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TRANSCRIPT
Breastfeeding MythBustersJulie K. Prussack, MD
Northern Michigan Family Medicine UpdateJune 27, 2019
None
Disclosures
1. Identify common breastfeeding myths.2. Support breastfeeding dyads in common experiences
and struggles including low milk supply, feeding expressed breastmilk, maternal alcohol use, maternal diagnostic imaging, and maternal anesthesia.
3. Access InfantRisk Center, LactMed, and KellyMomresources.
Objectives
Formula is equivalent to breastmilk.
Myth #1
Breastmilk is has many nutritional and health benefits, tailored for each specific child.
Truth #1
WIC Supplemental Nutrition Branch. California Department of Health Services. March 2005.
Excess Health Risks with Not BreastfeedingOutcome
Excess Risk (%)
For full-term infants
Otitis media 100
Atopic dermatitis 47
Gastrointestinal infection 178
Hospitalization for lower respiratory tract diseases 257
Asthma, with family history 67
Asthma, no family history 35
Childhood obesity 32
Type 2 diabetes mellitus 64
Acute lymphocytic leukemia 23
Acute myelogenous leukemia 18
Sudden infant death syndrome 56
For pre-term infants
Necrotizing enterocolitis 138
For never breastfeeding mothers
Breast cancer 4
Ovarian cancer 27
The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. URL: https://www.ncbi.nlm.nih.gov/books/NBK52680/
OutcomeExcess Risk (%)
For full-term infants
Otitis media 100
Atopic dermatitis 47
Gastrointestinal infection 178
Hospitalization for lower respiratory tract diseases 257
Asthma, with family history 67
Asthma, no family history 35
Childhood obesity 32
Type 2 diabetes mellitus 64
Acute lymphocytic leukemia 23
Acute myelogenous leukemia 18
Sudden infant death syndrome 56
For pre-term infants
Necrotizing enterocolitis 138
For never breastfeeding mothers
Breast cancer 4
Ovarian cancer 27
Eating *this* will increase your milk supply.
Myth #2
The best way to increase milk supply is to directly feed or express milk.
Truth #2
Establishing milk supply
• Skin-to-skin immediately after birth• Latch within the first hour• “Empty” breasts at least 8-12 times daily
Baby tracking app, SmallNest, reported that on average, parents of 2,000 U.S. and Canadian babies reported 16-18 feeds per 24 hours
ABM clinical protocol #5: peripartum breastfeeding management for the healthy mother and infant at term, revision 2013. Breastfeeding Medicine. Vol. 8, No. 6, 2013. URL: https://www.bfmed.org/protocols
Increasing milk supply
• Assess latch and transfer• Continue to drain breasts, including overnight
when prolactin is highest• Medications: metoclopramide, domperidone
(not FDA approved)• Hydrate and eat to thirst/hunger• Limited evidence for herbs and supplements
ABM clinical protocol #9: use of galactogogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeeding Medicine. Vol. 13, No. 5, 2018. URL: https://www.bfmed.org/protocols
Baby needs more breastmilk.
Myth #3
An infant’s milk intake stabilizes or decreases as they grow.
Truth #3
How much breast milk does a baby need? Medela. https://www.medelabreastfeedingus.com/article/169/how-much-breast-milk-does-a-baby-need
Newborn stomach size
From 1 month to 6 months
• Infants typically need 19-30 ounces per day• Average of 1-1.25 ounces per hour• If 8 feedings, bottles of 3-4 ounces per feed• After 6 months, with introduction of solids,
intake may gradually decrease to 14-19 ounces per day at 1 year
• Can use milk calculator at: https://kellymom.com/bf/pumpingmoms/pumping/milkcalc/
Bonyata, K. How much breast milk will my baby need? Kellymom.com. Updated 1/14/18. URL: https://kellymom.com/bf/pumpingmoms/pumping/milkcalc/
But baby wants more milk!
• Breastfeeding offers more than just nutrition• Can overfeed with the bottle• Encourage paced bottle feeding with slow flow
nipple
The Milk Mob. Institute for Advancement of Breastfeeding & Lactation Education. URL:http://lacted.org/libr-iable-samples/
Resources for parents and caregivers
http://www.nancymohrbacher.com/articles/2013/12/3/for-the-caregiver-of-a-breastfed-baby.html
https://kellymom.com/bf/pumpingmoms/employed-moms/childcare-breastfed-baby/
You need to pump & dump.
Myth #4
There is often no need to “pump & dump” for anesthesia, imaging, alcohol, or medications.
Truth #4
Anesthesia
Wanderer et al. Anesthesia & Breastfeeding: More Often Than Not, They Are Compatible. Infographic. Anesthesiology: October 2017, Vol.127, A15.
Imaging
• Radiographic studies do not make milk radioactive!
• Mammograms can be done, although with decreased sensitivity. Best done immediately after draining breasts.
