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Breastfeeding during baby immunisation

As a new mum I remember how hard I found it holding my babies whilst they had their immunisations and hearing them cry. I always breastfed them as soon as I could to comfort them. I recalled a paper which mentioned using sucrose to relieve the pain during painful procedures. I recall it being in the BMJ but have it may not have been but may have been Abad (1996).

No one ever suggested that I could breastfeed during the immunisation because my babies were born back in the 1980s when breastfeeding was far from the norm after 6 weeks.

However, this paper has looked data from 10 trials, with results for 1,066 babies, mostly between one and six months old, following their normal immunisation schedule. They found that babies who were breastfed before and during routine childhood immunisations cried on average for 38 seconds less and had lower pain scores compared to babies not breastfed. Thirty-eight seconds may not sound a lot but to a mum witnessing her baby’s distress it definitely matters.

The authors noted “There is good evidence that breastfeeding during blood tests reduces pain in new-born babies (up to 28 days old), but the evidence was unclear for older babies. There were no evidence reviews looking at whether breastfeeding might help during painful procedures in babies aged one month to one year” which made me sad. It suggests that we still don’t consider breastfeeding is the norm and is about so much more than nutrition.

They mention that The good practice in postoperative and procedural pain management guideline from the Association of Paediatric Anaesthetists of Great Britain and Ireland, published in 2012, recommends that breastfeeding (along with swaddling, pacifiers, and sugar) should be considered for babies being vaccinated.

None of the included studies reported any adverse effects such as choking, gagging, spitting or coughing. No studies reported on the acceptability of breastfeeding, from the mothers’ or healthcare professionals’ perspective. The studies didn’t report on the practicalities of breastfeeding in the immunisation clinics but surely this isnt impossible to arrange?

So next time your baby needs an immunisation or you as a professional need to immunise a baby maybe this is something to think about?

References

Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in new-born infants undergoing painful procedures. Cochrane Database Syst Rev. 2016 Jul 16;7(7):CD001069. doi: 10.1002/14651858.CD001069.pub5. PMID: 27420164; PMCID: PMC6457867. https://pubmed.ncbi.nlm.nih.gov/27420164/

Abad F, Díaz NM, Domenech E, Robayna M, Rico J. Oral sweet solution reduces pain-related behaviour in preterm infants. Acta Paediatr. 1996 Jul;85(7):854-8. doi: 10.1111/j.1651-2227.1996.tb14167.x. PMID: 8819554.

The good practice in postoperative and procedural pain management guideline from the Association of Paediatric Anaesthetists of Great Britain and Ireland

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1460-9592.2012.03838.x

Harrison D, Reszel J, Bueno M, et al. Breastfeeding for procedural pain in infants beyond the neonatal period. Cochrane Database Syst Rev. 2016;10:CD011248.

NHR Evidence Breastfeeding reduces crying during baby immunisation https://evidence.nihr.ac.uk/alert/breastfeeding-reduces-crying-during-baby-immunisation/

Opioids and breastfeeding

When paracetamol plus a non steroidal drug (ibuprofen, naproxen, diclofenac or celecoxib) are sufficiant to control pain opioid drugs may need to be used. They cause constipation so should be co prescribed with a stool softener). They are also addictive so should be used for the shortest possible time, in the lowest possible dose.

Codeine is not recomemnded for breastfeeding https://breastfeeding-and-medication.co.uk/thoughts/breastfeeding-and-codeine but one accidental dose or short term use, maybe overnight when no other pain relief is available does not mean that breastfeeding needs to be interrupted.

No breastfeeding mother should ever be asked to choose between adequate pain relief and breastfeeding

Opioids and breastfeeding factsheet

Scleratherpy and Breastfeeding

Another question not frequently asked but something I have been meaning to write for ages. Hope it helps for those who need to have this procedure.

Scleratherapy and Breastfeeding Factsheet

Aripiprazole and Breastfeeding

Aripiprazole seems to be being prescribed more frequently in pregnancy and therfore with newborns but it is becoming apparent from contacts that it can have a massive impact on breastfeeding. I may be seeing the unusual messages but it feels too much of a coincidence. I feel strongly that mums need to know how to watch for poor milk supply and understand the need to monitor their baby for milk intake if they are taking aripiprazole when breastfeeding.

Aripiprazole and Breastfeeding Factsheet

The Synacthen test and breastfeeding

Not a very frequently asked question but one which causes a lot of distress as many mothers are advised to interrupt or stop breastfeeding unnecessarily. Having tests is bad enough without trying to manage milk supply and a distressed baby.

Hope this information that breastfeeding can continue as normal after the test helps

The Synacthen test and breastfeeding factsheet