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Should breastfeeding continue when mom is sick?
By Kelly Bonyata, IBCLC
It is very, very rare for a mom to need to
stop breastfeeding for any illness. There are only a few very serious
illnesses that might require a mom stop breastfeeding for a period
of time or permanently. Per Dr. Ruth Lawrence, "HIV and HTLV-1
are the only infectious diseases that are considered absolute contraindications
to breastfeeding in developed countries" (Lawrence & Lawrence
2001).
During any "ordinary" illness such as a cold, sore
throat, flu, tummy bug, fever, mastitis,
etc. you should continue to breastfeed. Just remind your doctor
you are nursing so that if medications are needed he can prescribe
something that is compatible with breastfeeding.
Most medications are safe to take while breastfeeding, and for those
that are not recommended there is almost always an alternative medication
that is safe.
If mom has food poisoning, breastfeeding should continue.
As long as the symptoms are confined to the gastrointestinal
tract (vomiting, diarrhea, stomach cramps), breastfeeding should
continue without interruption as there is no risk to the baby. This
is the case with most occurences of food poisoning. If the food
poisoning progresses to septicemia, meaning the bacteria has passed
into mom's bloodstream (mom would most likely be hospitalized),
see this guidance from Dr. Ruth Lawrence:
"Maternal
infections of the genitourinary or gastrointestinal tract do not
pose a risk to infants except in the rare circumstances when septicemia
occurs and bacteria might reach the milk. Even in this event,
continued breastfeeding while the mother receives appropriate
antibiotic therapy that is compatible with breastfeeding is the
safest course for the infant. If the infecting organism is especially
virulent or contagious (e.g., an invasive group A streptococcal
infection causing severe disease in the mother), breastfeeding
should continue after a temporary suspension during the first
24 hours of maternal therapy. Prophylactic or empiric therapy
for the infant, against the same organism, may be indicated."
[source: Lawrence RM & Lawrence RA. Given the Benefits of
Breastfeeding, what Contraindications Exist?
Pediatric Clinics of North America 2001 (February);48(1):
235-51.]
The best thing you can do for your baby when you're sick is
to continue to breastfeed. When you have a contagious illness
such as a cold, flu, or other mild virus, your baby was exposed
to the illness before you even knew you were sick. Your milk will
not transmit your illness to baby, but it does have
antibodies in it that are specific to your illness (plus anything
else you or baby have been exposed to) - they'll help prevent baby
from getting sick, or if he does get sick, he'll probably not be
as sick as you.
Withholding your breastmilk during an illness increases
the possibility that baby will get sick, and deprives baby
of the comfort and superior nutrition of nursing.
You can also take measures to prevent baby from getting sick
by doing the usual things to prevent the spread of illness: washing
hands often, avoid sneezing/coughing on baby, limiting face-to-face
contact, etc .
When you're sick, it can help to just tuck baby into bed beside
you and nurse lying down whenever baby gets hungry. If baby starts
getting sick and not wanting to nurse, then see Baby
refuses to nurse when sick.
Many times moms don't nurse frequently enough and don't get enough
fluids to keep the milk supply going. Sometimes medications can
cause your milk supply to diminish, as well. To avoid a decreased
milk supply, drink plenty of fluids to avoid dehydration, continue
to nurse often and avoid/limit medications (like antihistamines)
that tend to decrease milk supply.
Page last modified:
02/03/2006
Written: 02/24/2002
References and Additional Information
@ 
@ other websites
References
Lawrence RM & Lawrence RA. Given the Benefits of Breastfeeding,
what Contraindications Exist? Pediatric Clinics of North America
2001 (February); 48(1): 235-51.
Lawrence RA. 1997. 
A
Review of the Medical Benefits and Contraindications to Breastfeeding
in the United States (Maternal and Child Health Technical Information
Bulletin). Arlington, VA: National Center for Education in Maternal
and Child Health.
Lawrence RA. Breastfeeding:
A Guide for the Medical Profession, 5th ed. St. Louis: Mosby,
1999.
Mohrbacher, N. and Stock, J. The
Breastfeeding Answer Book, Revised ed. Schaumburg, Illinois:
La Leche League International, 1997.
Riordan J and Auerbach K. Breastfeeding
and Human Lactation, 2nd ed. Boston and London: Jones and
Bartlett, 1999.
Breastfeeding and Hepatitis
Hepatitis
B and breastfeeding, World Health Organization UPDATE N22, November
1996
Breastfeeding
and Hepatitis C by Nancy E. Wight MD, FAAP, IBCLC
Hepatits
C Breastfeeding studies from womens-health.co.uk
Breastfeeding and HTLV-1
May JT. Molecular
Virology: Tables of Antimicrobial Factors and Microbial Contaminants
in Human Milk. Table 7: Effect of heat treatment or storage on antimicrobial
factors in
human milk. Accessed March 22, 2005.
"HTLV-1 (all cell-associated) is
destroyed within 20 minutes at 56°C (or 10 minutes at 90°C),
or by freezing at -20°C for 12 hours. Cell associated HIV
provirus DNA is destroyed by bringing milk to the boil. Boiling
milk destroys the immunoglubulins, lactoferrin, lysozyme and the
milk's bacteriostaic activity, but not the peptide beta defensin-1."
S Hino, S Katamine, T Miyamoto, H Doi, Y Tsuji, et al. Association
between maternal antibodies to the external envelope glycoprotein
and vertical transmission of human T-lymphotropic virus type I.
