyroid. Nearly 2/3 of the cases of low thyroid in women are diagnosed postpartum.
  • If you have a history of thyroid problems, ask your doctor to monitor your levels regularly so your medication can be adjusted. An underactive thyroid can cause fatigue, poor appetite, and depression. 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. If radioactive therapy is recommended, temporary weaning may be necessary. ( Find a doctor who is willing to work with you on maintaining your milk supply and resuming nursing after the radiation is eliminated from your body.

Keep in mind that all of the OTC medications approved for use in nursing mothers are very safe, and in nearly all cases, the risk of side effects on your baby is extremely small. Due to concerns about liability, many health care providers (HCPs) are going to err on the side of caution, just in case. This doesn’t mean that taking a decongestant or an antacid or a cough drop is dangerous.

You know those package inserts that come with every single drug? They are going to list every possible side effect known to man, even if the chances of anyone actually experiencing these are one in a million. They are even more cautious when telling nursing pregnant or nursing moms a medication is safe, even if there has never been a single case of a baby being affected by the drug. The lack of controlled studies (very hard to do with pregnant or nursing mothers) alone is enough to make HCPs say that a drug isn’t safe, even if nursing moms have been taking it for decades with no problems. They do this for two reasons: one, of course, is to make sure that you observe your baby in case he does experience side effects, as unlikely as that is; and two, because they don’t want to get sued.

I have an opinion about which of these two reasons HCPs give the most weight in making their recommendations, but I will keep that to myself. I will say that all the drugs on this list that are considered safe really are. HCPs are going to make sure of that before they give any kind of approval, so if you need to take any of these medications, do it. You don’t have to be a martyr. You are not going to hurt your baby. If you’ll notice, the most common side effects to be on the lookout for in your baby are drowsiness or sedation. I don’t know about you, but when I was a nursing mom and I got sick enough to even consider taking a medication, having a baby who was a little sleepier than usual for a short time was not necessarily a bad thing.

It’s almost always possible for a mother to continue nursing, even in the rare cases where temporary weaning is necessary. Remember all the advantages of human milk and how important breastfeeding is to you and your baby, and try to find a supportive health care provider who believes that nursing is as important as you do.

One helpful resource for nursing moms and their HCPs is Dr. Thomas Hale’s new InfantRisk Center. The InfantRisk Center provides up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding. You can call them Monday-Friday 8am-5pm central time at (806)-352-2519, or visit their website at infantrisk.com.

The Infant Risk Center recently released an iPhone/Android app with info on med safety of pregnant & breastfeeding moms, available to HCPs for a yearly fee. There is also a consumer version of the app called MommyMeds. Find out more at their website: http://www.infantrisk.com/

Another resource is the free Apple LactMed App for iPhone/iPod Touch. You can use it to find information about maternal and infant drug levels, possible effects on lactation and on breastfed infants, and alternative drugs to consider. You can find out more at http://toxnet.nlm.nih.gov/help/lactmedapp.htm

The information in this article came from the AAP Policy Statement, The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001, and Dr. Thomas Hale’s book Medications and Mothers’ Milk, 15th Edition, 2012

(Edited September, 2019)

Anne Smith, IBCLC

Breastfeeding Basics

Is it safe to breastfeed my baby when I’m sick?

Most illnesses are caused by viruses that are most contagious before you even realize you are sick, so your baby has already been exposed before you even develop symptoms. Continuing to breastfeed will help protect your little one, because your body produces antibodies to the specific bug that is causing the infection, and you pass them on to the baby in your breast milk.

Decongestants to Take While Breastfeeding

Whether her congestion results from seasonal allergies or a cold, a breastfeeding mother may wonder what she can do to help herself without hurting her baby. She should seek treatment while the discharge remains clear in color, as yellow or green congestion may signal a more serious underlying infection. A breastfeeding mother should discuss symptoms with her doctor or midwife before taking any medicine.

