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That new title is going to take a lot of getting used to! I am very proud and delighted to have been nominated for an MBE for services to mothers and babies as a founder of the Breastfeeding Network Drugs in Breastmilk Service. I never thought this would happen to me following a path which I didnt really plan 22 years ago but has led me to this amazing place. I feel inspired to keep going and hopefully change some more professional attitudes that prescribing a medication doesnt mean that a mother needs to interrupt breastfeeding. Thank you to the many, many people who have sent messages of congratulations today – I appreciate them so much.
I also want to thank my wonderful family for their support – my husband Mike, my daughters Kerensa, Bethany and Tara, my son in laws Christian, Steve, Rich and Ian and of course my treasured grandchildren Stirling, Isaac, Beatrix and Elodie and the new bump due in 2019. I cant tell you how much I love you all
In a report today Public Health England have made recommendations on dental health and breastfeeding. Full information can be accessed at : www.gov.uk/government/publications/breastfeeding-and-dental-health/breastfeeding-and-dental-health#breastfeeding-and-dental-health
- dental teams should continue to support and encourage mothers to breastfeed
- not being breastfed is associated with an increased risk of infectious morbidity (for example gastroenteritis, respiratory infections, middle-ear infections)
- breastfeeding up to 12 months of age is associated with a decreased risk of tooth decay
- breast milk is the only food or drink babies need for around the first 6 months of their life, first formula milk is the only suitable alternative to breast milk
- bottle-fed babies should be introduced to drinking from a free-flow cup from the age of 6 months and bottle feeding should be discouraged from 12 months old
- only breast or formula milk or cooled, boiled water should be given in bottles
- only milk or water should be drunk between meals and adding sugar to foods or drinks should be avoided
Recent systematic reviews such as that by Tham and others (2015)6 included studies where children were breastfed beyond 12 months. When infants are no longer exclusively breast or formula fed, confounding factors, such as the consumption of potentially cariogenic drinks and foods and tooth brushing practices (with fluoride toothpaste), need to be taken into account when investigating the impact of infant feeding practices on caries development. Tham and others (2015) noted that several of the studies did not consider these factors and concluded that with regard to associations between breastfeeding over 12 months and dental caries “further research with careful control of pertinent confounding factors is needed to elucidate this issue and better inform infant feeding guidelines”. Good quality evidence on breastfeeding and oral health is an area with significant methodological challenges which have been outlined by Peres and others (2018)7.
Of course I would also have to highlight that dental procedures, including sedation, local and general anaesthetic and use of antibiotics and analgesics need not interrupt breastfeeding
We all know as parents how hard it is to comfort a baby who is teething and to witness their distress. As a pharmacist, mother and grandmother I know that the standard products often recommended in the past contained a local anaesthetic often lidocaine.
In 2014 the FDA in USA first raised concerns stating that “Topical pain relievers and medications that are rubbed on the gums are not necessary or even useful because they wash out of the baby’s mouth within minutes, and they can be harmful”.
Today the MHRA have announced that parents and caregivers are being advised that products containing lidocaine used for teething in babies and children will be sold only in pharmacies, under the supervision of a pharmacist from the beginning of 2019. The MHRA review concluded there is a lack of evidence of benefit to using products containing lidocaine for teething before non-medicinal options. Evidence of any risk associated with these products is very small given the wide usage of these medicines. A pharmacist or healthcare professional can provide appropriate guidance. Teething is a natural process and lidocaine containing teething products such as teething gels should only be used as a second line of treatment after discussion with and guidance of a healthcare professional.
It is suggested that parents try non-medicine options such as rubbing or massaging the gums or a teething ring before considering teething gels after discussion with a pharmacist.
Further information can be found :
And a patient information leaflet: https://assets.publishing.service.gov.uk/media/5c0fd7cbed915d0c736a1e64/Lidocaine-patient-sheet.pdf
La Leche League GB have produced an excellent article on teething which can be accessed www.laleche.org.uk/breastfeeding-and-teething/#Pain.
The NHS also has sound information: https://www.nhs.uk/conditions/pregnancy-and-baby/teething-tips/
Products include Dentinox gel ®, Calgel ®, Bonjela ®, Anbesol gel ®
So many contacts recently about thrush and breastfeeding I have decided to record a presentation I have made many times over the years. I will in a few days record one with detailed prescribing information for doctors and pharmacists . A copy of the slides will go onto my website www.breastfeeding-and-medication.co.uk. Hope this helps everyone. I have found it necessary to leave several social media groups for my own sanity after reading threads where non evidence based practice seems to get perpetuated. This is my view after looking at thrush and breastfeeding for the last 20 years.
