Should I stop breastfeeding my baby if I think I have come in contact with the flu?

From the Center for Disease control http://www.cdc.gov/h1n1flu/infantfeeding.htm#d

No. Because mothers make antibodies to fight diseases they come in contact with, their milk is custom-made to fight the diseases their babies are exposed to as well. This is really important in young babies when their immune system is still developing. It is OK to take medicines to prevent the flu while you are breastfeeding. You should make sure you wash your hands often and take everyday precautions (http://www.cdc.gov/flu/protect/habits.htm). However, if you develop symptoms of the flu such as fever, cough, or sore throat, you should ask someone who is not sick to care for your baby. If you become sick, someone who is not sick can give your baby your expressed milk.

Protecting your baby against flu

Information sheet for parents from the International Lactation Consultants Association (ILCA)

Influenza (flu) can be very serious, especially in young babies. Luckily, there are many things mothers and other family members can do to help keep babies from getting sick, and to help babies recover more quickly if they do get sick.
Get Vaccinated!
Everyone who helps take care of your baby needs to be vaccinated against influenza. Make sure everyone gets the seasonal flu vaccine now and the H1N1 vaccine as soon as it is available.
• Pregnant women should be vaccinated as soon as possible, no matter what trimester of pregnancy they are in.
• Pregnant women and caregivers of infants less than 6 months old are priority groups for influenza vaccination, so they should be able to get these vaccines even if they are hard to find.
• Millions of pregnant and breastfeeding women have safely used seasonal influenza vaccines for many decades. Although the H1N1 vaccine is new, it was developed using the same process and is also expected to be safe.
• Recent studies have shown:
- Babies are better protected from influenza when they are born when their mothers were vaccinated during pregnancy.
Breastfeed!
Your milk is custom-made to protect your baby from infection and to fight germs that are around you, even if they are brand new germs, like the new H1N1 influenza virus.
• Breastfeeding is critically important during the first 6 months, when babies are too young to get the flu vaccine, because it is the only way to improve babies’ ability to fight flu infection. As babies get older and explore their world, they are exposed to many more germs. This is why breastfeeding continues to be an important way to protect babies’ health even after they are vaccinated.
• Avoid exposing baby to formula and items that can spread germs. When your baby gets formula, it’s harder for your milk to protect your baby’s health. This makes your baby more likely to get sick, and for sicknesses to be much more serious. Baby bottles and pacifiers are extremely hard to keep clean; they pick up all kinds of germs from hands, bags, and furniture. .
• Get Help. Ask an International Board Certified Lactation Consultant (IBCLC) any questions or concerns you have about breastfeeding.
- Before your baby is born, take a breastfeeding class.
- When your baby is born, ask for help if you have pain or other any problems getting started breastfeeding, and ask about getting help from a lactation consultant after you go home.
- When you go home, ask your family and friends for help so you and your baby can get lots of practice as you learn how to breastfeed.
- Talk to your pediatrician about breastfeeding.
Keep Baby Close!
As soon as your baby is born, snuggle with your baby skin-to-skin. Keep baby close after you go home, too. Make sure family and friends know this snuggling time with mom is a prescription for keeping baby healthy.
• Immediate skin-to-skin contact with mom makes your new baby’s immune system stronger and helps stabilize your baby’s heartbeat and breathing. Welcoming your baby this way also lets your baby latch onto your breast for the first time just right, all by himself. This makes breastfeeding much easier later on.
• Close contact with mom is important throughout infancy.
- Babies’ immune systems and brains grow better when they are held by their mothers.
- Being close helps you breastfeed as often as baby needs. This protects your baby against feeding supplements that make it harder for your baby to fight infection.
• Hold your baby in your arms, a sling, or other carrier, especially when you’re out and about. Keeping your baby close protects against exposure to germs and other people who may be sick, especially if you and your baby are around other children.
Ask Visitors to Wait
Ask family and friends to help you keep your baby healthy by staying away while they have a cough, fever, or other flu symptoms.
Get Rid of Germs
• Use a tissue – When you cough or sneeze, cover your nose and mouth with a tissue and throw the tissue in the trash after using it.
• In a pinch, an elbow will do – If you don’t have a tissue, cough or sneeze into the crook of your elbow – avoid coughing or sneezing into your bare hands.
• Wash your hands often with soap and warm water or alcohol-based hand rubs.
• Avoid touching your eyes, nose, and mouth. Wash your hands after you do.
• Avoid giving baby things that cannot be properly cleaned and can easily spread germs.
• Wash your baby’s hands with mild soap and warm water after being exposed to germs.
What To Do If…
YOUR BABY Becomes Ill with Flu
• Keep breastfeeding!! Your baby needs the infection-fighting antibodies in your milk now more than ever!
• Sick babies need to breastfeed even more often. Keep baby close and feed any time your baby gives you a feeding cue.
• Even if your baby has diarrhea or is vomiting, human milk is more easily and quickly absorbed than infant formula or electrolyte solutions.
• Always call your baby’s doctor if your baby becomes ill.
SOMEONE IN YOUR FAMILY Becomes Ill with Flu
• Call your doctor if you have been exposed to someone with flu symptoms (fever, cough, sore throat, body aches, headaches, chills and fatigue, diarrhea, or vomiting).
- Your doctor may prescribe an antiviral medication such as Tamiflu© or Relenza© to help you get well faster. These same medications are also used to protect you from getting the flu if you’ve been exposed to it.
- Antiviral flu medications work best when you begin them right after symptoms begin.
- Oseltamivir (Tamiflu©) and Zanamivir (Relenza©) are safe to take while breastfeeding. Do not stop breastfeeding in order to take these medications.
• Keep your baby at least 6 feet away from someone who is sick until the sick person’s fever has been gone (without fever-reducing medication) for 24 hours.
• Learn more at the website of the CDC at: www.cdc.gov/h1n1flu/guidance_homecare.htm
YOU Become Ill with Flu
• Get lots of rest and drink lots of fluids
• Ask a friend or family member who is not ill to help you take care of your baby so you can get better faster.
- If you are breastfeeding – keep breastfeeding. Flu is spread in the droplets that come from coughs and sneezes, not through breast milk. In fact, the antibodies your body makes to help you fight the flu are also in your milk, so breastfeeding can help keep your baby from getting sick!
• Wash your hands with soap and warm water before holding your baby and breastfeeding; wear a surgical mask while you are breastfeeding.
• Contact a lactation consultant for help if you are too sick to breastfeed.
- If you are not breastfeeding – ask a friend or family member to feed your baby.