Natural Remedies

Many safe natural remedies exist for both mother and breastfeeding baby. The breastfeeding resource Kellymom.com suggests mothers try a saline nasal spray or neti pot rinse. A steam humidifier with 10 to 20 drops of the essential oils eucalyptus, sage, balsam or anise helps open the nasal passages, as does a cotton ball soaked in eucalyptus oil and placed under the nose. Cayenne pepper dilates the blood vessels and aids with drainage. Kellymom.com also lists fenugreek tea as a natural decongestant that has the added benefit of increasing milk supply. In addition, while hot lemonade with honey is not a decongestant per say, it safely soothes a mother’s sore throat.

Pseudoephedrine

A July 2003 “Journal of Clinical Pharmacology” study lists pseudoephedrine among safe drugs for breastfeeding mothers and their babies, but it may reduce milk supply. The situation resolves itself with short-term use of the drug. The American Academy of Pediatrics, or AAP, echoes these findings, rating the drug L3, or moderately safe, for acute use and L4, or potentially hazardous, for chronic use. Brand names for pseudoephedrine include Sudafed, Actifed, Halofed and Novafed, among others.

Phenylephrine

The AAP has not yet reviewed phenylephrine, a slightly newer formulation of decongestant. However, mothers may prefer it over pseudoephedrine as it does not reduce milk supply, according to Dr. Thomas Hale’s Medications and Mothers’ Milk 2. Brand names of phenylephrine include Sudafed PE, Robitussin CF, DayQuil and Tylenol Sinus Congestion and Pain, among others.

Antihistamines

Antihistamines help dry out the sinuses. The AAP approves of the use of the nonsedating antihistamines Allegra, Claritin, Seldane and Actidil in breastfeeding mothers. Dr. Hale rates these medications in the L1 and L2 categories, meaning they have little to no effect on lactation. Kellymom.com reports that while the AAP does not yet approve of sedating antihistamines such as Benadryl, they are safe in moderation, as long as the mother watches her infant closely for signs of excess drowsiness. Sedating antihistamines do not adversely affect milk supply.

Pain

Avoid products with aspirin
Preferred medications are:

  1. Acetaminophen, no more than 3000mg/24 hours
  2. Ibuprofen, no more than 800mg every 6 hours
  3. Naproxen (Alleve) is less ideal than Ibuprofen because Naproxen has a longer 1/2-life

Cold Medications

Avoid all products with decongestants such as pseudoephedrine and phenylephrine, because these can cause a significant decrease in milk supply.
Preferred medications are:

  1. Cough medicines with guaifenesin (such as plain Robitussin)
  2. Cough medications with dextromethorphan (such as Robitussin DM)
  3. Nasal saline preparations
  4. Neti Pot

Allergy Medications

Preferred medications are:

  1. Antihistamines such as loratadine (Claritin), fenofexadine (Allegra), or cetirizine (Zyrtec) for sneezing and itchy eyes/nose, itching and hives.
  2. Stronger antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (Chlortrimeton) occasionally can cause irritability in the baby and might reduce the milk supply in high doses.
  3. Nasal cromolyn sodium (Nasalcrom)
  4. Topical OTC creams/ointments such as hydrocortisone

Heartburn

Preferred medications are:

  1. Ranitidine (Zantac), famotidine (Pepcid)
  2. Omeprazole (Prilosec), lansoprazole (Prevacid)

Constipation

Preferred medications are:

  1. Docusate Sodium, which are stool softeners.
  2. Milk of Magnesia
  3. Glycolax (Miralax), which is polyethylene glycol. This is not likely to enter the breastmilk
  4. Dulcolax (Bisacodyl)- none enters the breastmilk
  5. Psyllium- does not enter breastmilk

Diarrhea

Prescription lomotil (atropine/diphenoxylate) is not recommended during lactation.

