When NOT to breastfed

By To-wen Tseng. Original posted on San Diego County Breastfeeding Coalition's Blog.

Photo Courtesy AP

This week, a South Carolina woman was found guilty of killing her daughter with a morphine overdose from breast milk. A Judge sentenced her to 20 years in prison for killing her than 6-week-old daughter back in 2010.

Sad story indeed. Yes, breastfeeding is the best. However, there are special conditions in which mothers should not be breastfeed. These instances include when a mother is taking certain medications or drugs, when she has been diagnosed with a specific disease, or when other specific conditions apply.

Medications and breastfeeding 

Although most maternal medications are safe for breastfeeding mothers and their infants, certain medications are known to be dangerous to babies and can be passed to the baby in mother’s breast milk. Mother taking the following medicines should speak with her health care provider when considering breastfeeding: 

• Antiretroviral medications for HIV/AIDS treatment Anxiety medications
• Birth-control medications containing estrogen
• Cancer chemo therapy agents
• Illegal drugs
• Medications prescribed to treat migraines, such as ergot alkaloids
• Mood stabilizers, such as lithium and lamotrigine
• Sleep-aid medicines

In addition, mother who is undergoing radiation therapy should consult her doctors before breastfeed, although most therapies require only a brief interruption of breastfeeding.

This list of medications and other drugs is only a guideline. When breastfeeding, mother should discuss with her health care provider before taking any medication. These include prescribed medications, over-the-counter medicines, vitamins, and herbal therapies.

Medications that are safe during pregnancy are usually also safe for mothers to continue while breastfeeding. Medications that are given to infants and children are almost always safe for a breastfeeding mother. For more information regarding medications and breastfeeding please visit NLM ToxNet.

Health conditions and breastfeeding

Mothers with certain illness and infections may be advised not to breastfeed because of the danger of passing the illness or infection to the breastfed baby.

If the mother have any of the following conditions, she should speak with her health care provider before breastfeed her baby:

• Infection with human immunodeficiency virus (HIV)
• Infection with human T-cell lymphotropic virus type I or type II
• Untreated, active tuberculosis

If the mother is sick with a cold or the flu, she shouldn't stop breastfeeding. With most viral infections, we are infectious before we develop symptoms. As the infant has already been exposed, stopping breastfeeding will only deprive the infant or child of the maternal antibodies in the breastmilk. These antibodies and activated T-cells can help prevent or lessen the severity of the infant's illness.

International guidelines on HIV/AIDS and breastfeeding

The potential for HIV transmission to a baby through breastfeeding has been knows for some time. However, recommending against breast-feeding is not a simple solution, because breastfeeding is beneficial to both the mother and her baby. Reducing HIV transmission, while simultaneously ensuring improved HIV-free baby survival, is one of the most pressing issues of HIV/AIDS research.

WHO guidelines currently recommend that an HIV-infected mother who is breastfeeding in the developing world should also take antiretroviral drugs, which help prevent HIV transmission to her baby. In addition, it is recommended that HIV-infected mothers breastfeed exclusively for 6 months, and continue thereafter up to 12 months while solid foods are introduced. In the US, where safe alternatives (artificial milks and weaning foods) are available, and health conditions and medical care are significantly improved, breastfeeding is not recommended.

Other considerations and breastfeeding

In some rare additional situations, or if the mother or the baby has certain health conditions, mother may be advised not to breastfeed.

Mothers with certain chronic illnesses may be advised to take steps to ensure their own health while breastfeeding. Mothers who actively use drugs or do not control their alcohol intake, or who have a history of these situations, may be advised not to breastfeed.

Babies with classic galactosemia, a rare metabolic disorder in which the body cannot digest the sugar galactose, should not be breastfed. Galactosemia is detected by newborn screening, allowing proper treatment and diet to being immediately. If not detected, the galactose guilds up and becomes toxic for the infant, leading to liver problems, intellectual and developmental disabilities, and shock.