International Board Certified Lactation Consultants (IBCLCs) are health professionals with special knowledge and experience helping breastfeeding families. They can help you know how breastfeeding is going, answer your questions, and help you find solutions.

H1N1 INFLUENZA & breastfeeding (Japan)

Due to the recent cases of H1N1 (swine) influenza in Japan, LLL Japan has issued a press release in Japanese :
http://llljapan.org/binfo/flu.html
and also the Japanese Association of Lactation Consultants:
http://www.jalc-net.jp/FAQ_ans/influ2009.html
These may be useful to share with your doctor in case you have flu symptoms and are breastfeeding.

For information on the H1N1 influenza in English see:
http://www.cdc.gov/h1n1flu/breastfeeding.htm (breastfeeding)
http://www.cdc.gov/h1n1flu/guidance/pregnant.htm (pregnant mothers)

Breastfeeding / H1N1 (Swine) Flu Recommendations for Physicians

Breastfeeding / Swine Flu Recommendations for Physicians from the Academy of Breastfeeding Medicine
New Rochelle, NY, May 12, 2009—Breastfeeding can limit the severity of respiratory infections in infants and is particularly important for minimizing the risk and effects of infection during an influenza outbreak, such as the current H1N1 influenza virus (also known as the “swine flu”) outbreak, according to recommendations released by the Academy of Breastfeeding Medicine (ABM). The Academy’s complete recommendations are available online at www.bfmed.org
The new guidelines presented by ABM urge physicians to support continued breastfeeding even if the mother is suspected of having the H1N1 influenza virus, since the infant would likely have been exposed to the virus before the mother’s symptoms appeared. Continued breastfeeding may help limit the severity of respiratory symptoms in infants that become infected.
Other key recommendations encourage continued breastfeeding even if the mother is taking either of the two antiviral medications prescribed to treat or prevent influenza infection (oseltamivir or zanamivir). Breastfeeding should also continue if an infant becomes ill with suspected H1N1 flu. Furthermore, if breast milk is only part of an infant’s diet, it would be wise to increase the amount of breast milk the infant receives during an influenza outbreak, perhaps supplementing breastfeeding with expressed or pumped milk.
Good hygiene, including regular hand washing around the baby, can help minimize exposure to respiratory droplets that may carry the flu virus. Limiting close contact by non-caretakers, use of a mask if a caretaker has flu-like or other respiratory symptoms, and avoiding crowds are other recommended actions to reduce risk of infant exposure. According to ABM President, Caroline J. Chantry, MD, "It is timely for physicians to be reminded that breast milk contains a myriad of antiviral and immune boosting components beyond specific antibodies that will help protect the infant even when a mother does not have preexisting immunity to a particular illness."