Not much is known about anti-diarrheal medications during lactation, so it is best to use medications sparingly.
Preferred medication:

  1. Loperamide (Immodium), over-the-counter

Motion Sickness

Preferred medications:

  1. Meclizine (Bonine). Watch for infant sedation. In high doses, it could decrease maternal milk supply if used often.
  2. Dimenhydrinate (Dramamine). Watch for infant sedation. In high doses, it could decrease maternal milk supply if used often.

Is it safe for a breastfeeding mom to take cold medicine?

Yes, there are cold medications that are safe to take while you’re breastfeeding.

Just be careful, because cold medicines often combine several drugs in one liquid or pill. To limit your baby’s exposure, avoid products that tackle more than one symptom or that have more than one active ingredient listed.

Most decongestants are considered safe for breastfeeding, and less than 1 percent of the most commonly used one, pseudoephedrine, ends up in breast milk. One study has suggested that pseudoephedrine might reduce the production of breast milk since it works by constricting blood vessels, which could restrict the blood flow needed for milk production. But this remains to be proven, and after you’ve been breastfeeding for a month or two and your production is well established, it’s unlikely to be altered by pseudoephedrine.

The cough suppressant dextromethorphan has long been used during breastfeeding and is considered safe.

If you need an antihistamine, also used to treat allergies, they are generally considered safe. But keep in mind that so-called first-generation antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton) can potentially cause sedation in your baby (just as they can in you), while the second- and third-generation medications such as loratadine (Claritin) and fexofenadine (Allegra) are less likely to. Your pediatrician may have a preference as to which one you try first.

Learn more about the safety of commonly used medications during breastfeeding.

When a mother is ill, it affects the whole family. For a breastfeeding mother, there are additional concerns about how her illness may affect her baby, whether directly because of any medication she needs to take, or indirectly if the illness makes it more difficult for her to feed and care for her baby.

Balancing risks
Medications and breastmilk
Common illnesses
Less common conditions
Hospitalisation
Having surgery?
Anaesthetics
Recovery
If weaning is advised

Balancing risks

Whilst there may be a risk if you continue to breastfeed while taking a medication, it’s important to be well informed about the medication and to balance these with the risks of stopping breastfeeding—even temporarily. Substituting infant formula can be risky for a baby as it will deprive him of the antibodies and immune factors that help protect him from illness. Where there is a family history of allergy a baby may have an increased risk of developing asthma or eczema when exposed to infant formula. For a breastfed baby nursing is more than just food—it’s love and comfort too. So caring for your baby and keeping him happy without being able to breastfeed is likely to be difficult for everyone concerned. And if abrupt weaning causes overfull breasts, blocked ducts or mastitis, this will compound your problems.

Medications and breastmilk

Generally, a medication that is safe for babies is the best choice for a breastfeeding mother. In any case, watching for any side effects in a baby is always a sensible precaution. Usually, when a mother takes a medication, her baby receives a much smaller amount through breastfeeding than he would during pregnancy. However, medications that are considered safe during pregnancy may not necessarily be compatible with breastfeeding. A pregnant mother’s liver and kidneys may detoxify and excrete a medication before it reaches her baby through the placenta. After birth a breastfed baby must process the medication on his own once it has reached his bloodstream. Many medications can safely be taken by breastfeeding mothers. Some medications don’t pass into a mother’s milk, some are not absorbed from a baby’s digestive tract, and for some there is a long history of safe use by nursing mothers. However, it’s wise to check with your doctor or pharmacist as certain medications can cause problems. Consider the following points when making decisions:

  • Premature and newborn babies are the most likely to be affected by medications. After one month of age most babies are better able to handle certain medications.
  • A heavier baby will be less affected by a medication he receives through his mother’s milk than a lighter baby of the same age.
  • A baby who is receiving solid foods or formula as well as breastmilk will probably receive less of the medication than one who is exclusively breastfeeding. A breastfeeding toddler who nurses infrequently will receive less of the medication than a toddler who nurses more often.
  • A medication taken for weeks or months may have a greater potential impact on a breastfed baby than one that is taken for only a few days.
  • The level of a medication in a mother’s milk can vary according to the time between taking the medication and the next breastfeed.

