Article title: Breastfeeding: NWHIC
Conditions: Breastfeeding, HIV, Hepatitis C, phenylketonuria, galactosemia, drug abuse, smoking
Why should I
How is breast milk different from formula?
For how long should you breast feed your baby?
Can a baby be allergic to her mother’s milk?
Why is breastfeeding good for mothers?
Who else benefits from breastfeeding?
Is there any time when a woman shouldn’t breastfeed?
Can breast cancer be passed through nursing?
Do breast implants affect breastfeeding?
What are some of the challenges of breastfeeding?
How can someone go back to working outside the home and still breastfeed?
Is it safe to take medications while breastfeeding?
If I choose to breastfeed, is there any right way to do so?
How do I know that my baby is getting enough milk from breastfeeding?
More than two decades of research have established that breast milk is the best or most complete form of nutrition for infants and that it protects infants from a wide array of infectious and noninfectious diseases. Some of these include diarrhea, respiratory tract infection, otitis media or ear infection, pneumonia, urinary infection, necrotizing enterocolitis (damage to the intestine and colon), and invasive bacterial infection. Breastfed infants, compared with formula-fed infants, also seem to have stronger immune systems to fight infection, resulting in lower rates of chronic childhood diseases, such as diabetes, celiac disease, inflammatory bowel disease, childhood cancer, and allergies and asthma. As a result, breastfed babies have lower rates of hospital admissions. Some studies also suggest that the type of fatty acids available in breast milk enhances brain growth and development in infants, giving them earlier visual acuity and cognitive function.
Breast milk has greater nutritional value than infant formula. Human milk contains just the right amount of fat, sugar, water, and protein for human digestion, brain development, and growth. Cow's milk contains a different type of protein that may be good for calves, but human infants can have difficulty digesting it. Bottle-fed infants tend to be fatter than are breastfed infants, but not necessarily healthier.
Breast milk also contains immunologic agents or the mother's antibodies to disease. These antibodies are transferred to the infant and act against bacteria, viruses, and parasites. Anti-inflammatory agents in breast milk help to regulate the body's immune system response against infection. Also, a breastfed baby's digestive tract contains large amounts of Lactobacillus bifidus, beneficial bacteria that prevent the growth of harmful organisms. Since the infant's immune system is not fully mature until about 2 years of age, breast milk provides an advantage that formula-fed infants do not have.
Human milk straight from the breast is always sterile, and is never contaminated by polluted water or dirty bottles, which can lead to diarrhea in the infant.
The Surgeon General, in the newly released Blueprint for Action on Breastfeeding, recommend that babies be breastfed exclusively for the first four to six months of life, preferably six months, and ideally through the first year of life. Protection against infection is strongest during the first several months of life for infants who are breastfed exclusively. Breastfeeding into the second 6 months of life protects against infection, and longer duration of breastfeeding may provide an even stronger protective effect.
The only acceptable alternative to breast milk is infant formula. The guidelines from the American Academy of Pediatrics state that solid foods can be introduced when the baby is 4 to 6 months old, to complement the breast milk diet. In the first 6 months, water, juice, and other foods are generally unnecessary for breastfed infants. A baby should drink breast milk or formula, not cow's milk, for a full year.
Human milk contains at least 100 ingredients not found in formula. Healthy babies are not allergic to their mother's milk, although they may have a reaction to something the mother eats. If she eliminates it from her diet, the problem usually resolves itself.
Does the baby know the difference between breast milk and formula?
Many psychologists believe the nursing baby enjoys a sense of security from the warmth and presence of the mother, especially when there's skin-to-skin contact during feeding. Parents of bottle-fed babies may be tempted to prop bottles in the baby's mouth, with no human contact during feeding. But a nursing mother must cuddle her infant closely many times during the day. Nursing becomes more than a way to feed a baby; it's a source of warmth and comfort.
Breastfeeding is good for new mothers as well as for their babies. There are no bottles to sterilize and no formula to buy, measure and mix. It may be easier for a nursing mother to lose the pounds of pregnancy as well, since nursing uses up extra calories. Lactation (breastfeeding) also stimulates the uterus to contract back to its original size and reduces post-partum bleeding. Breastfeeding also may lower the risk of pre-menopausal breast cancer and ovarian cancer.
A nursing mother must get needed rest; otherwise her body may decrease milk production. She must sit down, put her feet up, and relax every few hours to nurse. Nursing at night is easy. No one has to stumble to the refrigerator for a bottle and warm it while the baby cries. If she's lying down, a mother can doze while she nurses.
