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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

What do mothers want professionals to know about contraception and breastfeeding

Last year I asked on my facebook page for experience of using contraception whilst breastfeeding using a googledoc survey. I had just under 80 responses in 24 hours and here I have tried to analyse the results. Five mothers reported that their supply was affected by the use of contraception. Many more were unhappy with the information that was given before prescription of the contraceptive. Food for thought

Please see https://www.breastfeedingnetwork.org.uk/contraception/ 

for information on the contraceptives and 

https://www.breastfeedingnetwork.org.uk/ehc/ 

on emergency hormonal contraception which I wrote for BfN.

Contraception and breastfeeding. What mothers want doctors to know analysis

what do mothers want healthcare professionals to know about breast and nipple pain in lactation

I asked for feedback on this question 12 months ago about pain during breastfeeding and finally time to write it up. Reading it again makes me sad. The pain of breastfeeding for some people cannot be ignored. I hope that this facilitates a discussion amongst professionals who see breastfeeding women. It’s important for mothers, for partners and for babies and time we stopped ignoring it.

This is the data that I extracted

what do mothers want healthcare professionals to know about breast and nipple pain in lactation

Some links that may help everyonehttps://www.breastfeedingnetwork.org.uk/if-breastfeeding-hurts-05-may-2015/embed/#?secret=xbxHk33i2Fhttps://www.breastfeedingnetwork.org.uk/thrush-detailed/embed/#?secret=PiSWCix58w

A Guide To Supporting Breastfeeding For The Medical Profession, Amy Brown and Wendy Jones

What would mothers like their healthcare team to know about IBD and breastfeeding?

The next and most personal blog about what what mothers want their professionals to know. Thank you to the members of the facebook page https://www.facebook.com/groups/BreastfeedingIBD for their views.

What would mothers like their healthcare team to know about IBD and breastfeeding?

See also: https://tinyurl.com/33emh32m facebook live video

Breastfeeding and Chronic Medical Conditions, Wendy Jones

Antibiotics and Breastfeeding

Although we now try very hard to avoid prescribing antibiotics unless essentail ( because of the risk that in the future we wont have antibiotics which are as affective against all infections), sometimes they are necessary. The use of antibiotics during breastfeeding often causes disquiet because most of them cause the baby to have loose bowel motions, sometimes tummy cramps, and sometimes vomiting. Is continuing to breastfeed actually causing harm and should feeding be interupted? Do we need pre biotics and probiotics to redress the balance in the baby’s gut?

It is hard to watch a baby in distress but it is important to remember that when we breastfeed during an infection we are also passing antibodies to that infection in breastmilk to protect the baby. Breastmilk contains all the factors to redress the balance and return the baby’s gut to its normal state far better than any probiotics derived from other sources.

But the ultimate choice is that of the breastfeeding mother.

I hope that the information in this factsheet helps make that decision. Please email me if you want to discuss anything : wendy@breastfeeding-and-medication.co.uk

Antibiotics and breastfeeding factsheet

Raised cholesterol and breastfeeding

When I was working as an independent pharmacist prescriber my main role was to look at primary prevention of cardio vascular disease – identifying factors which raised the risk of people to have a heart attack or stroke in the next 10 years. I used an online calculator using various data like BMI, smoking status, blood pressure and cholesterol ( https://qrisk.org/three/). I didnt see many breastfeeding patients and we concentrated on the over 50s. But in the process I learned a lot about managing weight and encouraging a healthy diet and portion size, smoking cessation and control of cholesterol. In many cases we managed to reduce the risk with lifetyle changes.

It seems that mothers may now have their cholesterol measure and advised that it is too high. I had 20 -30 minute appoitments to encourage lifestyle change. This isnt possible for GPs with pressures on appointments so often the mothers are offered medication to reduce cholesterol. Until recently the only drug compatible with breastfeeding was cholestryamine. This is fine if there isnt a history of familial hypercholesterolaemia and a much higher risk of a cardio vascular event.

A colleague pointed me to some data on elactancia which had a very different list of references and information on cholesterol in standard artificial formula. Thus began a journey to this factsheet over the past couple of months. It isnt a recommendation, as there are currently no studies on the use of statins during breastfeeding nor the effect on the baby . However, it looks at an evidence base which can prompt discussion with clinicians. I hope it helps.

My thanks to Sam Morris and Amanda Da Costa for their knowledge and support as pharmacists and breastfeeding helpers on the BfN Drugs in Breastmilk Information Service

Raised cholesterol and breastfeeding factsheet