Do you feel bad when breastfeeding?

Some mothers have very strong negative feelings well up inside them while breastfeeding, just before the milk begins to flow. These mothers feel fine and happy the rest of the time, and they know they are not suffering from post partum depression, so what is it that makes these bad feelings happen right before the "let-down" starts?

This is a recently recognised condition called D-MER, or Dysphoric Milk Ejection Reflex and there is a lovely website dedicated to this exact topic, D-MER: because breastfeeding shouldn't make you feel this way. They have found that it is a hormonal condition linked to a drop in dopamine that seems to occur whenever milk is released. The good thing to know is that it is treatable.

Watch their video here and visit their web site for more valuable information:

Self diagnosing your breastfeeding problem

Living here in Japan without much support in our own language, and with so much information freely available on the internet, self-diagnosing your own breastfeeding problems seems easy and economical.

The trouble is that there is a lot of dubious information out there, and it can be hard to sift through it all to get to the good stuff when you have a crying or hungry baby on your knee, and you need a few more hours sleep yourself.

Getting qualified expert help may be crucial to the success of your breastfeeding relationship, so I encourage you to make contact with a real live person if you can, rather than to rely on articles from the internet alone. Years of experience helping real live mothers and babies with their specific breastfeeding situations counts for a lot when it comes to helping you and your baby. Having someone listen to exactly what is happening in your life with baby can help zoom in on the real problem, and following up with some well-referenced internet reading can be a good way of confirming your options.

La Leche League's network of trained volunteer Leaders all over the world helps mothers by phone or email, and discussion meetings are held in many different countries. Here in Japan we have English speaking Leaders in Tokyo, Sendai and Wakkanai, and occasionally there are Leaders on the US military bases. See here for contact details.

There are more international Board certified Lactation Consultants (with the intials IBCLC after their name) around the world now than ever before, and this past year alone, Japan has almost doubled the number of IBCLCs, to 270. As the qualification becomes more and more recognised as the gold standard in breastfeeding management and care, then we will hopefully see more and more staff in hospitals and clinics getting certified. It is a rapidly growing profession and it is very exciting to see improvements in the level of skill and care provided. For IBCLCs in Japan go here or here.

In the meantime, I continue to hear stories every week of parents who were given wrong advice or misinformation and the breastfeeding relationship has suffered as a result, maybe even ended prematurely. Parents are understandably disappointed (sometimes angry) when they hear that there may have been other options.

One example that comes to mind is the common advice by doctors in Japan to wean for 3 days while taking antibiotics. This is usually just wrong. There are many antibiotics which are perfectly safe to take while breastfeeding, and anyway, weaning is not something that can be done "cold turkey" for 3 days...then you would end up being very engorged and possibly even with mastitis from milk stasis, and a severely depleted supply when breastfeeding resumes. Telling the mother to wean for 3 days can have devastating consequences . And what about the baby? What will the baby drink for those 3 days? We know formula changes the way your baby's body works, and why would you do that unnecessarily for antibiotics? A tiny little bit of antibiotics in the milk has far less impact on your baby's health than 3 days of formula. Dr Thomas Hale has written an excellent book called Medications and Mother's Milk to which your doctor can refer to ascertain the safety of medications while nursing.

Another example is when a mother who is concerned about low milk supply is told by her doctor to "pump her milk to see how much she has". A mother expressing her breast, by hand or machine, is nothing like a baby drinking breastmilk directly! For a mother already worrying, being able to express only a few drops just confirms her fears, and is not productive to the ongoing breastfeeding relationship. Expressing milk does not give an accurate picture of the available milk. It would be more constructive for the doctor to educate the mother about ways of knowing her baby is getting enough. (We can judge if baby is getting enough milk by checking the urine and stool output, and by ensuring baby is breastfeeding frequently enough, not by measuring the mother's ability to efficiently express her milk, which is a learned skill in itself.)

