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MEDICAL CONDITIONS / ILLNESS

Aids; Arthritis; Asthma; Cancer; Chickenpox; Cold, Flu or a Mild Infection; Diabetes; Epilepsy; Fibromyalgia; Food Poisoning; Giardia; Headaches; Hepatitis, A, B or C; Herpes Simplex I (Cold Sores) or II (Genital Herpes); Lupus; Lyme Disease; Measles (Rubella, German); Multiple Sclerosis; Myasthenia gravis (MG); Postpartum Depression (PPD); STDs (Chlamydia, Gonorrhea, syphilis); Shingles; Thyroid problems

Many mothers wonder if they can breastfeed if they have a chronic health problem, or even if they have a simple cold. In most cases, a breastfeeding mother can continue to nurse, benefiting both mother and baby.

Mom may worry if her illness and/or medications she may need to take will affect her nursing baby. If mom's illness is more serious, she needs to know that her fears and worries are very real, and that there is help out there to get through whatever she may be facing.

AIDS

To date, research has not determined if Aids can be transmitted through breastfeeding. Most women who are HIV positive are urged to avoid breastfeeding until further research has been done. For more information on HIV and breastfeeding, click here. Scroll down to the HIV information.

Arthritis, Lupus, Fibromyalgia, Myasthenia gravis (MG), Multiple Sclerosis (MS)

Rheumatoid Arthritis (RA) is a chronic inflammatory disease. A mother with RA might experience pain and swelling of the joints and fatigue. Other chronic conditions such as Lupus, Fibromyalgia, Multiple Sclerosis (MS) and Myasthenia gravis (MG) also fall into this category. All of these conditions may make it painful for mother to do her normal daily activities.

A mother with any of these conditions may worry that her condition may somehow be passed on to her baby by breastfeeding. Most of these chronic conditions are caused by alterations in mother's immune system or are genetic and cannot be passed on through breastfeeding. She may think (or others may suggest to her) that it would be easier to use formula rather than nurse, however breastfeeding may actually be easier!

There is very little physical "work" to nurse a baby, unlike what is required in the preparation of infant formula. A breastfeeding mother can nurse lying down, permitting her to get more rest and relaxation. In addition, the breastfed baby is usually healthier, preventing mother from stressing over illnesses, financial worries related to illnesses, etc. Stress is associated with the flare-ups of most of these conditions.

Using lots of pillows for support, slings, and nursing lying down are a few suggestions that help these mothers nurse their babies successfully. In addition, family members can help by offering to do light housework, run errands, etc. These are the same types of suggestions often used for mothers who do not have any chronic conditions, but they are especially helpful to moms who may have health concerns.

A mother with a chronic condition such as those listed above needs to be aware that the hormonal changes in pregnancy may cause a remission in the condition during her pregnancy. Somewhere between two and eight months after the baby is born, many mothers indicate that their symptoms returned and often seem worse than they were prior to pregnancy. Breastfeeding is not the cause of the return of the symptoms, but the return of the symptoms may be related to a natural cycling of hormones.

There are medications that are considered to be compatible with breastfeeding for moms who have these chronic conditions. Mom should check with her doctor to see what course of treatment is advised. She can then do some research (i.e. checking Dr Hale's book, Medications & Mother's Milk) to see if the suggested medication  is compatible with breastfeeding, and if not, what alternative medications may be okay. She can then share this information with her health care provider.

For more information:

http://www.lalecheleague.org/llleaderweb/LV/LVFebMar00p3.html

http://www.lalecheleague.org/llleaderweb/LV/LVFebMar00p5.html

Asthma

Mothers who have asthma need not worry if they can breastfeed. Asthma therapy can be continued as needed while breastfeeding, and generally does not have to be changed. If mother is concerned about the type of medication she uses, she can check with her local LC or her doctor, to see what information there is available on that particular medication. Another resource she can use is Dr Thomas Hale's book, Medications and Mother's Milk, or via his website, listed above.

