Medicines during breastfeeding: what is possible, what is not? Can I take medication while breastfeeding.

How to determine if you can take medicine if you are breastfeeding?

In the annotation for any drug there is a line “use during breastfeeding”, and, as a rule, in most drugs, an indistinct and frightening phrase is written like this: “no studies have been conducted in this group of patients, and it is worth taking the drug only if the risks to the mother exceed potential risk to the child.

What is it really?

In fact, such studies are very expensive, drug manufacturers usually do not conduct, and pharmaceutical companies are afraid of legal liability, so it is easier for them to write that the drug is not recommended for breastfeeding and persuade patients to refuse breastfeeding.

However, such studies were carried out by other non-interested organizations (WHO, American Academy of Pediatrics, etc.) and information on the compatibility of breastfeeding and drugs is publicly available. In most cases, the drug is allowed when breastfeeding, or you can choose an analogue safe for the baby and do not wean the baby from the breast.

The effect of the drug on the child depends on several factors:

• From how easily and well the drug penetrates into breast milk.
• From the amount of milk the child drinks (the less milk the child drinks, the less medicine gets to him).
• From the toxicity of the drug when it enters the child and the age of the child.

In most cases, less than 1-4% of the maternal dose of the drug gets into breast milk. As long as the percentage of the child dose does not exceed 10% of the maternal dose of the drug, the drug is practically safe for the child.

Several sites are now available to determine the compatibility of feeding with drugs, but the most convenient and easiest for parents is the Spanish resource created at the Marina Alta Hospital https://e-lactancia.org/. All information on this website is based on scientific publications and medical research.

3. Then enter the desired drug in the search bar:

4. Analyze the result, depending on the color of the large rectangle:

• If the risk is 0 ( Level 0) and marked green color means the risk to the child is very low , and taking this medicine is safe for the child.
• If the risk is 1 ( Level 1) and marked yellow color, the risk to the child is low , the drug is moderately safe, and when taking this drug, a slight effect on the child is possible. If you find an analogue that belongs to the green group, then it is better to replace it. The decision must be made depending on the dose of the drug and the age of the child. It is recommended to monitor the child after taking the drug by a nursing mother.
• If the risk is 2 ( Level 2) and marked orange color means the risk for the child is high , the drug is not safe for the child and it is advisable not to take it, replace it with a safer analogue, or stop breastfeeding while taking the drug. Be sure to monitor the child in case of taking the drug by a nursing mother.
• If the risk is 3 ( Level 3) and marked red color, the risks for the child are very high. It is recommended not to take the drug, or stop feeding or choose a safe analogue.

If the drug is dangerous for a child during lactation, you can try choose an analogue of this medicine, they are indicated here:

If nevertheless need to stop feeding , and you want to maintain lactation, you need to express while taking the drug. You can also express milk in advance, before starting to take toxic drugs, and create a "milk bank" for your child. .
To make a final decision on taking the drug during breastfeeding or canceling breastfeeding, it is still necessary consult with your physician and together weigh all the risks “for” and “against” taking this drug !!!

There are also other sources where you can get reliable information about the compatibility of drugs during breastfeeding, for example:

• US National Library of Medicine Reference Database https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm
• WHO Handbook https://whqlibdoc.who.int/hq/2002/55732.pdf

But, unfortunately, in some cases, there may be contraindications and obstacles to breastfeeding.

Contraindications for breastfeeding:

From the mother's side:

• operation in childbirth;
• severe forms of toxicosis during pregnancy;
• severe bleeding in the birth and postpartum period;
• violation of the general condition due to chronic diseases of the liver, kidneys, heart;
• oncological diseases, chemotherapy;
• blood diseases;
• maternal HIV infection. With a positive HIV test, milk can be expressed and given to the child after sterilization;

The last five points are persistent (absolute) contraindications to breastfeeding. This means that the child of a woman with this pathology should under no circumstances be applied to the mother's breast.

