If a lactating woman reports fever, chills, and malaise, mastitis should be considered. Treatment includes frequent and complete emptying of the breast and antibiotics. Breastfeeding usually should not be stopped because the mother’s mastitis commonly has no adverse effects on the breastfed infant.
Tuberculosis (active) Should not breastfeed; expressed milk may be provided to child.
Varicella Should not breastfeed; expressed milk may be provided to child.
H1N1 influenza Should not breastfeed; expressed milk may be provided to child.
Herpes simplex infection of Should not breastfeed; expressed the breast milk may be provided to child.
virus (HIV) mothers are not recommended to breastfeed. In developing countries women are recommended to combine breastfeeding with antiretroviral therapy (ART) for 6 months.
Use of phencyclidine (PCP), Recommended to stop use cocaine, or amphetamines of drugs as it can affect infant neurobehavioral development. Mothers enrolled in supervised methadone programs are encouraged to breastfeed.
Alcohol Limit ingestion to less than 0.5 mg of alcohol per kg of body weight due to association with motor development.
Radiopharmaceutical agents Express milk before exposure to feed infant. Express milk and discard during therapies. Radioactivity may be present in milk from 2 to 14 days, depending on agent. Consult with nuclear medicine expert.
Antineoplastic and Substitute formula. immunosuppressive agents
Modified from Eidelman AI, Schanler RJ: American Academy of Pediatrics
Section on Breastfeeding. Breastfeeding and the use of human milk,
Pediatrics 129(3):827–841, 2012.
Untreated mastitis may also progress to a breast abscess. If an abscess is diagnosed, treatment includes incision and drainage, antibiotics, and regular emptying of the breast. Nursing from the contralateral breast can be continued with a healthy infant. If maternal comfort allows, nursing can continue on the affected side.
Maternal infection with human immunodeficiency virus (HIV) is considered a contraindication for breastfeeding in developed countries. When the mother has active tuberculosis, syphilis, or varicella, restarting breastfeeding may be considered after therapy is initiated. If a woman has herpetic lesions on her breast, nursing and contact with the infant on that breast should be avoided. Women with genital herpes can breastfeed. Proper hand-washing procedures should be stressed.
There are limited numbers of medical contraindications for breastfeeding, including pediatric metabolic disorders such as galactosemia, and infants with phenylketonuria, although infants with the latter may alternate breastfeeding with special protein-free or modified formulas. Maternal contraindications are shown in Table 27-1.
Any drug prescribed therapeutically to newborns usually canbe consumed via breast milk without ill effect. The factors that determine the effects of maternal drug therapy on the nursinginfant include the route of administration, dosage, molecularweight, pH, and protein binding. Few therapeutic drugs are absolutely contraindicated; these include radioactive compounds, antimetabolites, lithium, and certain antithyroid drugs.The mother should be advised against the use of unprescribeddrugs, including alcohol, nicotine, caffeine, or “street drugs.”
Maternal use of illicit or recreational drugs is a contraindication to breastfeeding. If a woman is unable to discontinue drug use, she should not breastfeed. Expression of milk for a feeding or two after use of a drug is not acceptable. Breastfed infants of mothers taking methadone (but no alcohol or other drugs) as part of a treatment program generally have not experienced ill effects.