Cancer

The very thought of cancer is often very frightening, and for a new mother, who is breastfeeding, the feelings can be quite overwhelming. If a lump is found and mom is facing testing to determine if she does have cancerous cells, she should be encouraged to seek support from not only women who have been there and came through it, but also a knowledgeable group that can help support her needs and feelings in relation to her new baby and breastfeeding. She needs to be aware that in most cases, many types of cancer, if detected early and treated promptly, can be completely cured.

The first step she may face is testing to determine if she does (or does not) have cancer. Several tests may be used. They may include X-rays, ultrasound, mammograms, and fine-needle aspirations. These particular diagnostic tests do not affect mother's milk, so breastfeeding can continue.

If a mother needs a biopsy, she can still continue breastfeeding. In this case she would need to discuss her options and what medications will be used with her physicians, so that they can choose medications that would be compatible with breastfeeding during and after the surgery. If the area that the biopsy is done is close the nipple, she may temporarily suspend nursing on that side until the site has healed a little, then resume normal nursing. (Supply most likely will "catch up") She can nurse normally from the other breast.

Breastfeeding would need to be suspended temporarily if the doctors feel radioactive testing needs to be done. This is because radioactive materials accumulate in mother's milk and would be passed on to the baby. 

If mother has to temporarily suspend breastfeeding due to use of radioactive testing, she should pump regularly to maintain her milk supply. The milk should be discarded. Once treatment is complete, mother can return to breastfeeding if she desires to do so, and after her milk has been tested to be sure that there is no radioactivity there. Pumping frequently after the treatment is complete can help eliminate the radioactivity more quickly from her system.

Radiation therapy does not affect human milk but because there is a question of whether or not radiation therapy affects long-term ability to nurse from the affected breast, it is often advised that mother nurse from the unaffected breast only. In addition, radiation causes a reaction to the skin in much the same way sunburn would, so mom may find that the breast being treated would be too sore to comfortably nurse from anyway.

Breastfeeding during chemotherapy would not be advised nor recommended. It is almost always considered hazardous to a nursing baby.

Chickenpox

If mother comes down with chickenpox after her baby is born, she should see if covering sores may be acceptable to the doctor, so that she can continue breastfeeding. If the doctor feels a temporary separation is warrented, mom needs to regularly express her milk to maintain her supply. The milk is not "contaminated" and should be given to her baby, as it contains precious antibodies to help protect the baby from the virus. Once she passes through the contamination period (the sores are all crusted and no new sores have appeared for at least 72 hours), she should be able to safely resume breastfeeding.

Cold, Flu or a Mild Infection

Although many mothers worry about exposing their babies to a cold, flu, or an infection, she needs to know that even before she knew that she had the "bug", her body started producing an increase of specific antibodies that will help protect her baby from that particular "bug".

By the time that mom feels sick, the boost in antibodies is in "full force", so there is no need to suspend breastfeeding. While there is no guarantee that her baby will not come down with the same "bug", those specific antibodies the baby receives while breastfeeding should ensure that it's a milder case.

If mother were to put the baby on formula thinking that it would be better, her baby would then lose the protection of those specific antibodies to help fight the illness. In addition, it could very well result in her not only having to cope with feeling sick, but also with the physical discomforts of abrupt weaning (i.e. engorgement), and can be hard baby, who may be very bewildered by not being able to nurse, and become difficult to comfort.

Most moms find when they are feeling sick, it's easier for them to bring their babies into bed with them so that they can just "nurse and rest". For information on cold remedies compatible with breastfeeding click here.

Diabetes

Many diabetic mothers have enjoyed a successful breastfeeding relationship. While she needs to remain under the supervision of her doctor, the diabetic breastfeeding mom can certainly benefit from nursing her baby. Many breastfeeding mothers have said that they feel healthier than they have in a while, and they feel "normal", because they can nurse their babies much like a non-diabetic mother can.

Breastfeeding can reduce stress. This is important because stress aggravates diabetes. Breastfeeding while lying down which can help her get a little extra rest and relaxation, also very important to diabetic mothers. Breastfeeding may be beneficial to the diabetic mom, because the extra energy used to produce breastmilk may decrease the amount of insulin the mother needs.

What the mother may not know is that there are studies indicating that breastfeeding appears to offer some protection to the baby in reducing its risk of developing diabetes. 