Posted by Breastfeeding and Medication on Friday, July 20, 2018
I spend on average 4 full hours across every day providing info to mums told they HAVE to stop breastfeeding to take medicines. Do more people know about the drugs in breastmilk service or are professionals less willing to take risks so stopping breastfeeding seen as best option? How can we change the conversation ?
Where does it make sense to tell mothers stop breastfeeding to take medicines when we have specialist support texts and services? Breastfeeding has HUGE advantages for mums, babies and the economy. We need to listen, support and provide evidence based info for all mums breastfeeding and formula feeding not rely on manufacturers
There are economic savings for the health economy. Renfrew (2012) provided a detailed cost analysis of potential savings, reductions in hospital admissions and GP appointments:
Assuming a moderate increase in breastfeeding rates, if 45% of women exclusively breastfed for four months, and if 75% of babies in neonatal units were breastfed at discharge, every year there could be an estimated:
- 3,285 fewer gastrointestinal infection-related hospital admissions and 10,637 fewer GP consultations, with over £3.6 million saved in treatment costs annually
- 5,916 fewer lower respiratory tract infection related hospital admissions and 22,248 fewer GP consultations, with around £6.7 million saved in treatment costs annually
- 21,045 fewer acute otitis media (AOM) related GP consultations, with over £750,000 saved in treatment costs annually
- 361 fewer cases of NEC, with over £6 million saved in treatment costs annually.
In total, over £17 million could be gained annually by avoiding the costs of treating four acute diseases in infants. Increasing breastfeeding prevalence further would result in even greater cost savings”
In addition, if half those mothers who currently do not breastfeed were to breastfeed for up to 18 months in their lifetime, for each annual cohort of around 313,000 first-time mothers there could be:
- 865 fewer breast cancer cases with cost savings to the health service of over £21 million, 512 breast cancer-related quality adjusted life years (QALYs) would be gained, equating to a value of over £10 million.
This could result in an incremental benefit of more than £31 million, over the lifetime of each annual cohort of first-time mothers.
This is my blog written for the Breastfeeding Network for maternal mental health awareness week. Perinatal mental health and its impact on breastfeeding and vice versa is becoming a specific passion of mine. So sad that women are repeatedly told you cant have medication UNLESS you stop breastfeeding. Incorrect and unhelpful
Raynaud’s phenomenon affects up to 10% of otherwise healthy women aged 21-50 years of age. It is 9 times more common in women than men.
Yet many doctors are unaware that Raynaud’s can affect breastfeeding. It produces deep pain after feeds with a mother often automatically covering her nipples or massaging them to restore the blood flow. Symptoms are often mis-diagnosed as thrush when in fact the use of fluconazole can make the symptoms worse by causing further vasoconstriction.
Most mothers who experience problems with Raynaud’s during breastfeeding, have a history of cold hands and feet or a close relative who has. It may be that in a family it is routine to wear thick socks and gloves, maybe a vest without realising that they may be “unusual” in their response to the cold.
Babies of mothers with Raynaud’s may be born early and / or smaller because of restriction of blood flow to the placenta. It is not uncommon for there to be a maternal (or close family) history of migraines.
