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This is the beginning of the hayfever season with the sun coming out so today I recorded the video about the compatibility of drugs to treat symptoms and breastfeeding
I’ve also uploaded the powerpoint which I used to present this that you can share
- Non sedating antihistamine e.g cetirizine, loratadine, fexofenadine
- Nasal sprays which act locally e.g. Beconase®, Flixonase®, Mometasone, Nasocort®, Dymista®
- Eye Drops which act locally e.g sodium cromoglycate
Drugs which may cause drowsiness in mother and nursling may reduce supply e.g acrivastine (Benadryl ® , chlorpheniramine (Piriton ®), promethazine (Phenergan ®)
It is not acceptable to leave any mother in pain because she is breastfeeding nor to suggest that she could have more effective pain relief if she stopped breastfeeding.
I’m often asked about the safety of opioids during breastfeeding so this is a really interesting study
Despite opioids being used first line in emergency settings to treat severe acute extremity pain, there is limited evidence available to inform this practice.
In a study in JAMA (7 November 2017), researchers randomly assigned 416 patients in the emergency department with moderate-to-severe acute extremity pain to one of the following groups: 400mg ibuprofen/1000mg paracetamol; 5mg oxycodone/325mg paracetamol; 5mg hydrocodone/300mg paracetamol; or 30mg codeine/300mg paracetamol.
I have written this powerpoint presentation which I hope explains the analgesic ladder and helps professionals to understand the compatibility of analgesics and breastfeeding
- Paracetamol or NSAID
- Paracetamol + NSAID
Paracetamol+NSAID+Opioid (at the lowest possible dose for the shortest possible time co prescribed with a laxative)
Non steroidal anti inflammatory drugs
- Compatible with breastfeeding: ibuprofen, diclofenac (Voltarol ™, Difene™), naproxen (Naprosyn™) https://breastfeeding-and-medication.co.uk/fact-sheet/naproxen-and-breastfeeding
- No data on compatibility with breastfeeding: etoricoxin (Arcoxia™), meloxicam (Mobic™)
- compatible with breastfeeding: oral morphine, dihydrocodeine
- use with caution as may cause drowsiness: oxycodone (Oxycontin™, Oxyfast™)
- avoid if possible as may cause drowsiness: codeine
All opioids can cause nausea and dizziness but almost invariably cause constipation so it is wise to commence stool softeners like lactulose and/or docusate both of which are compatible with breastfeeding as they don’t pass into milk.
I delivered this presentation for Migraine Ireland and will upload it onto YouTube but sharing the powerpoint slides for training purposes. Happy to answer any questions firstname.lastname@example.org
Available on YouTube https://youtu.be/Lg52tht4XwU
As with most professionals, my own included, dentistry seems to lack education on breastfeeding as part of undergraduate training if questions sent to this page exemplify a wider issue. I have tried to provide information for CPD inline with that written for other healthcare professionals.
I have developed this powerpoint presentation on the pharmacokinetics of drugs which dentists may use or prescribe for CPD information in an effort to break down the barriers of continuation of breastfeeding.
I am happy to answer individual questions or training. Please contact email@example.com
- Breastfeeding mothers can have local anaesthetic injections with/without adrenaline and continue to breastfeed as normal
- Breastfeeding mothers can take analgesics for dental pain and continue to breastfeed as normal
- Breastfeeding mothers can have antibiotics and continue to breastfeed as normal
- Breastfeeding mothers can use mouthwashes, gels and liquids for mouth ulcers ( e.g. Anbesol®, Bonjela®, Medijel®, Rinstead®, Iglu®, Orajel®) and fluoride toothpastes e.g. Durophat® and continue to breastfeed as normal
- Breastfeeding mothers can have dental sedation for procedures and continue to breastfeed as normal.
- White fillings: In some parts of the UK white fillings are recommended in pregnancy and lactation following an EU Directive (July 2018) but have to be paid for by the patient rather than being part of free NHS treatment. The information states that “These restrictions on the use of dental amalgam aim to help reduce environmental mercury pollution and are not a result of any safety concerns about amalgam fillings for dental patients.”