Temporary (relative) contraindications on the part of the mother's health can be: caesarean section (stage of post-anesthetic sleep, syphilis, tuberculosis (open form), acute intestinal infections, infectious diseases: typhus and relapsing fever, anthrax, tetanus in the acute period, purulent mastitis) . If a mother develops acutely contagious diseases (erysipelas, typhoid, blood poisoning), she should express, sterilize milk and give to the child. With flu, sore throat - breastfeeding is allowed, but the mother must have a hygienic mask.

In the presence of gynecological diseases, breastfeeding continues, but strict hygiene is important. If the mother is sick with syphilis, then the issue of feeding is decided depending on the period of infection: if infected after 6 months of pregnancy, feeding is prohibited, if infected before this period, breastfeeding is possible. If the mother is ill with tuberculosis, the child is isolated from her for 2 months, but feeding with expressed sterilized milk is allowed.

From the side of the child:

• severe condition of the newborn;
• deep prematurity;
• serious malformations (heart, maxillofacial apparatus, digestive system, etc.);
• violation of cerebral circulation;
• severe jaundice of the newborn;
• metabolic diseases with impaired production of certain enzymes in the body;

Such children need to be fed with expressed milk, because due to their weakness they cannot suck it out of their mother's breasts.

Difficulties with breastfeeding:

From the side of the child:

• malformations of the jaws and nose (it is necessary to adapt or, at first, feed the child with expressed breast milk through a probe or from a spoon);
• fungal infection of the oral cavity - thrush;
• sluggish, lazy sucking;
• swallowing air, frequent regurgitation;
• nasal congestion;

From the mother's side:

• altered shape of the nipples (inverted, pointed, poorly developed). In this case, nipple massage will help, the use of special triangular-shaped pads (in the form of a “clover leaf”) for the physiological contact of the baby’s nose with the mother’s skin;
• tight breasts (stagnation of milk). To improve the outflow of milk, it is necessary to express a small amount of it before feeding the baby, to massage the gland;
• cracks and abrasions of the nipples. For treatment, you can use UV radiation, every other day 5-6 times, lubrication of cracks with creams containing lanolin;
• mastitis. In this case, you need to feed with expressed sterilized milk;
• increased secretion of milk - galactorrhea;
• the onset of a new pregnancy in a nursing mother. Usually it does not affect lactation and the composition of milk, therefore, up to 5 months of pregnancy, a woman can put her baby to her breast;
• reduced milk secretion - hypogalactia;

Absolute contraindications:

From the side of the child:

Metabolic diseases, or congenital metabolic disorders (phenylketonuria, galactosemia, maple syrup disease);

From the mother's side:

An open form of tuberculosis with bacillus excretion.

Syphilis with infection of the mother for 6-7 months. pregnancy

HIV infection (expressed, pasteurized)

Especially dangerous infections (plague, smallpox, anthrax, tetanus)

Decompensation of chronic somatic diseases (heart, kidney, blood, etc.)

Acute mental disorders or neurological (only with the permission of a psychiatrist and neurologist)

Malignant diseases

The mother's intake of highly toxic drugs (cytostatics, Relanium, radioactive drugs, chloramphenicol, tetracycline, sulfonamides, estrogens, antithyroid drugs, iodine, lithium, etc.)

Relative contraindications:

From the side of the child:

At birth - asphyxia (Apgar score below 7 points), severe perinatal trauma (HFRT, cephalohematoma);

Unsatisfactory general condition; regurgitation syndrome;

Deep prematurity;

Congenital malformations that prevent active capture and sucking of the breast (cleft palate, upper jaw);

Malformations of the heart, gastrointestinal tract, etc.

Potentially severe hypoglycemia in the newborn;

Children with HDN due to Rhesus conflict

From the mother's side:

Surgical intervention in childbirth and the postpartum period;

Pathological blood loss during childbirth and the postpartum period;

Childbirth in pre - and eclampsia

The presence of any infectious processes in childbirth

Rational nutrition of a nursing woman

A properly constructed diet for a pregnant and lactating woman, its timely correction with the help of specialized products, allows you to achieve the optimal composition of breast milk and ensure the proper development of the child.

The nutrition of a nursing woman should provide:

Satisfaction of all physiological needs of the mother for energy and essential nutrients.

Supplemental supply of energy and nutrients necessary for the production of sufficient milk with high nutritional value.

