pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Drugs and Breast Milk – Alcohol Withdrawal

One of the most common questions I am asked is “can I take such and such medicine while I’m breast feeding?”

The concern, of course, is: does such and such medicine get into the breast milk and effect the baby when I breast feed?

Nearly without exception the answer is yes. Almost all medicines and materials the mother eats are excreted in the breast milk, to some extent.

The real questions are: 1. Is the excretion in a high enough concentration to effect the baby; and, 2. Will the effect from the drug harm the baby in any way.

A few examples are:

FOODS: Many people are surprised to find that a baby can develop a cows milk protein allergy even though they had been breast-fed and never tasted a drop of cow’s milk in their life.

Of course this comes from the cow’s milk that the mother has been drinking.

Experienced mothers will all tell you that there are foods they cannot eat without giving the baby gas. Like cauliflower, pizza, beans, and spicy foods.

food-breastfeeding-sidePAIN RELIEVERS: Aspirin is usually not secreted in a high enough concentration to even control a moderate fever of a child.

Codeine taken by the mother, on the other hand, has been occasionally shown to be high enough to cause respiratory depression and constipation in the infants.

ANTICOAGULANTS: Coumadin and heparin are excreted in the breast milk and are usually grounds for discontinuing breast-feeding during the use of these medications.

ALCOHOL: This is another substance which gets into the breast milk. If the mother ingests small amounts it usually has a soporific (sedative) effect on the infant, and also has possibilities of other side-effects as well. In regular small doses the sleeping effect may cause him to miss feedings and, in fact, become malnourished.

In larger doses the alcohol can cause “frank drunkenness” with all it’s problems like hypoglycemia (low blood sugar), seizures, respiratory depression, and liver toxicities.

While we are on the topic of alcohol, an interesting article crossed my desk the other day.

It is commonly known that 60-80% of newborns born to narcotic users will experience withdrawal symptoms.

WITHDRAWAL: Until recently, however, it has not been known that alcohol does indeed produce similar types of withdrawal problems.

A study done in Atlanta, Georgia showed that babies born to mothers who drank moderately to heavily during pregnancy showed typical signs of drug withdrawal within three days of birth.

infant-irritability-alcohol-withdrawalThese symptoms included continued restlessness, tremors (shaking), poor sleep habits, tight muscles, frequent uncontrollable crying, increased sucking needs, and other exaggerated changes in reflexes.

The article stated, "such infants start life with several strikes against them."

With all of the above symptoms the babies experience less acceptance by their mothers, families, and hospital personnel.

It’s hard to establish proper feeding schedules and digestive upsets are common including diarrhea, vomiting and signs of colic.

The sucking movements confuse mothers into feeding more often than necessary, leading to vomiting and other abdominal distress.

Parents then become frustrated and what should have been a happy relationship becomes very difficult.

Sometimes theses habits and "getting off on the wrong foot" establish behaviors and problems with the relationships that carry on through the child’s entire life.

If you have any questions regarding any medications you are taking and how they will effect your breast-feeding infant, you should contact your pediatrician prior to using the medication.

Most of the time the advise is to go ahead and use it, but other times he will want you to substitute a less toxic medicine or discontinue breast-feeding.

In addition, you should remind any physician you are seeing, that you are breast-feeding prior to him prescribing the medication.

It’s critical for mothers not to drink, use drugs, or smoke during pregnancy. If you do, however, and your infant shows sign of distress, you should consider the possibility of drug or alcohol withdrawal.

Seeking professional help early and honestly with your physician will help establish and ease the baby’s and parent’s distress.

[Addendum: Of course we now know about Fetal Alcohol Syndrome which not only brings with it the above symptoms immediately after delivery but additional physical, mental and emotional changes common in the syndrome]

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