Chapter 10
d. Almost all human milk contains traces of many environmental contaminants, but many studies confirm the superiority of breastmilk in spite of these contaminants.
in most cases, a preterm or newborn infant will be more susceptible to the effects of caffeine than an older baby or nursing toddler.
Silicon ( breast augmentation-increase in size) - silicone breast implants have platinum levels that exceed those found in the general population
-incidence of capsular contracture is also higher with silicone implants than with saline. -is severe scar tissue formed-impair milk supply
Lactation consultant
-to inform mothers about treatment options, which may include complementary medicine.
What mothers can do ?
- Use the least offensive drug -adjusting her schedule for taking the drug and avoiding medications with long plasma half-life.
BC
-just share the info do not give your opinion -Document everything -Mother should receive a copy or electronic form about the drug ( info) -DO NOT recommend meds -that considered prescribing -If mother ask you about a treatment: you can tell her" other mothers have found this treatment helpful. Send the info to her to share it with her Dr.
Environmental toxins are deposited
- primarily in fat and are excreted through the mother's milk
Herbal tea: -Caution women against high intake of herbal tea as a substitute for caffeinated drinks, as herbal teas may contain active ingredients that can pass into human milk and cause toxic effects.
-Cathartics such as buckhorn bark and senna can cause cramps and diarrhea both in the infant and in the mother. -Chamomile tea may sensitize the infant to ragweed pollen and cause an allergic reaction. -Sage, parsley, and peppermint inhibit lactation; women often use them for weaning
Drugs in the mother's milk may either increase or decrease milk production and secretion
-Cause changes in the baby's behavior -feeding, and sleeping patterns such as fussiness, lethargy, rash,vomiting, or diarrhea
A medication that is considered safe during pregnancy may not necessarily be safe during lactation
-During pregnancy, the maternal liver and kidney detoxify and excrete substances for the fetus through the placenta. -During lactation, however, the infant must handle the drug on his or her own
Drugs of abuse
-Prenatal use of recreational drugs is associated with fetal distress, lower Apgar scores, impaired fetal growth, impaired neurodevelopmental outcome, and acute infant withdrawal, SID Breastfeeding mothers should avoid all drugs of abuse
How accurately share info from lactmed
-Read the relevant info to the mother, -Copy or scan the info and send it to the mother about the drug -Include the copyright and front cover page -Include a link of the drug information on lactmed -Send the info to the mother so he can discuss with her health care provider - Ask mother to repeat back to you her understanding of the information that you shared -If mother needs more technical info call BRAID, [email protected]
Caffeine
-Some women appear to have low absorption and efficient metabolism and excretion, so that levels of caffeine in their milk remain low. Given these variations, each mother-infant pair is unique with respect to caffeine response - watch for signs of caffeine sensitivity in their babies, such as wakefulness, hyperactivity, and colicky behavior -Newborn and preterm babies are particularly susceptible to caffeine's effects, because their immature digestive systems take longer to eliminate caffeine from the body
Alcohol
-reaching the same level in the mother's milk as it does in her blood -Excessive amounts are known to block the release of oxytocin and affect letdown -It is generally considered safe to breastfeed when mother feels normal again—that is, when the effects of the alcohol have worn off -If a mother consuming more than one or two drinks at a time, or if you suspect alcohol is a problem for her, she may need to be referred for help. -Be aware that heavy alcohol use and maternal depression can be a sign of intimate-partner abuse -Alcohol consumption can cause sleepiness in the baby -can result in lower weight gain
A drug that is safe for the fetus and the breastfeeding infant
-still affect the mother's letdown reflex, milk production, or milk secretion.
Consideration of meds:
-the degree to which it is excreted into the mother's milk and its possible effects on the infant .
Factors that influence the level of a substance found in the infant's bloodstream include :
1-how soon after birth the mother takes a medication- more of a medication can penetrate the mother's milk several days postpartum ,than in later weeks following the infant's birth 2- how the medication is metabolized 3- what the baby's age and size are-An older and larger baby may be able to metabolize a substance more effectively-. The baby's age will also determine the ability of the liver to detoxify a substance and excrete it in the urine or stool.
Maternal diet, especially fish consumption, is a factor in breast milk levels of certain pollutants.
All recreational drugs are contraindicated for use by breastfeeding women.
Marijuana can lower or inhibit prolactin levels and compromise the mother's ability to produce sufficient quantities of milk
Amphetamines,- the mother should wait 24 to 48 hours after taking them before breastfeeding -associated with a baby's death, Hallucinations, extreme agitation, and seizures
Over the counter medication pose a risk to the infant because the moms will use them without knowing the effects on infant or milk production.
Antihistamine -pseudoephedrine can lower mothers' milk production by as many as 24 percent - produce sedation in the baby -mother should watch for unusual changes in her baby's behavior, feeding, and sleeping patterns such as fussiness, lethargy, rash, vomiting, or diarrhea-when they are taking over the counter meds or any other meds
When a mother ask about a medication-while nursing?
Document all communication-both verbal or written Ask mother_ generic, trade name, dosage, reason for taking the drug Mother's name- email, phone number Baby's age and health status Other meds the mother's taking Ask- do you know about Infant risk center -have you called them -If not give the number: 806-352-2519 www.infantrisk.com
Cocaine -Effects of cocaine intoxication in the infant include irritability, jitteriness, tremors, increased heart and respiratory rates, and convulsions orseizures
Heroin-It can cause increased sleepiness and poor appetite in the infant, resulting in an undernourished baby -ineffective sucking reflex may also result from heroin ingestion, as well as tremors, restlessness, and vomiting Methadone-The AAP has placed methadone in the approved category for breastfeeding women -Methadone is an opiate that is sometimes given to heroin addicts in recovery. -Buprenorphine is a newer treatment for heroin addiction,for postpartum pain associated with cesarean section-found a correlation with low infant weight gain
When a mother drinks alcohol, the level of alcohol in her milk equals that which is in her blood. b. A Canadian health program recommends that mothers wait at least two hours per drink to avoid unnecessary infant exposure to alcohol. c. Daily consumption of more than one or two drinks a day may expose the baby to unhealthy amounts of alcohol as well as affecting the mother's ability to care for her child.