It is incredible how much is misunderstood about fully breastfed babies and the way women's breasts work. Perhaps it is because the doctors and nurses have so little experience with successfully breastfed babies that they don't really have the faith or the belief that it is possible to fully nurture a child with breastmilk alone. Or perhaps it is just a general reflection of our society that doesn't value breastfeeding and the special relationship between a mother and baby. But if any of us can read articles on the internet and be informed about current breastfeeding topics and developments, you would hope that a health professional working with mothers and babies would also be keeping up-to-date too.

If you are breastfeeding and you are worried about anything in relation to your baby, as well as your doctor, get in touch with LLL or an IBCLC, and go over your concerns with them. Use them as a sounding board, for an instinct check. Sometimes what looks at first glance like a possible medical problem may just require a minor breastfeeding "tweak". Sometimes your baby may be doing something like refusing solid foods, or suddenly waking more at night or being very gassy. Check in with your LLL Leader or local IBCLC about these, as sometimes even if it doesn't look breastfeeding-related it might be! And sometimes, just talking to an experienced mother can help you decide if you should get a qualified opinion on things.

There is no substitute for your human resources who specialise in breastfeeding...we will do everything we can to support you and get you heading in the right direction, to reach your own breastfeeding goals. Providing you with the best information, the most up-to-date and reliable resources is what we do. Yes, this is a shameless plug...we LOVE what we do!!

When mum is sick

Can you still breastfeed when you are sick yourself? With cold, flu and tummy bug season upon us in Japan, this is a common question.

There are very few illnesses which would require a mother to stop nursing. You may feel tired, run down and unable to be much of a good mother, but the recommendation is to tuck yourself in bed with your baby and continue breastfeeding, rest, keep up your fluids, and if you need to take medications, let your doctor know you are breastfeeding. Most medications are compatible with breastfeeding, but here in Japan the doctor often says you will need to wean for three (or more) days while taking any medications, even simple antibiotics. The research shows that this is basically not true in most cases, and it is not hard to find this information through a simple google search. And remember, if it is a cold you have, then antibiotics aren't going to do anything for you anyway! If it is mastitis (a breast inflammation), it is crucial to continue nursing while taking the medications to avoid the risk of developing an abscess.

Think about the logistics and agony of weaning just for three days. During those three days, your breasts will become engorged and painful if you don't express your milk. Your milk supply will diminish if you don't express your milk regularly because of the "use it or lose it" prinicple. Your baby will need to be fed an alternative which is not without health risks. Most likely they will be fed by bottle, which they may not have experienced before...and without the built-in comfort of nursing directly, a normal part of life for your baby till now, your baby may also become quite stressed. This is not what you need while you are sick!

Your doctor may not have mentioned any of these things to you while handing you the medications. Is your doctor really supportive of breastfeeding? Did he/she mention that not continuing breastfeeding and substituing infant formula presents a greater risk to your baby's health than the risk of the transfer of a small amount of medication in your milk?

Dr Thomas Hale, pharmacologist and author of Medications and Mother's Milk (a book which all doctors should have on their shelves) tells us that in order for medications to transfer into human milk, they need to be highly lipid soluble, attain high concentrations in maternal plasma, be low in molecular weight, low in protein binding and pass into the brain easily. After those considereations, then we look at the bioavailability of the medication in the infant. He says :"numerous medications are either destroyed in the infant's gut, fail to be absorbed through the gut wall, or are rapidly picked up by the liver. Once in the liver they are either metabolized or stored". (p9) So factors like whether the medication passes freely into the mother's milk and the half life of the drug all need to be considered before we can really tell whether the dose the infant would receive via the milk is harmful to them. And we should not ignore that there are larger risks associated with formula use.

For more information see the articles on breastfeeding while mother is sick at kellymom. There are lots of references there for further reading too.

If you decide to use a herbal remedy, remember that just because it is herbal doesn't always mean it is safe while breastfeeding. This book has more information on herbs and nursing.

Note: Antihistamines or contraceptives containing estrogen have been linked to low milk supply.