Epilepsy

Mothers who have epilepsy have successfully breastfed their babies. The medications commonly used to control their seizures are not necessarily contraindicated when breastfeeding. Dilantin, for example is one medication commonly used to control seizures, and according to information from Dr Thomas Hale, author of Medications and Mother's Milk, hundreds of women have breastfed while taking Dilantin and their infants were just fine. Another medication commonly used for breastfeeding mothers is Tegretol (carbamazepine). It is listed in Dr. Hale's text as category L2 or "safer" for use in lactation. This drug is one of the most commonly used seizure medications in pediatrics.

Usually a mother can feel a seizure "coming on", and will have time to put her baby down in a safe place. Having a playpen or porta-crib in each room of the house, and on each floor if the house is not one level, is a common suggestion that can be very helpful to a mother with epilepsy.

Nursing in a large padded chair, or using pillows, blankets or towels to help pad a regular chair is another common suggestion. For moms who like to nurse lying down, another idea is to use guardrails on the bed, or pad the floor and nurse there.

Using gates across doorways and stairs is particularly helpful once baby becomes mobile, and is often a standard procedure used even if mom is not epileptic.

For additional support to the mother who has epilepsy, there is a newsgroup, alt.support.epilepsy, which provides an online meeting place for people with the disorder to share experiences and information.

Additional info on breastfeeding and epilepsy can be found:

http://www.medhelp.org/perl6/neuro/archive/10705.html

http://www.parentsplace.com/expert/lactation/qas/0,,239838_106149,00.html

Food Poisoning

Food poisoning sounds scary, but is not normally harmful to the nursing baby. It usually stays localized in mom's intestinal tract and will not pass into her milk.

It may cause vomiting, cramps and diarrhea, and almost always passes within a few days. As long as the symptoms are localized in the abdominal area, breastfeeding can continue without interruption.

In rare cases, the food poisoning becomes systemic, or gets into the bloodstream. In this case mother would become extremely ill, and breastfeeding would need to be suspended until she has antibiotics to clear the infection (when the infection is systemic the infection would pass into the milk). Regular pumping to prevent engorgement and maintain supply is recommended, so that she can resume nursing once the infection is under control.

Additional information on food poisoning and breastfeeding can be found here:

http://www.nursingmother.com/helpme/helpme_asklc_ans35.html

Giardia

Giardia is a parasitic infection that causes diarrhea. It appears the medication most commonly used to treat Giardia is Flagyl (metronidazole). This is used commonly in pediatrics to treat gastrointestinal infections. Additionally, according to information from Dr Hale's site, many breastfeeding mothers have used Flagyl with no adverse reactions reported in their babies. The amounts passed to the nursing baby appear to be far lower than what the baby would receive if he were being treated directly (pediatric dose). An alternative drug used to treat Giardia is Furazolidone. Drug resources indicate that the use of this drug is compatible with breastfeeding, except in infants with the rare G6PD deficiency.

Headaches

Many women who suffer from severe, or migraine headaches, are concerned about treating their headaches while breastfeeding. There are medications used to treat these headaches, such as Imitrex or Fioricet, which can be used while breastfeeding.

Frequent headaches might be hormonally related, as many women report severe headaches prior to the onset of their periods or ovulation each month, however there seem to be less instances of severe headaches while they are breastfeeding.

For information on natural healing techniques for migraines, click here.

Hepatitis, A, B or C

Hepatitis A, ("infectious hepatitis") is the short-incubation form of viral hepatitis. There is no need to suspend or stop breastfeeding if mother contracts Hepatitis A.

Hepatitis B, ("serum hepatitis"), is the long-incubation form of viral hepatitis. Hepatitis B symptoms, though similar to those of Hepatitis A, are often more severe and longer lasting. If a mother is diagnosed with Hepatitis B, (after pregnancy) her baby can be given a vaccine that will allow breastfeeding to continue without interruption. If a mom is diagnosed prior to delivery, and her baby is treated immediately, the baby may be breastfed.

