Children's Medicines: Bell, Edward A

Children's Medicines
Bell, Edward A.
Published by Johns Hopkins University Press
Bell, Edward A.
Children's Medicines: What Every Parent, Grandparent, and Teacher Needs to Know.
Johns Hopkins University Press, 2017.
Project MUSE., <a href=" https://muse.jhu.edu/.
For additional information about this book

https://muse.jhu.edu/book/72141
[ This content has been declared free to read by the pubisher during the COVID-19 pandemic. ]
APPENDIX A
Maternal Medications
and Breastfeeding
The American Academy of Pediatrics recommends that women

breastfeed their newborn infants, when possible, because breast-
feeding provides many benefits to the feeding infant and the mother.
Human breast milk contains an excellent balance of nutrients and
provides additional benefits to the infant, including protection
from many types of infection, such as ear infections, diarrhea, and
meningitis. Breast milk contains natural antibodies from the moth-
er that decrease the risk of these infections to the infant, and possi-
bly other types of infections as well. Breastfeeding also plays a role
in decreasing the risk of sudden infant death syndrome (SIDS) and
may decrease the risk of your infant’s developing allergies or asthma.
Breastfeeding additionally benefits the mother. The hormones
prolactin and oxytocin are released during breastfeeding. These
hormones provide a natural feeling of maternal relaxation and ma-
ternal-infant bonding and help the mother’s body recover and heal
from pregnancy and childbirth. Prolactin and oxytocin also delay
the return of a mother’s menstrual period and decrease a risk of
ovarian and breast cancer later in the mother’s life.
Most medicines are safe to use while breastfeeding, because the
amount of medicine that distributes into breast milk is a small and
clinically insignificant amount and is unlikely to be of danger to a
feeding infant. However, some medicines do distribute into breast
131
milk to a greater extent and may be of potential concern for the
baby’s health. For some medicines, especially newer medicines, we
do not have enough information to assess if a mother’s use of the
medicine is clinically significant for her baby’s health.
You can search a medically accurate and reliable Internet site
called LactMed at http://toxnet.nlm.nih.gov to find information
about a specific medicine’s use while breastfeeding. This Internet
site, from the National Institutes of Health, is updated monthly and
is the largest online source of information about maternal medicine
use and breastfeeding. It is easy to search for specific medicines and
what is known about their effects on an infant.
The amount of a medication that distributes into breast milk de-
pends upon several factors, including how much medication is ab-
sorbed by the mother, how the mother metabolizes the medication,
chemical characteristics of the medication, the amount of breast
milk taken by the infant, the age of the infant, and other factors.
The type of medicine (that is, how it functions in the body) and its
adverse effect profile are important as well. An additional consid-
eration when thinking about taking medicines while breastfeeding
is the effect of the medication on milk production, because some
medications can reduce the amount of milk the mother produces.
Many medicines can be safely taken by a woman while breast-
feeding her infant. Commonly used medicines considered safe
while nursing include the following, which are only several exam-
ples of medicines considered safe to use while breastfeeding:
◆ acetaminophen (Tylenol and generic)
◆ ibuprofen (Motrin, Advil, and generic)
◆ loratadine (Claritin and generic)
◆ cetirizine (Zyrtec and generic)
As with all medicines taken by a mother who is breastfeeding her
infant, it is best to use the medicine at the smallest dose possible to
control the illness or symptoms, and to take the medicine for the
shortest time period possible.
132 • A ppendix A
To minimize the amount of medicine that distributes into breast
milk consider following these suggestions:
◆ Take the medicine at a time when you are not as likely to be
breastfeeding your infant. For example, take your medicine
just after you have breastfed your infant or when you
expect your infant to sleep for several hours. This allows the
medicine to reach its highest concentration in your blood
and milk when your infant will not be breastfeeding.
◆ Use “short-acting” medicines when possible. Some medicine
products are made to last longer, so they can be taken only
once or twice per day. Many of these medicines are also
available as short-acting products, which means that they
often need to be taken three or more times per day. These
short-acting products don’t stay in the bloodstream as long,
which is preferred when you are breastfeeding.
◆ Always closely watch your infant for any change in behavior
if you are taking medicine and breastfeeding. For example, if
your infant is sleeping much more, or less, since you started
taking a medicine, it is possible that some of the medicine is
getting into your milk and affecting your infant.
Some antidepressant medicines, such as the selective serotonin
reuptake inhibitors (SSRIs) discussed in chapter 4, are commonly
used by adults and deserve careful consideration if a mother would
like to breastfeed her infant. Some SSRI medicines may distribute
into breast milk to a clinically significant amount and may produce
adverse effects in the infant. Although some information is known
about antidepressant medicines distributing into breast milk, the
long-term effects on an infant’s development are still unknown.
Many antidepressant medications and similar medications used to
treat anxiety or mood disorders distribute into breast milk to some
extent, although we do not know how much for many medications.
Case reports have been published documenting blood levels of
some antidepressants, such as fluoxetine (Prozac and generic), dis-
Maternal Medications and Breastfeeding • 133

tributing from swallowed breast milk into infants’ blood to about
10 percent of the blood level of the mother. This amount may be
clinically significant and may result in adverse effects in the infant.
The long-term effects of these medications on the developing brain
chemistry of infants are unknown.
Concerns have additionally been raised about the use of sever-
al herbal products during breastfeeding, including echinacea and
St. John’s wort. Current recommendations are to avoid these herbal
products and possibly other herbal products during breastfeeding.
Very little information is known about the use of herbal products
by a mother while breastfeeding.
If you desire to breastfeed your infant and you are taking any
medicines, including over-the-counter products and herbal prod-
ucts, it is best to inform your pediatrician and discuss the safety
of using these medicines while breastfeeding and the potential for
adverse effects in your infant.
134 • A ppendix A

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Children's Medicines

Published by Johns Hopkins University Press

For additional information about this book

The American Academy of Pediatrics recommends that women

Maternal Medications and Breastfeeding • 133

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