Introduction

Breast milk is widely acknowledged as the most complete form of nutrition for infants, including premature and sick newborns. In addition to containing all the nutrients your baby needs in the first six months of life, breast milk also contains disease-fighting substances that not only help to protect against infections and allergies but also reduces the child’s risk of getting sick later in life. A large number of health problems in children such as respiratory and gastrointestinal diseases might be decreased, or even prevented, by breastfeeding the infant exclusively for at least the first six months of life. The longer the mother breastfeeds, the more likely her child will get the health benefits of breastfeeding. Breastfeeding also helps a mother return to her pre-pregnancy weight while reducing her risk for chronic illnesses such as breast and uterine cancers. The emotional health of the mother may be also be enhanced by the bond she develops with her infant during breastfeeding, resulting in less anxiety and a stronger sense of connection with her baby.

Almost all mothers can breastfeed successfully, which includes initiating breastfeeding within the first hour of life, breastfeeding exclusively for the first 6 months and continuing to breastfeed (along with giving appropriate complementary foods) up to 2 years of age or beyond.

When a mother is doubtful whether breastfeeding should be avoided, she should seek advice from a medical doctor, who will need to conduct a case-by-case assessment to determine if the mother’s own or infant’s medical condition warrants her to avoid, interrupt or stop breastfeeding.  Whenever the cessation of breastfeeding is considered, its benefits should be weighed against the risks posed by the presence of the specific health condition .

Only a few health conditions in the infant or the mother may justify recommending that breastfeeding be avoided temporarily or permanently. As a guide, these are listed below (WHO, 2009).

Infant conditions

1.  Infants who should not receive breast milk or any other milk except special formula:

• Infants with classic galactosemia: a special galactose-free formula is needed.

• Infants with maple syrup urine disease: a special formula free of leucine, isoleucine and valine is needed.

• Infants with phenylketonuria: a special phenylalanine-free formula is needed (some breastfeeding is possible, under careful monitoring).

2.  Infants for whom breast milk remains the best feeding option but who may need other food in addition to breast milk for a limited period:

• Infants born weighing less than 1500 g (very low birth weight).

• Infants born at less than 32 weeks of gestational age (very pre-term).

• Newborn infants who are at risk of hypoglycaemia due to impaired metabolic adaptation or increased glucose demand (such as those who are pre-term, small for gestational age or who have experienced significant intrapartum hypoxic/ischaemic stress, those who are ill and those whose mothers are diabetic)  if their blood sugar fails to respond to optimal breastfeeding or breast-milk feeding.

Maternal conditions

Mothers who are affected by any of the conditions mentioned below should receive treatment according to standard guidelines.

1.  Maternal conditions that may justify permanent avoidance of breastfeeding:

• HIV infection

2.  Maternal conditions that may justify temporary avoidance of breastfeeding:

• Severe illness that prevents a mother from caring for her infant, for example sepsis.

• Herpes simplex virus type 1 (HSV-1): direct contact between lesions on the mother’s breasts and the infant’s mouth should be avoided until all active lesions have resolved.

• Maternal medication:

  • Sedating psychotherapeutic drugs, anti-epileptic drugs and opioids and their combinations may cause side effects such as drowsiness and respiratory depression and are better avoided if a safer alternative is available;

  • Radioactive iodine-131 is better avoided given that safer alternatives are available – a mother can resume breastfeeding about two months after receiving this substance;

  • Excessive use of topical iodine or iodophors (e.g., povidone-iodine), especially on open wounds or mucous membranes, can result in thyroid suppression or electrolyte abnormalities in the breastfed infant and should be avoided;

  • Cytotoxic chemotherapy requires that a mother stop breastfeeding during therapy.

3.  Maternal conditions during which breastfeeding can still continue, although health problems may be of concern:

• Breast abscess: breastfeeding should continue fromthe unaffected breast; feeding from the affected breast can resume once treatment has started.

• Hepatitis B: infants should be given hepatitis B vaccine, within the first 48 hours or as soon as possible thereafter.

• Hepatitis C.

• Mastitis: if breastfeeding is very painful, milk must be removed by expression to prevent progression of the condition.

• Tuberculosis: mother and baby should be managed according to the national tuberculosis guidelines.

• Substance use:

  • Maternal use of nicotine, alcohol, ecstasy, amphetamines, cocaine and related stimulants has been demonstrated to have harmful effects on breastfed babies;

  • Alcohol, opioids, benzodiazepines and cannabis can cause sedation in both the mother and the baby.

Mothers should be encouraged not to use these substances, and given opportunities and support to abstain. Mothers who choose not to cease their use of these substances or who are unable to do so should seek individual advice on the risks and benefits of breastfeeding depending on their individual circumstances. For mothers who use these substances in short episodes, consideration may be given to avoiding breastfeeding temporarily during this time.

Reference:

1. Acceptable Medical reasons for Use of Breast-Milk Substitutes, World Health Organization, WHO/NMH/NHD/09.01, WHO/FCH/CAH/09.01, 2009.