- Tooth Whitening: There appears to be no information available on the use of tooth whitening agents during lactation. Whilst it is unlikely that any significant transfer of the agents used into breastmilk will take place, if it can be delayed until breastfeeding has finished naturally, that would be preferable but there are many questions from mothers about to get married who dont want to wait. Unless the products spill from the bath in which the liquid is placed, resulting in burns to the mother’s mouth absorption into breastmilk is unlikely.
In a report Public Health England have made recommendations on dental health and breastfeeding. Full information can be accessed at : www.gov.uk/government/publications/breastfeeding-and-dental-health/breastfeeding-and-dental-health#breastfeeding-and-dental-health
- dental teams should continue to support and encourage mothers to breastfeed
- not being breastfed is associated with an increased risk of infectious morbidity (for example gastroenteritis, respiratory infections, middle-ear infections)
- breastfeeding up to 12 months of age is associated with a decreased risk of tooth decay
- breast milk is the only food or drink babies need for around the first 6 months of their life, first formula milk is the only suitable alternative to breast milk
- bottle-fed babies should be introduced to drinking from a free-flow cup from the age of 6 months and bottle feeding should be discouraged from 12 months old
- only breast or formula milk or cooled, boiled water should be given in bottles
- only milk or water should be drunk between meals and adding sugar to foods or drinks should be avoided
Recent systematic reviews such as that by Tham and others (2015)6 included studies where children were breastfed beyond 12 months. When infants are no longer exclusively breast or formula fed, confounding factors, such as the consumption of potentially cariogenic drinks and foods and tooth brushing practices (with fluoride toothpaste), need to be taken into account when investigating the impact of infant feeding practices on caries development. Tham and others (2015) noted that several of the studies did not consider these factors and concluded that with regard to associations between breastfeeding over 12 months and dental caries “further research with careful control of pertinent confounding factors is needed to elucidate this issue and better inform infant feeding guidelines”. Good quality evidence on breastfeeding and oral health is an area with significant methodological challenges which have been outlined by Peres and others (2018)7.
Of course I would also have to highlight that dental procedures, including sedation, local and general anaesthetic and use of antibiotics and analgesics need not interrupt breastfeeding
This weekend I had the great pleasure of talking to DoulaCare Ireland on the topic of over medicalising breastfeeding. Many of the stories were shared by the wonderful people who responded to my call out on the Facebook Breastfeeding and Medication page and I thank them all for their contributions.
DoulaCare Ireland have been most generous in saying that I can share the recording (unedited) made of the session. I hope you enjoy it. Questions as usual to firstname.lastname@example.org welcome
I was recently asked to present a training session for practice nurses on treating asthma in the breastfeeding mother. Sharing here a version as a CPD opportunity. Any questions please email me email@example.com
I had been asked to talk to midwives for an update today but sadly due to timing wasnt bale to do so. But having saved the day I decided to record the talk anyway
Happy to answer any questions firstname.lastname@example.org
This is the handout of the presentation https://breastfeeding-and-medication.co.uk/wp-content/uploads/2022/05/Prescribing-during-breastfeeding-midwives-2022.pdf
and the link to the YouTube video which includes my presentation https://youtu.be/L3b43BgeiR8
Having an investigation or a procedure when breastfeeding causes anxiety but when a mother is told to interrupt breastfeeding the consequences are much greater.
This is a powerpoint presentation based on one I gave in Rotterdam in 2019 which I hope helps CPD and again will be recorded when I find enough hours in my day
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.
See also: https://tinyurl.com/33emh32m facebook live video
I’ve have been adding presentations on YouTube so that they are available for professional CPD whenever you are free and also to help families where the written word is less accessible. Forgive my my tech skills arent perfect ( but I’m learning) . More videos to come. If there is one you would like to request mail me email@example.com
Breastfeeding and Medication You Tube https://www.youtube.com/channel/UCxvkXp8oV-zMqcpWTsnULow