It is always wise to check over-the counter medications. Although paracetamol and ibuprofen are considered compatible with breastfeeding some medications, like aspirin, are not safe for babies. Others, such as cold and flu remedies, can cause sleepiness and reduce your milk production. Medications with only one active ingredient may be a better choice than compound medications.

Health concerns and illnesses

An LLL Leader can help you find more information on breastfeeding with particular illnesses and health conditions, and support you as you consider options.

Common illnesses

Common colds, flu and stomach bugs can be hard to cope with while breastfeeding— particularly if you don’t feel like eating. Even if you can’t eat, try to keep up your fluid intake to prevent dehydration. You will continue to make milk for your baby, though if you feel very ill it may seem as though you are producing less milk. Continuing to breastfeed whenever your baby is interested will help maintain milk production while you are ill and increase it afterwards if needed. There is no need to stay apart from your baby—he will already have been exposed to the illness before you realised you were ill. Continuing to breastfeed gives him valuable protection against the effects of your illness. Sensible hygiene precautions such as using tissues and binning them immediately, and washing hands with soap and water or using hand cleansers can help reduce transmission of illness.

Less common conditions

If you have contracted a less common illness, such as chickenpox, impetigo or Herpes simplex you will want to know how it will affect you and your baby. Your midwife, health visitor, GP or hospital consultant can give you detailed medical information about your illness and how to minimize risks of transmission.

Mental health concerns

Since mothers often experience depression, a lot of information is available on medications and breastfeeding. It is usually possible to find appropriate treatment that can be taken while breastfeeding. With prompt treatment mothers recover quite quickly and are then able to fully enjoy parenting their new baby. And breastfeeding helps maintain the important bond between mother and baby even if a mother is depressed.

Chronic health concerns

Many mothers have breastfed with long term medical conditions including asthma, diabetes, cystic fibrosis, lupus, multiple sclerosis, epilepsy and thyroid disease. Breastfeeding requires very little physical effort and helps protect a baby from future illness.

Hospitalisation

If you need to spend time in hospital you will naturally have concerns about separation from your baby. First consider whether the treatment could be delayed until your baby is older, or take place with you as an outpatient. Explain to your health care professionals that not being able to breastfeed or express milk will put you at risk of painfully overfull breasts, blocked ducts, mastitis and a reduction in your milk production and ask for access to your baby or to a pump to be written into your careplan.

Having surgery?

Make clear to your partner and health care team on the day that if you are not alert enough to breastfeed after the operation they will need to help you express your milk. If you can’t keep your baby with you whilst in hospital, ask that your partner or whoever is looking after your baby be able to bring your baby in before and after the procedure so you can breastfeed. This is likely to be much easier and more restful for you than expressing.

Hope for the best—plan for the worst

Even if you can breastfeed in hospital, planning for the possibility that you might not will help you cope. If you are going to be apart from your baby, you’ll need to make arrangements to express your milk. It may not be easy to gain regular access to hospital pumps so it’s a good idea to learn to hand express and/or take in your own or a rented pump. If the pump requires electricity, the hospital electricians may be required to test it for safety before you can plug it in. For a planned hospital stay ask to have it tested in advance. You might also practice expressing beforehand.

Your baby’s needs

Your baby will miss you so if you know you will be apart, try to find a carer whom your baby already knows and loves eg his daddy or a grandparent. If possible, express and freeze milk in the weeks beforehand so you have an emergency supply for your baby.