Nursing also is nature's contraceptive--although not a very reliable one. Frequent nursing suppresses ovulation, making it less likely for a nursing mother to ovulate, menstruate, or get pregnant. There are no guarantees, however. Mothers who don't want more children right away should use contraception even while nursing. Hormone injections and implants are safe during nursing, as are all barrier methods of birth control. The labeling on birth control pills says another form of contraception should be used if possible, until the baby is weaned, since estrogen may be harmful to infants. The only safe oral contraceptive for nursing mothers is a progestin-only birth control pill, also called the "mini-pill." Unlike oral contraceptives that contain both estrogen and progesterone, the mini-pill only contains progesterone and will not affect milk production.
Breastfeeding also is economical. Even though a nursing mother works up a big appetite and consumes extra calories, the extra food for her is less expensive than buying formula for the baby. Nursing saves money while providing the best nourishment possible.
Breastfeeding is not only good for infants and mothers, but can benefit the family, the health care system, the employer, and the nation as a whole. Even after accounting for the costs of breast pump equipment, if necessary, families can save several hundreds of dollars they would have spent on formula. Because breastfed infants are sick less often, they require fewer visits to the doctor, prescriptions, and hospitalizations. This results in lower medical costs for the nation. In companies with established lactation programs, absenteeism rates and medical costs are lower, and productivity is higher.
Most common illnesses, such as colds, flu, skin infections, or diarrhea, cannot be passed through breast milk. In fact, if a mother has an illness, her breast milk will contain antibodies to it that will help protect her baby from those same illnesses.
A few viruses can pass through breast milk, however. HIV, the virus that causes AIDS, is one of them. Women who are HIV positive should not breastfeed. Also, women with human T-cell leukemia virus type 1 (HTLV-1) should not breastfeed because of the risk of transmission to the child. Hepatitis C is another virus that may be transmitted through breastfeeding if the mother has cracked or bleeding nipples. Otherwise, the risk of Hepatitis C is the same whether breast or bottle fed.
An infant born with a condition called galactosemia cannot metabolize lactose, a sugar found in all mammalian milk, and must be fed plant-derived formula. Infants with phenylketonuria can be successfully breastfed, but doing so requires special clinical management.
Breast cancer is not passed through breast milk. Women who have had breast cancer can usually breastfeed from the unaffected breast. There is some concern that the hormones produced during pregnancy and lactation may trigger a recurrence of cancer, but so far this has not been proven. Studies have shown, however, that breastfeeding a child reduces a woman's chance of developing breast cancer later.
It is not known whether breastfeeding by women who have breast implants has an effect on the nursing infant. Many women with implants lactate successfully. Women who have had reduction mammoplasty may not be able to lactate if the glandular tissue has been removed or the connection between it and the nipple is interrupted.
For all its health benefits, breastfeeding can be challenging. In the early weeks, it can be painful if it is not done properly. A woman’s nipples may become sore or cracked if she allows her infant to latch on to the nipple, instead of the areola. She may experience engorgement more than a bottle-feeding mother, when the breasts become so full of milk that they’re hard and painful. She can reduce the risk of painful engorgement by using proper latch-on and positioning, as well as by allowing the baby to nurse on-demand. Engorgement can be relieved by frequent feedings, massaging the breast, and by applying warm or cold compresses between feedings. Nursing women may also develop clogged milk ducts, which can lead to mastitis, a painful infection of the breast. While most nursing problems can be solved with home remedies, mastitis requires prompt medical care.
Another possible challenge is that nursing can affect your lifestyle. A nursing mother must wear clothes that enable her to nurse anywhere. She must take special care to eat well and avoid food that might irritate the baby. She should stop smoking and check with her doctor before continuing taking prescription drugs. Drinking alcohol should be limited, since alcohol appears in breast milk.
Women who plan to go back to work soon after birth will have to plan carefully if they want to breastfeed. If her job allows, a new mother can pump her breast milk several times during the day and refrigerate or freeze it for the baby to take in a bottle later. Or, some women alternate nursing at night and on weekends with daytime bottles of formula. Her milk production can adapt to the alternating schedule.
If a woman’s workplace does not have a lactation program, she should ask her supervisor or Human Resources department to arrange for her needs. Working mothers who are breastfeeding need a private, clean relaxing environment where they can pump milk, an adequate storage place for the milk, adequate breaks during the day to pump, more flexible work schedules, and, ideally, onsite childcare facilities. If an employer gives a woman resistance to her needs, she can refer the employer to the Surgeon General’s Blueprint for Action on Breastfeeding, which encourages employers to make accommodations for breastfeeding mothers.