Prevention of allergens and compounds that can cause irritation of the mucous membrane of the digestive tract with mother's milk.

During the period of breastfeeding, the calorie content of the mother's diet should be 700-1000 kcal higher than usual and be 2700-2650 kcal / day.

The amount of liquid in the daily diet (soup, tea, milk, kefir, juices, lactogenic drinks) is brought to about 2 liters.

The diet of lactating women should be complete, varied and include all the main food groups, the consumption of which allows satisfying the physiological needs of this contingent for energy and nutrients.

An approximate daily diet for a breastfeeding woman:

200 g of meat, poultry or fish, 1 liter of milk or dairy products, 100-150 g of cottage cheese, 20-30 g of cheese, 20-30 g of butter and 20-30 g of vegetable oils; about 300 - 500 g of fresh and cooked vegetables; up to 300 g of fruits and berries, 200-300 ml of juices (freshly prepared and canned).

Whole cow's milk, the excess of which in the mother's diet can cause allergic reactions and intestinal disorders in the child, is preferable to replace with fermented milk products. It is very important that the diet of nursing mothers contains a sufficient amount of plant fibers that stimulate intestinal motility. Plant fibers are also rich in wheat, buckwheat and oatmeal, wholemeal bread, and dried fruits.

A careful approach is needed to the selection of products characterized by allergenic properties, containing a large amount of essential oils (spices) and extractives.

In the diet of nursing mothers, it is necessary to limit onions, garlic, spices, canned snacks, salted fish, pickles, as well as foods that are obligate allergens (chocolate, cocoa, citrus fruits, tomatoes, strawberries, eggs, nuts, honey, shrimp).

During the period of breastfeeding, a woman should eat a multiple of the feeding of the child. 20 - 30 minutes before feeding a child, it is advisable to drink a warm drink (milk, tea, rosehip infusion, lactogenic infusions).

To correct the nutrition of a nursing woman, specialized foods enriched with protein, vitamins and minerals can be recommended (see table 4).

Alcohol while breastfeeding

A sip of wine in honor of something ... Already regular consumption of alcohol during pregnancy can harm the baby. However, this also applies to the feeding period, since the baby drinks with you when you do it. He may even be "drunk" and even blissfully "nod". And it is still very difficult for him to break down alcohol. Therefore, the use of alcoholic beverages is strictly prohibited.

Nevertheless, when guests come, delicious food is expected or the day turned out to be especially difficult - you can, rarely and on special occasions, drink a glass of champagne, light wine or a glass of beer. It doesn't hurt, on the contrary, such a small sip will probably relieve your tension and you can again take care of your child with more eagerness. However, caution is needed with spicy and strong drinks! Not only will they harm your baby, but your milk supply will also decrease.

If you drink a glass of wine, it is better to do it during feeding or immediately after it - 30-60 minutes after that, the alcohol content in the mother's milk will rise to the same level as in her blood. Until the next feeding, it will at least decrease again.

Sometimes a small sip to unload will help overcome difficulties with the flow of milk. But a glass should not become a habit!

Although alcohol during breastfeeding is not as strictly prohibited as during pregnancy, its consumption should be moderate. Alcohol passes into breast milk and can pass to the baby. Although many experts believe that a small amount of alcohol given to a child in isolated cases is unlikely to cause problems, in general drinking large amounts of alcohol should be avoided. It's also good if you try not to feed your baby for two hours after drinking alcohol. This will minimize the amount that the baby will receive with breast milk. Alcohol in breast milk can make the baby drowsy and make it difficult to move.

There is also evidence that children suck out much less breast milk from a mother who has consumed alcohol; perhaps this is due to the fact that alcohol has a blunting effect on the breast milk ejection reflex. (Here's another reason not to drink champagne while breastfeeding!)

Smoking while breastfeeding

In Germany, 30% of all pregnant women smoke, while in Japan only 2%. However, you probably already knew for a long time that smoking is bad for your baby, both before and after childbirth. However, few smokers manage to completely stop smoking during pregnancy and lactation. Those women who cannot quit smoking are usually hesitant to breastfeed. However, this solution is wrong! Feeding, even in this case, should be preferred to refusing it. Better try to control your bad habit.