Anaesthetics

Medications used for local and general anaesthesia do not remain in a mother’s system or affect her milk. It is safe to breastfeed as soon as you are alert enough to handle your baby. For planned treatment ask in advance for detailed information on which drugs you will need to take and on pre-op procedures such as fasting. Request post-op pain relief medication that is compatible with breastfeeding. To help you cope with fasting prior to a medical procedure avoid tea, coffee and salty foods and eat well and drink plenty of water the day before. Don’t be surprised if you find it difficult to express much milk during the hours leading up to your operation. Afterwards, milk production will pick up very quickly with frequent breastfeeding. After any operation, try to organise as much help as possible with meals, household tasks etc. Depending on how you are feeling, you may even appreciate someone helping you care for your baby. Plan complete rest for the first 24 hours and then take things easy for at least a week.

Recovery

The important thing for any mother after any illness is taking time to recuperate. Be wary of trying to do too much too soon. Eating and drinking, rest and relaxation will help both your recovery and, combined with frequent nursing, your milk production. If your baby is fussy at the breast you may be concerned about whether you are making enough milk. Encourage your baby to breastfeed frequently and offer both sides to give your breasts the message to boost milk production—you’ll probably notice a difference within just a day or two. You may find breastfeeding while lying down lets you rest and nurse your baby. If you are groggy from medications, ask whoever is looking after you to help keep your baby safe. If you still don’t feel like eating much, try frequent small meals or snacks and sips of juice. Try a night-time snack and drink until your normal appetite returns.

If weaning is advised

Enforced weaning is not easy on either mother or child so if you are told to stop breastfeeding your baby because of a medical condition or medication, it’s normal to feel overwhelmed and upset. Do contact an LLL Leader to discuss the options—she can access information on individual medications if needed. Whilst each medication needs to be checked individually, many are compatible with breastfeeding. For a short course of treatment, temporary weaning may be an option. To minimize discomfort and maintain milk production you will need to express or pump your milk frequently instead of nursing, discarding it until your treatment is completed. You can then re-establish breastfeeding.

Nursing is more than just a method of feeding. It’s also a familiar source of closeness and comfort. So if weaning really is necessary try to end breastfeeding as gradually as time allows, giving your baby lots of love and extra attention. You can hand express or use a pump to reduce your milk production gradually. This will help keep your breasts comfortable and slow down hormonal changes. Our leaflets A Sudden End to Breastfeeding and Thinking of Weaning? How Breastfeeding Ends can give you ideas about how to proceed and how to help your child adjust to life without nursing.

Written by Karen Butler, Sue Upstone & mothers of LLLGB.

Further Reading
Adjusting to Motherhood
A Sudden End to Breastfeeding
Engorged Breasts – avoiding and treating
Expressing Your Milk
Hand Expression of Breastmilk
If You Leave Your Baby
Is My Baby Getting Enough Milk?
Safe Sleep and the Breastfed Baby
Storing Your Milk
Thinking of Weaning
When Mum Can’t Be There

Books
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Breastfeeding and Medication, Jones, W., Routledge

Breastfeeding Today stories
Breastfeeding Through Critical Illness

Additional Sources of Support
The Breastfeeding Network Drugs in Breastmilk Information Service (Facebook page)
The Breastfeeding Network – Drugs Factsheets
The Hospital Infant Feeding Network

This information is available to buy in printed form from the LLLGB Shop

Copyright LLLGB 2016

Breastfeeding When You’re Sick

It’s not easy being under the weather when you’re a mom. You can’t call in sick and you can’t take a day off. But at least there’s one item you can take off your worry list: When it comes to breastfeeding your baby, you’re in the clear. It’s safe and even beneficial to continue breastfeeding when you have a cold or the flu. Here’s what you should know about breastfeeding while sick, including over-the-counter medications that are safe to take while breastfeeding.

Is it safe to breastfeed if I am sick?

Yes, it is still safe to breastfeed when you’re feeling under the weather. Breast milk is still the healthiest source of nourishment for your baby while also providing your baby with antibodies and other immunological factors that will help keep your little one from getting sick. If you’re too sick to breastfeed, expressed breast milk has the same benefits—just choose a healthy caregiver to feed your baby a bottle.

