Breastfeeding Flashcards
Current breastfeeding recommendations
Until 6 months old
Can be done until 2year with complementary foods
Benefits of breast feeding
-for child
-for mother
Child - decreased incidence of
-asthma, atopic conditions
-diarrhoea, vomiting
-necrotising enterocolitis
-obesity and CVD
-acute infections (OM, Hinfluenzae meningitis, UTIs)
-SIDS
-T1, 2DM
Mother - decreased incidence of
-breast and ovarian cancer
-CVD
-obesity
-osteoporosis
-PND
-PPH
-T2DM
Renal and liver function of infant
Preterm - eGFR 0.6-0.8
Term - eGFR 2-4
2-4wks - eGFR 50
Liver function - immature at birth with delayed maturation of drug metabolising enzymes
How does the number of feeds affect medication choice
Number of feeds fluctuates based on baby’s needs and milk supply
Weaning at 6 months => no of feeds decreases
Decreased no of feeds => decreased exposure to medication
IF BALANCING MEDICATION WITH BREASTFEEDING, PRIORITISE BREASTFEEDING
How does medication enter breastmilk
-what medication characteristics have reduced passage into breast milk?
-what medication groups are trapped in milk due to lower pH of milk
-vaccinations that are compatible with breastfeeding
Diffusion => equilibrates with maternal plasma levels
If it enters CNS, it will enter milk
High molecular weight - insulins, heparins
High protein binding - warfarin, NSAIDs
Low lipid solubility - loratidine
Lower pH - amoxicilin
Active chemical ingredients in iodine barbiturates are changed by the lower pH of milk => get trapped
All vaccines are ok EXCEPT YELLOW FEVER
How to medically stop milk supply
-dose 1st day PP
-dose once lactation already established
-why might you do this?
-when should you not do this
Cabergoline 1mg single dose 1st day postpartum => stops PRL production
Cabergoline 250mcg every 12hrs for 2days if lactation already established
-stillbirth, neonatal death
-transfer of infection to baby via breastmilk
-toxic treatment that may be transferred
-by choice
DO NOT GIVE IN HTN, PRE-ECLAMPSIA
CAUTION IF RISK OF PPPsychosis
Safety of ABx
Penicillins
Cephalosporins - cefalexin
Trimethoprim
Tetracycline - avoid if possible
-if needed, use tetracycline for U3wks
Safety of painkillers
NSAIDs - ibuprofen, diclofenac preferred
-avoid aspirin due to risk of Reye’s syndrome
Avoid opioids - ESPECIALLY CODEINE
-if using, prescribe for shortest period, lowest effective dose, under strict monitoring
-monitor child for sedation, resp depression, poor feeding
-TRAMADOL safe but be alert to signs of overdose in child
Use of antidepressants
-which ones are safe
-what to avoid
-timings of breastfeeding where possible
SERTRALINE, PAROXETINE
TCA - safe to use in term children
MONITOR FOR SEDATION, POOR FEEDING, BEHAVIOURAL DISTURBANCES
Avoid St John’s Wort, MAOIs
Breastfeed immediately before medication taken
Use of contraception
-COCP
-POP
-IUS, IUD
COCP - O affects milk production
-less problematic after 6 months
POP - safe during breastfeeding, can start anytime
IUS, IUD - safe when breastfeeding
-insert within 48hrs or 4wks after birth - risk of perforation
Use of antihistamines
-suitable routes
-sedating vs non sedating
Use intranasal CS spray, drops, eye drops where possible
-sodium cromoglicate - eyes
-xylometazoline - nasal decongestant (risk of rebound congestion if used for 1wk+)
-azelastine - intranasal antihistamine
-fluticasone, beclometasone - intranasal CS
Non-sedating preferred - don’t cross BBB
-ceterizine, loratidine :)
Sedating - cross BBB
-chlorphenamine used for the shortest period, at lowest effective dose
MONITOR FOR DROWSINESS AND IRRITABILITY