Compromise:

Try to reduce your daily number of cigarettes to a maximum of five.

Smoke after you have fed - then the nicotine will already be partly destroyed by the next feeding time, and your child will “smoke” less with you.

No one should smoke in the presence of a child, as passive smoking is harmful to the bronchi.

Maybe you can stop smoking those last five cigarettes too?

Exposing your baby to secondhand smoke is always bad, but it's worst if you do it while you're breastfeeding. Breastfeeding mothers who smoke produce less milk than nonsmoking women. This may explain the fact that children whose mothers smoke are less likely to breastfeed. In addition, nicotine and other by-products of smoking end up in the mother's milk, and these are the substances that harm the baby.

It should also be added that in more than 50% of cases, smoking is associated with colic (a disease that occurs in newborns) and sudden death syndrome in an apparently healthy child. So there are many reasons to quit smoking. If you can't quit the habit, smoke after feeding your baby, not before.

You should also smoke outside or in another room to reduce the amount of smoke your child might inhale. (These tips also apply to mothers who bottle-feed babies: smoking is bad for all babies, whether breastfed or formula-fed. This goes for friends who smoke, and all family members. If they want to smoke, they should get out of the house. ) Do not also think that if you smoke, you should not breastfeed your baby. It is better to smoke and feed a baby than to completely deprive him of breast milk.

Can I drink coffee while breastfeeding?

Although it seems to you that never before in your life have you needed a cup of strong coffee as much as now, when you are deprived of sufficient sleep, there are many reasons why you should give up this drink. Frequent consumption of caffeinated products (coffee, tea, cola, cocoa, chocolate, and some prescription and over-the-counter medications) causes anxiety, overactivity, and insomnia in some breastfed babies.

Herbs for breastfeeding

You should pay attention to the composition of herbal tea. Find out what types of tea can be consumed during the feeding period and which cannot. If you are not sure, check with your doctor. Several newborn babies have died because their mothers drank large amounts of herbal tea. It is also risky to give any herbal tea to a small child unless you know for sure if the product is harmful to him.

You should be very careful with these products. They may be natural, but most of them contain pharmacologically active substances that can harm your baby. Few studies have been done on the effects of these products on a breastfed baby, so it is best to exercise caution unless you know for sure that the product is not contraindicated for breastfeeding mothers.

Contraindications to breastfeeding

Tuberculosis is a contraindication to breastfeeding

Mycobacterium tuberculosis is able to penetrate into mother's milk, at the same time, cases of infection of a child in this way (through milk) have not been recorded.

With active tuberculosis with the release of mycobacteria into the environment (the so-called open forms), breastfeeding is contraindicated - there is a high risk of infection by airborne droplets.

With tuberculosis without isolation of mycobacteria (the so-called closed forms), breastfeeding is allowed.

Viral hepatitis - contraindications to breastfeeding

In hepatitis A, breastfeeding in the acute period is contraindicated.

With hepatitis B and C, breastfeeding is allowed, but through special silicone pads.

Streptococcal infection - a contraindication to breastfeeding

Breastfeeding is possible at normal body temperature in a nursing mother and provided that adequate antibiotic therapy is carried out.

HIV infection is a contraindication to breastfeeding

Breastfeeding is contraindicated.

Acute cytomegalovirus infection

The virus passes into milk. Nevertheless, healthy full-term babies can be fed.

Herpes simplex virus infections

Breastfeeding is allowed provided that there are no rashes directly on the mammary gland.

What infections are breastfeeding allowed for?

If the general condition of the mother allows, then, subject to standard hygiene rules, breastfeeding is advisable when:

• acute respiratory viral infections;
• acute intestinal infections;
• infectious mononucleosis;
• toxoplasmosis;
• measles;
• rubella;
• chickenpox;
• epidemic parotitis.

Postpartum lactational mastitis

Lactostasis - stagnation of milk in one or more areas of the mammary gland. Lactational mastitis is an inflammatory process in the mammary gland during lactation. There are no signs to clearly distinguish lactostasis and lactational mastitis from each other.