Most medications have not been tested in nursing women, so no one knows exactly how a given drug will affect a breastfed child. Since very few problems have been reported, however, most over-the-counter and prescription drugs, taken in moderation and only when necessary, are considered safe.
Even mothers who must take daily medication for conditions such as epilepsy, diabetes, or high blood pressure can usually breastfeed. They should first check with the child's pediatrician. To minimize the baby's exposure, the mother can take the drug just after nursing or before the child sleeps. In the January 1994 issue of Pediatrics, the American Academy of Pediatrics included the following lists.
Drugs USUALLY compatible with breastfeeding:
acetaminophen (like Tylenol)
antiepileptics (although one, Primidone, should be given with caution)
alcohol in moderation (large amounts of alcohol can cause drowsiness, weakness, and abnormal weight gain in an infant)
aspirin (should be used with caution)
caffeine (moderate amounts in drinks or food)
ibuprofen (like Advil)
You also can go to the American Academy of Pediatrics Web site (http://www.aap.org/) for a more detailed list of drugs.
Drugs That Are NOT Safe While Nursing:
Some drugs can be taken by a nursing mother if she stops breastfeeding for a few days or weeks. She can pump her milk and discard it during this time to keep up her supply, while the baby drinks previously frozen milk or formula. These include radioactive drugs used for some diagnostic tests like Gallium-69, Iodine-125, Iodine-131, or Technetium-99m, antimetabolites, and a few cancer chemotherapy agents.
There also are drugs with which new mothers have to choose between taking them or breastfeeding. Some of these drugs that should never be taken while breastfeeding include:
Bromocriptine (Parlodel): A drug for Parkinson's disease, it also decreases a woman's milk supply.
Most chemotherapy drugs for cancer: Since they kill cells in the mother's body, they may harm the baby as well. Examples of these include:
Cyclophosphamide: May suppress the baby’s immune system; unknown effect on growth; association with carcinogenesis; neutropenia.
Doxorubicin: May suppress the baby’s immune system; unknown effect on growth or association with carcinogenesis.
Ergotamine (for migraine headaches): Causes vomiting, diarrhea, convulsions in infants.
Lithium (for manic-depressive illness): Excreted in human milk.
Methotrexate (for arthritis): Can suppress the baby's immune system; unknown effect on growth or association with carcinogenesis; neutropenia.
Cyclosporine (for severe arthritis and psoriasis, aplastic anemia, Crohn’s disease, kidney disease, and for after organ transplant surgery): May suppress the baby’s immune system; unknown effect on growth or association with carcinogenesis.
Drugs of Abuse: Some drugs, such as cocaine and PCP, can intoxicate the baby. Others, such as amphetamines, heroin and marijuana, can cause a variety of symptoms, including irritability, poor sleeping patterns, tremors, and vomiting. Babies become addicted to these drugs.
Tobacco Smoke: Nursing mothers should not smoke. Nicotine can cause vomiting, diarrhea and restlessness for the baby, as well as decreased milk production for the mother. Maternal smoking or passive smoke may increase the risk of sudden infant death syndrome (SIDS) and may increase respiratory and ear infections. However, for women who cannot or will not stop smoking, breastfeeding is still advisable, since the benefits of breast milk outweigh the risks from nicotine exposure.
Drugs whose effects on nursing infants is unknown but may be cause for concern:
Diazepam, Lorazepam, Midazolam , Perphenazine, Prazepam, Quazepam, Temazepam
Amitriptyline, Amoxapine, Desipramine, Dothiepin, Doxepin, Fluoxetine, Fluvoxamine, Imipramine, Trazodone
Chlorpromazine Galactorrhea, Chlorprothixene, Haloperidol, Mesoridazine, Chloramphenicol, Metoclopramide, dopaminergic blocking agent, Metronidazole, Tinidazole
According to the FDA, the following advice should help make breastfeeding a pleasant experience for the mother and baby.
Get an early start: Nursing should begin within an hour after delivery if possible, when an infant is awake and the sucking instinct is strong. Even though the mother won't be producing milk yet, her breasts contain colostrum, a thick, yellowish fluid that contains antibodies to disease.
Use proper positioning: The baby's mouth should be wide open. After placing the nipple in the baby’s mouth as far back as possible, make sure his or her lips and gums are around the areola and not only on the nipple. This minimizes soreness for the mother. A nurse, midwife, or other knowledgeable person can help her find a comfortable nursing position.