• Per American College of Radiology, it is safe to continue breastfeeding after iodinated or gadolinium-based contrast agents.
Manual on Contrast Media. American College of Radiology. Version 10.3, 2018. URL: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf
American College of Radiology
“Because of the very small percentage of iodinated or gadolinium-based contrast medium that is excreted into the breast milk and absorbed by the infant’s gut, we believe that the available data suggest that it is safe for the mother and infant to continue breast-feeding after receiving such an agent… [If the mother chooses to “pump & dump,”] There is no value to stop breast feeding beyond 24 hours.”
Manual on Contrast Media. American College of Radiology. Version 10.3, 2018. URL: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf
Alcohol in Breast Milk
• Alcohol is found in the breast milk in approximately the same concentration as in the blood, and similarly leaves the breast milk as it is metabolized by the mother
• Legal limit to drive 0.08%=percent alcohol in breast milk at legal limit
• Percent alcohol in apple juice: 0.06-0.66%• Percent alcohol in non-alcoholic beer: <0.5%
Gorges et al. Estimates of Ethanol Exposure in Children from Food not Labeled as Alcohol-Containing. J Anal Toxicol. 2016 Sep; 40(7): 537–542.
Alcohol in Breast Milk
• Highest concentration at 30-60 min. after drinking
• On average, one drink is metabolized completely in 2 hours (nomogram by Motherisk: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213923/pdf/11852608.pdf)
Alcohol in Breast Milk
• Thomas Hale (2017): “…mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.”
• Alcohol does decrease oxytocin release and therefore inhibit let-down reflex and production
• Studies have shown that weight, linear growth, and psychomotor development can be affected by moderate drinking in breastfeeding mothers
Hale, Thomas. Medications and Mothers’ Milk, 2017 edition. Springer Publishing, 2017: 348-350.
Medication Safety
• InfantRisk Center at Texas Tech University
• (806) 352-2519 8AM-5PM Central Time
• InfantRisk.org• InfantRisk App ($9.99)• MommyMeds App
($3.99)
• LactMed• https://toxnet.nlm.nih.gov/
newtoxnet/lactmed.htm• LactMed App (Free)
Medication Safety
L1 L2 L3 L4 L5Compatible Limited Data
-Probably compatible
No Data -Probablycompatible
Limited Data - Possiblyhazardous
Hazardous
Tylenol Sertraline Oxycodone Codeine Amiodarone
Ibuprofen Benadryl Bupropion Marijuana Isotretinoin
Amoxicillin Flagyl Doxycycline Chantix Kombucha
Loratadine Guaifenesin Nicotine Tizanidine Fluorouracil
Dextrometh-orphan
Methylphen-idate
HormonalContraception
Colchicine Methotrexate
Metformin Prednisone Sumatriptan Glimepiride Tamoxifen
You cannot breastfeed while pregnant.
Myth #5
It is generally safe to breastfeed in low-risk pregnancies.
Myth #5
Breastfeeding during pregnancy
• Nipple stimulation does release oxytocin, but in a similar or lesser amount than with sexual activity
• Oxytocin receptors are sparse until 38 weeks and are also blocked by progesterone
• Only a few small observational studies have been done, but there is no evidence to suggest an increase in miscarriage or preterm delivery
Flower, Hilary. A New Look at the Safety of Breastfeeding During Pregnancy. KellyMom.com, 2013. URL: https://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/
Breastfeeding during pregnancy
Can be complicated by:• Nursing aversion• Nipple sensitivity• Decreased milk supply• Change in milk taste/composition• Self-weaning
AAFP Breastfeeding Position Paper
“Breastfeeding during a subsequent pregnancy is not unusual. If the pregnancy is normal and the mother is healthy, breastfeeding during pregnancy is the woman’s personal decision.
If the child is younger than two years, the child is at increased risk of illness if weaned.”
Breastfeeding, Family Physicians Supporting (Position Paper). American Academy of Family Physicians, 2014. URL: https://www.aafp.org/about/policies/all/breastfeeding-support.html
AAFP Breastfeeding Position Paper
“Breastfeeding the nursing child during pregnancy and after delivery of the next child (tandem nursing) may help provide a smooth transition psychologically for the older child.”
Breastfeeding, Family Physicians Supporting (Position Paper). American Academy of Family Physicians, 2014. URL: https://www.aafp.org/about/policies/all/breastfeeding-support.html
• Most infants sleep through the night by 6 months.• Formula will help my infant sleep through the night.• Supplemental formula will help my infant gain weight
better than supplemental breast milk.• Maternal dietary fiber makes babies more gassy/fussy.• You cannot make enough milk by exclusively pumping.• Smoking mothers should not breastfeed.• People with a history of breast surgery cannot breastfeed.• Transgender and adoptive parents cannot breastfeed.
More Myths…