Symptoms which differentiate Raynaud’s phenomenon with other causes of breast pain are:
- Pain in both breasts after feeds
- Pain which may be precipitated by being cold or for example going down the freezer aisle in a supermarket
- Rapid 3 colour change in the nipples after feeds
- Pain that is resolved by warmth or gentle massage
- A history or close family history of poor circulation
Treatment of Raynaud’s during breastfeeding
- Don’t ignore the fact that pain after breastfeeds may be due to less than perfect attachment of the baby at the breast. A white tip to the nipple after feeds is not the same as the tri colour change typical of Raynaud’s
- Nifedipine 30mg a day (either as 10mg three times a day or long acting 30mg once daily. The amount in breastmilk is too small to affect babies although it may give the mother hot flushes and / or headaches. The following extract is taken from Breastfeeding and Medication 2nd Ed to be published May 2018
- High doses of vitamin B6 (Newman 2012), magnesium (Smith 1960, Turlapaty Leppert1994), calcium (DiGiacomo 1989), fatty acids (Belch 1985) and fish oil supplementation (DiGiacomo 1989) have also been suggested but take a minimum of 6 weeks to be effective. Ginger 2000mg-4000mg daily. Capsules usually contain 500mg. It may also be beneficial to add ginger to your diet, to drink ginger tea, or to put a spoonful of ground ginger in your bathing water (Royal Free hospital www.royalfree.nhs.uk/pip_admin/docs/Raynaudsnatural_186.pdf)
Nifedipine relaxes vascular smooth muscle and dilates coronary and peripheral arteries. It has activity in reducing blood pressure and in the treatment of Reynaud’s syndrome
Nifedipine is almost completely absorbed from the GI tract but undergoes extensive first-pass metabolism. It is up to 98% bound to plasma proteins. It is used to treat hypertension (Penny and Lewis 1989; Ehrenkranz et al. 1989) and also to improve circulation in Reynaud’s disease (cold extremities and nipple vasospasm) in doses up to 30 mg daily (Lawlor-Smith and Lawlor-Smith 1996; Garrison 2002; Anderson et al. 2004). Side effects for the mother include flushing and headache, which may limit its usefulness. It is present in breastmilk but in levels too small to be harmful and there have been no reports of adverse effects in babies (see Chapter 5).
In Taddio et al’s study (1996) of 21 women taking 40 mg daily the babies were estimated to be exposed to 0.1% of the maternal weight adjusted dose via breastmilk. Nifedipine is widely used to treat pre-eclampsia and eclampsia in the mother together with methyldopa or a beta blocker. Ehrenkranz et al. (1989) studied one woman who took 10, 20 or 30 mg three times daily on different days. Using the maximum dose transferred by the 30 mg regimen, the authors estimated that the baby would be exposed to the authors estimated that an exclusively breastfed infant would receive an estimated maximum of 7.5 µg per kilogramme of nifedipine daily. Its relative infant dose is quoted as 2.3–3.4% (Hale 2017 online access).
The BNF reports that the amount secreted into breastmilk is too small to be harmful but that manufacturer advises it should be avoided.
Compatible with breastfeeding.
- Anderson JE, Held N, Wright K, Raynaud’s phenomenon of the nipple: a treatable cause of painful breastfeeding, Pediatrics, 2004;113(4):e360–4.
- Ehrenkranz RA, Ackerman BA, Hulse JD, Nifedipine transfer into human milk, J Pediatr, 1989;114:478–80.
- Garrison CP, Nipple vasospasm, Raynaud’s syndrome, and nifedipine, J Hum Lact, 2002;18(4):382–5.
- Lawlor-Smith LS, Lawlor-Smith CL, Raynaud’s phenomenon of the nipple: a preventable cause of breastfeeding failure?, Med J Aust, 1996;166:448. Letter.
- Penny WJ, Lewis MJ, Nifedipine is excreted in human milk, Eur J Clin Pharmacol, 1989;36:427–8.
- Taddio A; Oskamp M; Ito S; Bryan H; Farine D; Ryan D; Koren G,. Is nifedipine use during labour and breastfeeding safe for the neonate?, Clin Invest Med, 1996;19(4 Suppl.):S11. Abstract.
It is some time since I had time to post / blog . However, it’s a new year with new resolutions and new committment. The first news is that there is a new edidition of my book Breastfeeding and Medication due out on 1 May.
This new edition contains information on more drugs and a chapter on the management of some chronic conditions which may affect breastfeeding mothers. In most cases there are options to support the mother’ optimal care whilst allowing her to continue to breastfeed her baby as long as she wishes. This is a topic which raises many questions on social media which informed the choice of conditions to consider.
It’s available to pre-order now on Amazon now – make it your new year’s resolution to buy to support breastfeeding mothers and to inform pescribing decisions
delighted to have had the opportunity to record a webinar tonight with Kathleen Kendall-Tackett tonight on the importance of dads and grandmas to the breastfeeding mum . You can catch up still https://praeclaruspress.givezooks.com/events/webinar-the-importance-of-dads-and-grandmas-to-breastfe
just done my technical check for the Webinar on the importance of dads and grandmas to the breastfeedng mum to be broadcast next Thursday 6-7.30pm UK time Come join me $15 https://praeclaruspress.givezooks.com/events/webinar-the-importance-of-dads-and-grandmas-to-breastfe