Does illness pass through breast milk?

Cold and flu viruses do not pass through breast milk. Certain more serious diseases such as HIV, HTLV-1 or brucellosis (a rare bacterial infection) do pass through breast milk and you should talk to your healthcare provider if you have been diagnosed with these illnesses.

Does being sick affect my milk supply?

It can, especially if you’re not nursing or pumping as much as you normally would because you’re not feeling up to snuff. But a drop in your milk supply is not likely to be permanent. Being sick for a few days is just a small bump in the road when it comes to the long breastfeeding game, so continue to breastfeed if you feel up to it and pump as often as you can.

How can I keep my baby from catching my cold?

There are a few basic precautions you can take to help keep your little one healthy:

Recommended Reading

Breastfeeding Breastfeeding: Basics and Tips for Nursing Your Baby Breastfeeding Pumping Breast Milk 101 Baby Feeding Picking The Best Breast Pump for You Nursing & Feeding 7 Best Nursing Pillows for New Moms Breastfeeding Breastfeeding: Basics and Tips for Nursing Your Baby Breastfeeding Pumping Breast Milk 101 Baby Feeding Picking The Best Breast Pump for You Nursing & Feeding 7 Best Nursing Pillows for New Moms

  • If you can arrange for a caregiver to help you care for your child while you’re sick, it may be worth it. Let your partner or other family members help with diapering, playtime, bathtime and bedtime, and don’t try to do it all yourself—you need rest to get well!
  • Cover your mouth and nose with a tissue when you cough or sneeze.
  • Wash your hands with warm soap and water after you cough or sneeze and especially if you’re handling your breast pump.
  • Use a disinfectant on surfaces to avoid the spread of disease.
  • Be observant: If you notice that your child has a fever, respiratory issues including shallow or slow breathing, or is less responsive than normal, consult with your doctor immediately.

Don’t forget that the flu vaccine is one of your best weapons in keeping your whole household healthy. Moms-to-be should get the flu vaccine while pregnant to protect themselves and their newborn up to 6 months, and babies should get the flu vaccine after 6 months. Everyone that’s around your child—including partners, caregivers, and family members—should get vaccinated, too.

What medicine can I take while nursing?

Nearly every over-the-counter medication carries some warning to breastfeeding moms, so it’s best to consult with a doctor before taking any sort of medication. That said, many medications are safe to take while breastfeeding. These include (but are not limited to):

  • Acetaminophen (Tylenol)
  • Ibuprofen (Advil, Motrin)
  • Antihistamines (such as Claritin; Benadryl is also safe but may cause infant drowsiness)
  • Decongestants (Afrin, Allegra and so on), but not those containing pseudoephedrine, which may decrease milk supply
  • Most antibiotics

What medicine is unsafe while breastfeeding?

Some medications may be harmful to take while nursing. These include (but are not limited to):

  • Pseudoephedrine, an antihistamine (Sudafed, which may decrease milk supply)
  • High-dose vitamins and certain supplements

Safe cold remedies for nursing moms

To start off, get as much rest as possible if you’re battling a cold—it’s all about giving your immune system a chance to fight back. These remedies may also help:

  • Load up on vitamin C. Foods like oranges, tangerines, grapefruit, strawberries, melon, kiwi, mango, tomatoes, bell peppers, papaya, broccoli, red cabbage and spinach can boost your immune system.
  • Amp up on zinc. Foods like turkey, beef, pork, cooked oysters, eggs, yogurt, wheat germ and oatmeal are loaded with zinc and can also help boost immunity.
  • Stay hydrated. Drink plenty of water or warm soothing beverages like tea and broth to stay hydrated while you’re sick. This can help the illness to pass more quickly.
  • Switch on a humidifier. Dry air can make your cough worse. o Using a cool-mist humidifier to keep the air in your home moist can help relieve coughing.
  • Try saline. Keep your nasal passages moisturized with saline drops, sprays or rinses.
  • Choose safe medications. Cold medications that are safe to take when you’re nursing include many decongestants (other than those that contain pseudoephedrine) as well as pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). Talk to your doctor before taking any cold medicine to see what she recommends.