Hepatitis C does not appear to be transmitted by breastfeeding. Mothers with chronic hepatitis C are often advised that they can nurse their infants, but they should discuss this with their physician. Other types of infections need to be evaluated by the obstetrician and pediatrician, but nearly all will be found to be safe for breastfeeding.

More information can be found here:

http://www.who.int/chd/publications/newslet/update/updt-22.htm

http://www.hepatitis-central.com/hcv/news/nov99/transmission.html  

http://www.aap.org/family/brstguid.htm

http://www.babycenter.com/expert/8840.html

Herpes Simplex I (Cold Sores) or II (Genital Herpes)

The Herpes virus is spread through contact with open sores. A mother who has herpes should take care to cover the sores so that her baby does not touch the open sore. If there are sores on mom's breast(s), and they can be covered so that the baby doesn't touch them, breastfeeding can continue. She should wash her hands before holding the baby and after any sores are touched. If mom has cold sores on or near her mouth, avoid kissing the baby.

If the sore is on the nipple or areola, or anywhere where baby may come into contact with it while nursing, it may be best for mom to express her milk until the sore(s) heal. If the other breast is unaffected, breastfeeding can continue on that side uninterrupted.

Mother should be careful not to contaminate her milk via hand contact with sores, or from contact with breast pump. Milk that might be contaminated should be discarded. Milk that has been carefully expressed and contamination avoided can be given to the baby.

While a mother should discuss these issues with her doctors, breastfeeding can be initiated and continued with proper precautions.

More on herpes and breastfeeding can be found here:

http://www.babycenter.com/expert/8840.html

http://www.lalecheleague.org/FAQ/herpes.html

Lyme Disease

There is currently no evidence that Lyme disease can be transmitted by breastfeeding. More research needs to be done. Most breastfeeding experts advise that there seems to be no danger in continuing to breastfeed if Lyme disease is suspected or diagnosed. 

Infected deer ticks carry Lyme disease. Symptoms include a circular - or "bulls-eye" - rash (which usually appears within three to thirty-two days after being bitten by the infected tick); fever; headache; chills, and fatigue.

Mothers should receive proper evaluation by her doctor if Lyme disease is suspected, and if diagnosed, should begin proper treatment immediately. Breastfeeding can then continue. For additional information on Lyme disease:

http://www.babycenter.com/expert/8840.html

Measles, Rubella

Measles - While it does happen, most women have either had measles or received a measles vaccine as a child, so having the measles as an adult is rare. If mom is unsure if she's ever had measles or a vaccine for measles, she should consult with her doctor.

The real danger is to the unborn baby, or the newborn, so if mother catches measles some time after giving birth, no special precautions are necessary. Mom's milk will not transmit the virus, and it will contain antibodies to help the baby fight it off. If the baby catches the measles after birth, it is almost always a mild case.

Rubella is a mild infectious disease that is usually no more serious than a common cold is. Again, the concern is to an unborn baby whose mother catches rubella before the babe is born, not to a baby whose mother catches it in the weeks following birth. If mother contracts rubella, her baby will have been exposed to it long before she begins to have the symptoms of it. The baby will do better if breastfed, as the immunities will help protect him. Human milk may even provide a natural immunization to rubella.

Postpartum Depression (PPD)

Postpartum Depression is more common than many realize, and although it may be more frequent among non-breastfeeding mothers, those who nurse their babies may also have ppd.

Breastfeeding can help because of the hormonal influences having a calming effect, but in some cases, especially if there is a family history of ppd, mom may need some "outside" help. Sharing the ups and downs with close family or friends can help her work through the issues, and not bear it alone. If it becomes difficult to function on a daily basis, talking with her doctor is recommended. There are medications available for mothers who suffer with ppd that are compatible with breastfeeding.

STDs (Chlamydia, Gonorrhea, syphilis)

Chlamydia, Gonorrhea and Syphilis are probably the most common STDs. Clamydia and Gonnorrhea are not transmitted through breastfeeding. In the case of syphilis, the baby can continue to breastfeed if there is no contact with the sores. All of these STDs are treated with antibiotics, and breastfeeding can continue.

It is important if a mother suspects she has an STD that she go to her doctor for an exam and discuss with him/her options for treatment. In most cases, STDs (such as those listed above) can be cured, HIV and Herpes being two of very few exceptions.