Maternal anti-env antibodies correlate with protection in non-breast-fed
children. J Clin Invest. 1995 June; 95(6): 2920–2925.
Journal
articles on HTLV & Breastfeeding
Breastfeeding and HIV
May JT. Molecular
Virology: Tables of Antimicrobial Factors and Microbial Contaminants
in Human Milk. Table 7: Effect of heat treatment or storage on antimicrobial
factors in
human milk. Accessed March 22, 2005.
"HIV is destroyed by milk pasteurisation.
HIV-1 is reduced ten-fold at 56°C for 121 seconds and at 62.5°C
for 10 seconds in liquid."
AnotherLook
at breastfeeding and HIV/AIDS "AnotherLook is a nonprofit
organization dedicated to gathering information, raising critical
questions, and stimulating needed research about breastfeeding in
the context of HIV/AIDS."
Mother
to Child Transmission information at UNAIDS.org
New Studies Point To Reduced Risk Of Postnatal HIV
Transmission During Breastfeeding (12/1/05) press release from the World Alliance for Breastfeeding Action (WABA)
Breastfeeding – Guarding Maternal & Child Health in an HIV & AIDS World - Summary from the WABA Symposium on
Breastfeeding and HIV & AIDS, Washington D.C. USA, 2 July 2005.
Breastfeeding and HIV International Transmission Study Group. Mortality
Among HIV-1-Infected Women According to Children's Feeding Modality:
An Individual Patient Data Meta-Analysis. J Acquir Immune Defic
Syndr. 2005 Aug 1;39(4):430-438.
Kuhn L, Trabattoni D, Kankasa C, et al. Alpha-defensins
in the prevention of HIV transmission among breastfed infants.
J Acquir Immune Defic Syndr. 2005 Jun 1;39(2):138-42.
HIV
transmission through breastfeeding : a review of available evidence.
WHO, 2004. (ISBN 92 4 156271 4)
HIV
and Infant Feeding. A guide for health-care managers and supervisors
WHO, 2003. (ISBN 92 4 159123 4)
HIV
and Infant Feeding. Guidelines for decision-makers. WHO 2003.
(ISBN 92 4 159122 6)
An
Analysis of the Inaccurate Information About HIV-Positive Women
and Breastfeeding by David Crowe (December 2002)
WABA/UNICEF
Colloquium on HIV and Breastfeeding (20-21 September 2002) includes
various papers and transcripts of the proceedings
Mothers
and babies and HIV: What is the risk of breastfeeding? by Pamela
Morrison IBCLC (Updated Jan 2002)
Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, Coovadia HM;
South African Vitamin A Study Group. Method
of feeding and transmission of HIV-1 from mothers to children by
15 months of age: prospective cohort study from Durban, South Africa.
AIDS. 2001 Feb 16;15(3):379-87.
Breastfeeding
and HIV: A Dilemma for the Developing World by Yvonne E. Vaucher,
MD, MPH (December 2001)
Infant
feeding choices for HIV positive mothers by Pamela Morrison,
IBCLC and Ted Greiner, PhD, from Breastfeeding Abstracts,
May 2000, Volume 19, Number 4, pp. 27-28.
Mother-Child
Transmission of HIV by Maryanne Stone-Jimenez, from Leaven
Volume 35, No. 1, February-March 1999, pp. 3-5
Position
Paper on HIV and Infant Feeding from the International Lactation
Consultant Association
Heat
treatment of expressed breastmilk (62.5C for 30 minutes) destroys
the HIV virus. A simple method called Pretoria Pasteurisation (see
below) has been found to result in undetectable levels of HIV-1
virus in expressed breastmilk.
Pasteurized
breastmilk as a replacement feed for the babies of HIV-infected
mothers by Pamela Morrison, IBCLC
Jeffrey BS. New,
simple local method for pasteurising HIV-positive mothers’
breast milk. MRC News (Medical Research Council of South
Africa) August 2000; 31 (4): 23-24.
Improvement
of the nutritional status of infants. from Research Highlights,
Maternal and Infant Health Care Strategies Research Unit, Medical
Research Council of South Africa (November 2001).
"In
this study, breast milk is pasteurised by the process of passive
heat transference by taking boiling water, placing breast milk
in a container in the water, and allowing it to cool. We have
found that if 500ml of water in a one litre aluminium cooking
pot is boiled, and between 50ml and 150ml of breast milk is placed
in a standard peanut butter jar in the water, the milk heats up
to between 59°C and 63°C for approximately 15 minutes.
This process is called Pretoria Pasteurisation and is very inexpensive,
requiring almost no technological support. Thus, almost any mother
can pasteurise her own milk.
"The
next step was to check if this process destroys HIV. This study
has been successfully completed and no living virus could be demonstrated
in breast milk from either HIV-infected mothers who expressed
their breast milk, or in HIV naive breast milk spiked with HIV.
"Over
and above killing the virus, a significant advantage of this inexpensive
method is that about 80% of the essential ingredients (antibodies,
vitamins, etc.) of breast milk are unaffected."
Jeffrey BS, Mercer KG. Pretoria
pasteurisation: a potential method for the reduction of postnatal
mother to child transmission of the human immunodeficiency virus.
J Trop Pediatr 2000 Aug;46(4):219-23.
Articles
on HIV and Breastfeeding by breastfeeding researcher Ted Griner,
PhD (about halfway down his main page)
Breastfeeding
Letters sent to the World Alliance for Breastfeeding Action
mailing list by Ted Griner, PhD, Coordinator of the WABA Research
Task Force (includes several on HIV and breastfeeding)
