Posted tagged ‘lactation’

Many medications are safe for nursing moms

February 22, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

An exhaustive new review should provide reassurance for nursing moms: many medications are safe for you to take, and genuinely serious reactions are very rare. Moreover, most serious reactions that do occur are to just a handful of medications. Common sense can be a good guide to keeping nursing babies safe when their moms take medication.

In this study, from February 2016, the authors did a truly comprehensive search of the literature for all studies and case reports of problems caused by medications in breast milk. The same authors had done a similar study in 2002, and decided it was time for an update.

Some of the findings:

  • About 60% of reported reactions occurred during the first month of life; and 80% during the first two months. This makes sense—the youngest babies consume the most milk per weight, and also have the least ability to metabolize medications.
  • 70% of adverse reactions were to medications that affect the brain, including narcotic pain medicines, antidepressants, and antipsychotic medications.
  • All of the deaths reported (there were only 2) involved one or more narcotic pain medications.
  • The use of multiple nervous system depressants at the same time increased the risk of serious reactions.

The bottom line: be careful especially with the youngest babies, especially when using multiple medicines, and especially when using medicines like narcotics that are known to cause slow and shallow breathing. That doesn’t mean nursing moms can’t take these medicine, but it does mean that they ought to take advantage of non-narcotic pain medicines, first, and if they do take narcotics their babies need to be monitored closely. A “pump and dump” strategy can be employed if mom needs potent pain medicines for a short time. It is not reasonable to expect nursing moms to live with untreated pain.

A great resource for nursing moms and the doctors who give them advice is the Lactmed database from the National Institutes of Health. You can look up just about any medication there, and see what studies are available to give you real and reliable information on milk transfer and potential issues with nursing babies. Some of the information is quite technical, but it’s better than the vague handwaving found in other places.

Speaking of which: one of the worst places to look for safety info for breastfeeding moms are the official “product inserts” of medications. They pretty much always say that nursing moms can never take any medicine (I don’t think they’re allowed to eat any food, either. Just water and rocks. Safety first!) Remember: product inserts are written by lawyers, for lawyers. They’re there to fulfill the crazy byzantine regulatory framework of the FDA. And to ward off lawsuits, and possibly vampires too. They’re not there to give parents or doctors useful information.

The health of moms is important, too. Often, moms stop taking their own medications out of fear that it may harm their nursing baby. Reviews like this, looking at what’s actually published and documented, provide some useful reassurance for moms and babies alike.

Wet nurse

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Can a wee drop ‘o formula help breastfeeding?

June 20, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

It’s a tiny little study, a simple one, but could it really be? Could offering newborns just a little bit of formula actually help support breastfeeding in the long run?

Researchers in California reported this month a study of 40 newborns, all of whom were recruited from families who had planned to nurse exclusively, and all of whom got off to a little bit of a rocky start. They had all lost > 5% of their birthweight after 1 day of life, which is not a disaster, but means that they weren’t getting super-good milk transfer yet. These 40 babies were randomized to either get 10 mL of formula (that’s 2 tsp) after nursing, or to continue exclusive breastfeeding.

By the end of their hospital stay, only 2 of the 20 early-formula babies were still getting formula (compared to 9 of the 19 control babies, whose parents had decided to go ahead and give formula on their own.) And: three months later, twice as many little-bit-of-early-formula babies were nursing, 80%, compared to only 40% of the families who had been randomized into the exclusive-breastfeeding group.

Small study, but those sure are impressive results.

To a practicing pediatrician, the outcomes of this study makes some sense. Though many babies nurse well, others seem to grow impatient waiting for mom’s milk to come in. These impatient babies can get cranky and upset, and mom get all sorts of conflicting information that only adds to their guilt and apprehension. A little wee drop o’ formula does seem to settle babies down, maybe enough for them to calmly nurse, and maybe enough to give mom the confidence to keep trying.

I realize that there are a lot of pediatricians and lactation counselors who won’t be very happy with this study—it flies in the face of our typical advice for nursing moms. But we’re here to be humble and learn, and this study might just have something to teach us about the best way to support breastfeeding.

Are tattoos safe during nursing?

January 21, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

“I’ve just recently gotten a tattoo and I’m still breastfeeding my daughter. Is it safe?”

There are two potential issues with getting a tattoo while nursing, though neither one is a huge risk.

One is that tattoo needles can theoretically transmit diseases like hepatitis C or HIV. However, legitimate tattoo artists use sterile or single-use needles along with other steps to ensure tattooing is safe. The risk of transmission if reasonable precautions are taken is very close to zero. So a back-alley tattoo is a bad idea, but a tattoo from a legit business that takes infection control seriously is unlikely to lead to unexpected diseases.

The other potential issue is from the tattoo ink itself. Tattoo inks are not regulated medically– that is, they’re not safety-tested to make sure they’re safe for injection. However, I know of no actual cases of babies being sickened from the chemicals in tattoo inks. In practice, tattoo inks have been used for many, many years and are probably safe. But there’s no medical authority watching over tattoo inks, and no one can guarantee that they’re safe for you or your breast milk.

I will say that it would be a bad idea to have a tattoo removed while nursing. Tattoo removal involves using a laser to break the ink pigment into little bits that can then be carried away and excreted by the body. That means that the tattoo ink bits will be in your blood, traveling around, and we really know even less about the safety of these little particles than we do about the safety of the intact ink. If you have a tattoo and you’re nursing, it is much better to leave it alone than try to have it laser-removed.

So: no one can guarantee that tattooing is safe while nursing, but with reasonable precautions it probably is, and if there is any risk it’s probably very, very small. The definite good health benefits of nursing both for you and your baby in my judgment mean that you ought to keep nursing, and don’t worry about it.