For more information on these and other STDs:

http://www2.parentsplace.com/expert/lactation/basics/qa/0,3459,6307,00.html

Shingles

Shingles is not a contraindication to breastfeeding or using the milk. It may be treated with Acyclovir (zovirax) which is AAP approved for breastfeeding mothers.

Thyroid problems

Hormonal changes during pregnancy and/or breastfeeding can cause thyroid levels to temporarily increase or decrease, even if the mother has never experienced any thyroid problems before. Lactation, however, does not cause thyroid dysfunction. For many this is also a temporary condition.

The thyroid gland controls the rate of all the body's metabolic processes. For the mother who wishes to nurse her baby, thyroid issues are not a problem and not a reason for her NOT to nurse. She should of course be under the care of a doctor who supports her desire to breastfeed and monitors her thyroid function and medications carefully. Most cases of either type of thyroid concerns (over active or under active thyroid) can be diagnosed by the use of simple blood tests. Mother may want to talk to her doctor about having an ultrasound of the thyroid done first. There is no need to stop breastfeeding for this, and it might be a good first step, as opposed to radioactive tests. Occasionally, however, the need for radioactive testing and visualization of the thyroid are recommended.

If radioactive testing is unavoidable, temporary weaning is necessary. This is necessary any time radioactive testing (radioactive iodine injection) is necessary. Breastfeeding while the radioactivity is still present in the milk would expose the baby to radioactivity.

The length of time the mother needs to suspend breastfeeding will depend on the type and dose of radioactive material used for the test. Technetium-99m (Tc-99m) pertechnetate is usually the preferred agent used (cessation of breastfeeding only required for 30 hours).

A test will need to be done to make sure the radioactivity is completely gone. This is done by a facility that has access to a Geiger counter. Baby should be kept away from the area that will be injected (around the thyroid gland) because just being near that area can expose him to "excess" radioactivity.

During the temporary suspension of breastfeeding, mother should express her milk regularly to maintain supply. Frequent pumping can also help to eliminate the radioactive materials from her system. Milk expressed during this time should be discarded. When supplementing during the time breastfeeding must be suspended, use a bottle nipple that is either a newborn or slow flow size so that the baby does not begin to prefer the "ease" of the bottle, and balk at returning to the breast.

The under active thyroid, or HYPOthyroidism, is very common. Symptoms may include fatigue, depression and poor appetite. It may also result in a low milk supply and thus affect baby's weight gain. The symptoms may be overlooked or blamed on being a new mother and/or on breastfeeding itself.

Medications for hypothyroidism are NOT contraindicated during breastfeeding. The supplements that mother takes to treat this condition will not harm the nursing baby.

The overactive thyroid, or HYPERthyroidism, requires some close monitoring but does not demand weaning. There are medications used for hyperthyroidism that are compatible with breastfeeding, but the nursing baby should be frequently checked to be sure that it's thyroid levels are okay. For the overactive thyroid, the preferred drug for nursing mothers is PTU.

"If" the baby's thyroid levels drop as a result of mom's intake of the thyroid medication, rather than weaning, it should be a consideration to give the baby a thyroid supplement.

Additional information on thyroid issues can be found here:

http://www.thyroid.net/

http://neonatal.ttuhsc.edu/lact/html/radio.html

Sources for above information include, but are not limited to:

The Breastfeeding Answer Book, LLL
Breastfeeding and Human Lactation, Riordan & Auerbach.
Medications and Mother's Milk, Thomas Hale, PHD

Copyright 2000 - 2006  Jim Yount

Send email to Paula Yount for any questions or comments about this site.

Disclaimer:  The pages contained herein are meant purely for informational purposes and every effort is made to provide accurate and up-to-date information. This information, however, is not meant to take the place of your doctor, nor should the information contained on this web site be considered specific medical advice with respect to any specific person and/or any specific condition. The author, therefore respectfully but specifically disclaims any liability, loss or risk - personal or otherwise - that is, or may be, incurred as a consequence, directly or indirectly, from use or application of any of the information provided on this web site.