Take good care of yourself and your breastfeeding baby, and feel better soon!

By Beverly Ann Curtis, APRN, PNP-BC, IBCLC

Colds are never fun and trying to mother with a cold can be downright difficult. If you are not feeling well with runny nose and cough, lots of fluids and rest is always a good recipe for getting back to normal.

Cold symptoms last 6-10 days with symptoms peaking on day 4-5 and subsiding by day 7-10. If your symptoms are worsening by 7 days into a cold, you should see your doctor. If you run a fever beyond 3-4 days, medical care should be sought. Flu-like symptoms are not a normal part of a common cold and may be indicative of a breast infection or other illness. Consult your physician if you experience these. Otherwise rest and sleep when baby sleeps.

If you are ill and not feeling well, you may inadvertently skip feedings or feel the need for someone else to feed your baby. This may cause a decrease in your milk supply. To maintain your supply, make sure you get plenty of rest, drink fluids, and continue to eat three meals a day and three snacks. It is safe to continue to breastfeed even when you are ill unless your doctor advises otherwise. Your body will produce antibodies that pass into your milk and protect your infant from your infection. Breastfed babies do experience illness and can pick up illness from others in their household but generally, the breastfed babies illness is less severe than formula fed infants and the infant recovers from illness sooner.

Medication

Tylenol, or acetaminophen and Advil,or ibuprofen are approved for use while breastfeeding. Benadryl and other allergy medications may reduce your milk supply and also may make the baby drowsy. Antihistamines and decongestants, including Dimetapp and Sudafed, are not recommended while breastfeeding, as they may substantially decrease your milk supply. See Dr. Thomas Hale’s website for a thorough discussion on medications and breastfeeding. While Benadryl and older versions of antihistamines are not recommended because they may decrease milk supply, Zyrtec and Claritin are OK.

Vaporizers

Vaporizer with plain water may be beneficial in moistening the nasal passages and helping to clear the airway. Menthol products in a vaporizer should be avoided and have been identified as an irritant in nasal passages in infants.

Zinc

Zinc Gluconate,as found in Cold-eeze and Zicam is considered safe with breastfeeding although the nasal gel is recommended over the oral drops. According to Thomas Hale, PhD,” Zinc is an essential mineral that is required for your cell’s enzymatic functions and the recommended daily allowance for adults is 12-15 mg per day. While zinc does enter the breastmilk, growing newborns require zinc and as long as supplementation does not exceed 25-50 mgs per day,….avoid zinc sulfates because those have been shown to be detrimental to proper immune system function.”

Neti Pot

A Neti Pot is recommended for people with allergies or sinus problems, and works to clear the nasal passages during the common cold. Since it only uses water and the mother is not actually ingesting anything, it is very safe for a nursing mom.

Flu

Seasonal flu treatment includes either Oseltamivir (Tamiflu) or zanamivir (Relenza). These antivirals work early on in the illness and are not indicated if fever and illness has been present for more than 48 hours. The CDC considers oseltamivir safe to use in breastfeeding mothers. At present, there is no breastfeeding data on zanamivir (Relenza). Physicians are advised to use oseltamivir (Tamiflu) instead of zanamivir (Relenza) in breastfeeding mothers.

Herbal remedies

Many herbal remedies and their safety have not been evaluated for the breastfeeding infant. Just because a product is marked natural does not mean it is safe while breastfeeding. Caution should be used for any consumption of herbals as well as prescribed medications. If insufficient data is available on a specific herbal remedy then it is advised to avoid it while breastfeeding. Insufficient data is available for Airborne, a cold remedy, and therefore should be avoided for breastfeeding mothers.

Bev Curtis is the former Executive Director of the Breastfeeding Center of Pittsburgh.

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