Lactostasis and lactational mastitis are actually two stages of the same process: lactational mastitis is a complication of lactostasis. In any case, feeding from a healthy breast should be continued in full. Feeding from the diseased breast should be continued if the pain is tolerable.

If you can express enough milk from a diseased breast to feed, then you can feed this milk, but most likely you are doing it wrong: if it is possible to endure pain during pumping, then you need to endure pain during feeding and apply the baby to the patient more often chest. If the pain is so unbearable that you can neither feed nor pump, this is a direct indication to see a doctor. Numerous modern studies have proven that milk expressed during mastitis, even with an admixture of pus, is safe for feeding a child.

In some situations, breastfeeding is contraindicated. Let's find out which ones.

Maternal contraindications to breastfeeding

If you've had a double mastectomy or breast reduction surgery that removed your nipples or severed your milk ducts, it will make breastfeeding impossible. Also, if you have the AIDS virus, you should not breastfeed. There is evidence that, in rare cases, the virus has been transmitted to the infant through mother's milk. A woman with active TB who has not been treated should also abstain from breastfeeding.

A mother who uses cocaine or other drugs should not breastfeed because substances that pass quickly into milk can cause serious illness or even death in the baby. Other substances that also require temporary suspension of breastfeeding include radioactive isotopes, antimetabolites, cancer chemotherapy drugs, and a small number of other drugs.

Contraindications to breastfeeding by the child

If a child is diagnosed with galactosemia, they do not have liver enzymes and cannot digest lactose. Since breast milk contains a high content of lactose, breastfeeding in this case is contraindicated. Continued feeding may cause mental retardation. The child must be switched to a special formula such as Nutramigen. Some states include this disease in the test, which is carried out on all babies for some dangerous diseases.

Breastfeeding is contraindicated in such diseases of the mother:

• oncological diseases;
• open form of tuberculosis with bacilli excretion;
• especially dangerous infections (natural smallpox, anthrax);
• mother's HIV-positive status;
• acute mental illness;
• hepatitis C in the active phase of the disease.

Contraindications to breastfeeding

Contraindications to breastfeeding by the child

Newborns not matching their gestational age

Such children may not only have a low body weight for a given gestational age, but also developmental delay. It depends on the factor that came into play during the pregnancy. It is known that maternal arterial hypertension in the third trimester causes a delay in the growth of fetal body weight, and the transfer of rubella in the first trimester causes growth retardation. The greater the growth retardation in a newborn during pregnancy, the greater the problems in feeding such a child. Newborns of this group often develop hypocalcemia, hypothermia, hypoglycemia. Breast milk contributes to the full development of the digestive tract.

Pathological conditions of the fetus and hypoxia of the newborn

Newborns requiring observation or intensive care have a low Apgar score. Depending on the clinical condition, breastfeeding should be delayed by 48 hours. Sometimes this period can be extended up to 96 hours. Hypoxia leads to a decrease in intestinal motility and a decrease in the level of stimulating hormones. These newborns may have neurological problems and may not always respond adequately to subsequent breastfeeding attempts. For such children, the optimal position near the mother's breast may be the pose of a ballerina or a soccer ball. When the baby is positioned in front of the mother, the baby's head and face are stabilized by the mother's hand and directly against her breast.

Gastrointestinal Disorders

Gastrointestinal disorders are quite common in both breastfed and formula-fed newborns. The only rule is that newborns in the event of a disease should receive breast milk, as far as possible. Breast milk is a physiological food that does not cause dehydration and hypernatremia. The mother of the child needs a corrective diet. Allergy to mother's milk is rare.

Intolerance to lactose

Lactose is the main carbohydrate in milk, hydrolyzed by the hydrolytic enzyme lactose phloretin glucoside, a small intestine enzyme. Congenital lactose deficiency is an extremely rare disorder inherited in an autosomal recessive manner. The enzyme hydrolyzes lactose, phloretin glucoside, glycosylceramides.

In most cases, clinical manifestations decrease at the age of 3-5 years. Prematurely born babies do not have lactose tolerance. Correction of the mother's diet is necessary, the introduction of lactose-hydrolyzed breast milk.