Mothers can reduce their exposure to environmental contaminants by: a. Avoiding exposure to chemicals such as oil-based paints, glues, solvents and cleaners. b. Limiting ingestion of swordfish, albacore tuna, fats in meats and organ meats.
A BC cannot directly advise a mother as to the safety of any substance.
One important factor is the binding capacity of the medication with protein. When drugs are tightly bound to protein in the mother's blood, they are less likely to end up in her milk. mothers need to share with their physicians ALL of the medications, herbs, and supplements they are currently taking, because any substance might interact with other substances and cause a problem that none of them alone would cause. You can encourage a mother to ask her healthcare provider, "Is the drug I am using also used to treat infants directly?" -drugs that are given directly to infants should be compatible with breastfeeding.
To locate a particular medication in a drug listing, you first need to determine the drug's generic name.
Recommended sources include Medications and Mothers' Milk, by Hale (2010); Clinical Therapy in Breastfeeding Patients, by Hale and Berens (2002); Drug Therapy and Breastfeeding, by Hale and Ilett (2002); Non-prescription Drugs for the Breastfeeding Mother, by Nice (2007); and Drugs in Pregnancy and Lactation, by Briggs et al. (2008).
Infant dose of less than 10 percent of the adult dose is considered safe
When a substance passes into the milk, the infant's gastrointestinal (GI) tract often offers protection from it, either by not absorbing it or by altering it.
o Avoid excessive alcohol consumption. o Avoid all drugs of abuse.- o Avoid occupations, hobbies, and fabrics that involve possible exposure to chemicals.
o Avoid eating shark, swordfish, king mackerel, and tilefish to lower mercury intake -limiting consumption of freshwater fish o Limit consumption of canned albacore tuna and other fish. o Avoid eating organ meats-liver, gizzards, hearts, brains, intestines (has higher concentrations of toxins) o Wash or peel fresh fruits and vegetables.
• Questions to ask about a medication: o Will it pass into the mother's milk and be absorbed in the baby's GI tract? o Can the baby safely be exposed to the substance as it appears in the milk?
o How soon after birth will the medication be taken? o What is the baby's gestational age?
Applying what you learned— • Recommend that mothers minimize effects of a medication through the following steps:
o Take the medication immediately after nursing or 3 to 4 hours before the next feeding. o Avoid breastfeeding when the medication is at its peak level in the milk. o Avoid drugs with a long half-life - This form is more difficult for the baby to eliminate and could build up over time to higher concentrations in the baby's plasma. o Select the least offensive drug -Medications Forum, a Web-based forum for healthcare professionals, is a key resource that provides information about new drugs on the market and their propensity for transfer into breast milk-www.ibreastfeeding.com
• Recommend that mothers: o Consider alternatives that do not involve medication or substitute a safer medication. o Weigh the benefits of a medication against its possible risks to the baby.
o Weigh the risks of a medication to the baby against the risks of artificial baby milk. o Avoid nicotine and tobacco, or time breastfeeding to minimize the baby's exposure to these substances through breastmilk.- nicotine, and therefore smoking, as incompatible with breastfeeding. -She can also time her breastfeeding to minimize the baby's exposure in her milk, smoking after a feeding rather than just before it - Children whose parents smoke in the home have a greater susceptibility to respiratory ailments, including asthma, -Exposure to secondhand cigarette smoke is linked to increased incidence of otitis media,sudden infant death syndrome (SIDS), Depressed autonomic cardiovascular control - Nicotine in the mother's milk can cause fussiness, diarrhea, shock, vomiting, rapid heartbeat, andrestlessness in an infant. Altered sleep patterns -Mother may experience a decrease in milk production due to lowered prolactin levels, leading to poor infant weight gain -Diminish the mother's milk secretion, lower the fat concentration in her milk, or inhibit her letdown reflex if the mother smokes immediately before feeding her baby - ask mothers of slow-gaining babies whether they smoke - Mothers who smoke will need twice the usual intake of vitamin C because smoking interferes with the body's ability to use that vitamin
Social toxicants: • Newborn and preterm babies are especially susceptible to caffeine because it takes them longer to eliminate this toxin. • Generally, having one or two drinks socially is not a problem in relation to breastfeeding.
• A mother may breastfeed when the effects of alcohol have worn off. • All recreational drugs are contraindicated.
Environmental contaminants: cont • PCBs affect the mental development of children. • BPA has been found in human milk.-It has also been linked to breast cancer and to the early onset of puberty
• DDE reduces protection against atopic disorders such as asthma, eczema, and hay fever. -Several studies have found that women with higher levels of DDE in their milk have more difficulty with milk production and are more likely to stop breastfeeding earlier, which implies that this chemical may interfere with lactation
Environmental contaminants: • Silicone breast implants have not been proven dangerous when breastfeeding. • Toxins are primarily deposited in fat and are found in breastmilk.
• The flame-retardant chemicals found in many modern-day products affect learning, memory, behavior,thyroid hormones, and other bodily functions when they are passed to children through breastmilk.
Medications: • Few medications are contraindicated in breastfeeding. • In general, a relative infant dose of less than 10 percent of the adult dose is considered safe.
• When counseling mothers, lactation consultants should use only drug information from well-documented sources. • Lactation consultants should become acquainted with drug groups and their risks and benefits.