Nurse on demand: Newborns need to nurse frequently, whenever they show signs of hunger, at least every two hours, and not on any strict schedule. Signs of hunger include increased alertness or activity, mouthing, or rooting. Crying is a late indicator of hunger. Newborns should be nursed approximately 8 to 12 times every 24 hours until satiety, usually 10 to 15 minutes on each breast. In the early weeks after birth, non-demanding babies should be aroused to feed if 4 hours have elapsed since the last nursing. This will stimulate the mother's breasts to produce plenty of milk. Later, the baby can settle into a more predictable routine. But because breast milk is more easily digested than formula, breastfed babies often eat more frequently than bottle-fed babies.
No supplements: Nursing babies don't need sugar water or formula supplements. These may interfere with their appetite for nursing, which can lead to a diminished milk supply. The more the baby nurses, the more milk the mother will produce.
Delay artificial nipples: A newborn has to learn how to breastfeed. It is best to allow time to establish a good sucking pattern before introducing a pacifier. Artificial nipples require a different sucking action than real ones. Sucking at a bottle could also confuse some babies in the early days.
Air dry: In the early postpartum period or until her nipples toughen, the mother should air-dry them after each nursing to prevent them from cracking, which can lead to infection. If her nipples do crack, the mother can coat them with breast milk or other natural moisturizers to help them heal. Vitamin E oil and lanolin are commonly used, although some babies may have allergic reactions to them. Proper positioning at the breast can help prevent sore nipples. If the mother is very sore, the baby may not have the nipple far enough back in his or her mouth.
Watch for infection: Symptoms of breast infection include fever, irritation, and painful lumps and redness in the breast. These require immediate medical attention.
Expect engorgement: A new mother usually produces lots of milk, making her breasts big, hard and painful for a few days. To relieve this engorgement, she should feed the baby frequently and on demand until her body adjusts and produces only what the baby needs. In the meantime, the mother can apply warm, wet compresses to her breasts, and take warm baths to relieve the pain. She also can express some milk before breastfeeding, either manually or with a breast pump. For severe engorgement, warmth may not help. In this case, she may want to use cold compresses as she expresses milk. Ice packs used between feedings can relieve discomfort and reduce swelling. Pain from engorgement also may be relieved by feeding the baby in more than one position, or gently massaging the breasts from under the arm and down toward the nipple. This will help reduce soreness and ease milk flow. Do not take any medications without approval from your doctor. Acetaminophen (e.g., Tylenol) may relieve pain and is safe to take occasionally during breastfeeding.
Eat right, get rest: To produce plenty of good milk, the nursing mother needs a balanced diet that includes 500 extra calories a day and six to eight glasses of fluid. She should also rest as much as possible to prevent breast infections, which are aggravated by fatigue.
Babies vary in their eating and diaper habits, but the American Academy of Pediatrics advises breastfeeding mothers to watch for certain signs that their babies are getting enough milk. These signs are as follows:
at least six wet diapers per day and two to five loose yellow stools per day, depending on baby’s age. (Stools should be loose and have a yellowish color to them. Be sure stools are not white or clay-colored.)
steady weight gain, after the first week of age.
pale yellow urine, not deep yellow or orange.
sleeping well, yet baby looks alert and healthy when awake.
For More Information...
You can find out more about breastfeeding by contacting the following organizations:
National Women's Health Information Center
HHS Blueprint for Action on Breastfeeding
Internet address: http://www.4woman.gov/Breastfeeding/index.htm
Food and Drug Administration
Internet address: http://www.fda.gov/fdac/features/895_brstfeed.html
National Institute of Child Health and Human Development
Internet address: http://www.nichd.nih.gov/
Women, Infants and Children (WIC) Program, USDA
Internet address: http://www.fns.usda.gov/wic/
American Academy of Pediatrics
Internet address: http://www.aap.org/
American College of Obstetricians and Gynecologists
Internet address: http://www.acog.com/
La Leche League International
Internet address: http://www.lalecheleague.org/
The Human Lactation Center, Ltd.
666 Sturges Highway,
Westport, CT 06880-2899
(203) 259-5995 (Voice)
(203) 259-7667 (FAX)
4062 First Avenue
San Diego, CA 92103-2045
(619) 294-7787 (FAX)
(619) 295-5192 (Voice)
This information was adapted from FDA Consumer October 1995 "Breastfeeding Best Bet for Babies" by Rebecca D. Williams, and from the Department of Health and Human Services’ Office on Women’s Health’s, 2000 "Blueprint for Action on Breastfeeding."
All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services; citation of the source is appreciated.
Publication date: April 2001
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