Galactosemia is a disease caused by a deficiency of galactose-1-phosphate - uridine transferase. Refers to congenital pathologies. Clinical manifestations:

• jaundice;
• vomit;
• liquid stool;
• brain disorders:
• electrolyte disturbances;
• weight loss.

It is necessary to transfer the child to feeding therapeutic artificial mixtures, because high levels of lactose in milk contribute to an increase in glucose and galactose in the child's blood.

Phenylketonuria is a metabolic disorder of the amino acid phenylalanine, in which it accumulates due to the absence of the enzyme. A child with phenylketonuria has low birth weight, microcephaly, and congenital heart disease. The levels of phenylalanine in human milk are 29 to 64 mg per 100 ml. Infants with this pathology require breast milk supplemented with Lofenalac formula (low in phenylalanine).

Human milk has a low phenylalanine content compared to formula. The prognosis of mental development is favorable if treatment is started early and the level of phenylalanine in the blood does not exceed 120-300 mmol / l. It is possible to introduce thick food no earlier than 6 months.

cystic fibrosis

Breastfeeding is carried out with the addition of proteolytic enzymes. In severe cases, it is possible to use hydrolyzed mixtures.

Enteropathic acrodermatitis (Danbolt-Closs syndrome)

Acrodermatitis enteropathica is a rare, unique disease, transmitted in an autosomal recessive manner, characterized by a symmetrical rash around the mouth, genitals, and in the folds of the limbs. The rash is acute vesiculobullous, eczematous, often secondary infection with C. albicans occurs.

The disease is observed during weaning, accompanied by diarrhea, hair lottery, agitation, low levels of zinc in the blood. Women's milk contains less zinc than cow's. Zinc preparations in the form of gluconate or sulfate should be included in the treatment.

Down syndrome

Newborns with Down syndrome may not always be able to suckle effectively at the breast. The help of the mother and medical staff is needed to teach the child to take the breast correctly and adequately. Use the position of the child near the mother's breast, which provides support for the child, taking into account the hypotension of his muscles, which is corrected by the coordinated movements of the mother. A pillow can be used to correct the position of the child. A pediatrician, cardiologist, geneticist, nurse, and other medical experts provide a mother's assistance in caring for her child. Breastfeeding is especially important for these children because they are prone to infection and have an increased rate of generalized infection.

Hypothyroidism

Newborns with hypothyroidism need to be breastfed because milk has high levels of thyroid hormones.

Hyperplasia of the adrenal glands

Newborns who received breast milk during the neonatal period had a lower frequency of spitting up, a stable clinical condition.

Breastfeeding a newborn with perinatal pathology

If a sick newborn child does not receive breast milk, then:

• there is a longer course of the disease, especially perinatal infections, sepsis;
• high level of complications of invasive therapy;
• the child loses more in weight and resumes it longer;
• a longer period of infusion therapy, partial parenteral nutrition is needed;
• the newborn does not receive immunobiological protection factors with mother's milk, which predetermines both a longer duration of the disease and a greater amount of medication, including antibacterial and immunoreplacement therapy;
• there is no psycho-emotional contact with the mother, the child does not receive emotional pleasure when feeding. Today it is known that the contact of a mother and a sick newborn child improves the blood circulation of the child's brain;
• the amount of breast milk in the mother decreases;
• the newborn may refuse to breastfeed after feeding; expressed milk.

Endorphins, the level of which increases in the case of psycho-emotional contact between mother and child, reduce vascular spasm, including the brain, intestines, lungs, which may be one of the mechanisms for improving the results of intensive care and nursing premature infants and infants with perinatal pathology who received breast milk. milk in constant contact with the mother,

If a sick child continues to suckle or breastfeed, this makes it possible:

• maintain optimal water and electrolyte balance;
• reduce the period of treatment of the child and the duration of his stay in the hospital;
• reduce the volume of invasive procedures, namely infusion therapy, parenteral nutrition;
• reduce the amount of medicines (economic effect for healthcare institutions);
• reduce the iatrogenic effect on the child;
• get emotional pleasure and psychological comfort when feeding;
• support and resume lactation in the mother during breastfeeding;
• ensure immunobiological homeostasis of the child's body.