Pediatrician Dr. Bob Sears makes it his business to stay on top of the latest developments and news regarding vaccinations. He is the author of The Vaccine Book: Making the Right Decision for Your Child. He spoke on the topic of vaccines at the La Leche League conference I went to last weekend.

La Leche League conferences are great because children are welcome at the lectures. As I chased my 10-month-old around the back of the room (until she finally fell asleep in the sling as you can see above), I managed to take in a lot of valuable information from the lecture. Dr. Sears discussed the occurrence and severity of various childhood illnesses, how vaccinations have affected the prevalence of those illnesses, toxins in vaccines, delayed and alternative vaccination schedules, the debate about vaccines and autism, and how the “same” vaccines vary by manufacturer and brand. I like that he offers an opinion on particular vaccines but does not push vaccination or not vaccinating; it’s all about the parents making an informed decision. If you get an opportunity to hear him speak, it’s well worth it! He stayed long after the lecture ended to answer individual questions, and I took the opportunity to ask him some questions I had about my daughter’s potential reaction to the rotavirus vaccine.

One tip that’s not in The Vaccine Book: Making the Right Decision for Your Child: be wary of any future swine flu vaccination developed for humans. I plan to stay tuned to Dr. Bob’s blog for The Vaccine Book for the latest information on that and other vaccines.

Both the Centers for Disease Control and Prevention (CDC) and the United States Breastfeeding Committee (USBC) have issued strong guidance on the importance of breastfeeding for protection against the H1N1 swine flu. The CDC states, “Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness.”

Thus, the CDC urges new mothers to initiate breastfeeding early and to feed frequently. Mothers already breastfeeding should continue to do so, even if they become ill. Formula feeding should be avoided or minimized and breastfeeding maximized. In the Health News Digest, USBC Chair Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC, recommends breastfeedng in emergency situations such as a swine flu outbreak:

Research clearly shows that breastfeeding provides a safe, reliable food source, full of disease-fighting cells and antibodies that help protect infants from germs and illnesses. Mothers exposed to influenza produce specific protection for their infants and transmit this through their breast milk. Infant formula does not provide these specific infection fighting properties. Unnecessary formula supplementation should be eliminated so the infant can receive as much benefit as possible from maternal protective antibodies and other immune protective factors.

Key points from the CDC swine flu guidance include:

1. If a mother is ill with swine flu, she should continue breastfeeding and feed the baby more often. If she is too ill to feed at the breast but can pump, expressed breast milk should be fed to the baby. The risk of transmission of the H1N1 virus through breast milk is unknown, but reports of transmission of the regular, seasonal flu through breast milk are rare.

2. If the baby becomes too ill to feed at the breast, he should receive the mother’s expressed breast milk or donated human milk from a non-profit milk bank.

3. Antiviral medication treatment and prophylaxis are compatible with breastfeeding.

4. All usual precautions against virus transmission should be taken, including hand washing and covering coughs and sneezes.

My baby is sick. Possibly sick from the vaccine intended to protect her from illness. And I am sick at heart. You see, I took her in for her 9-month well baby visit three days ago. At that time, she received two vaccinations: DTaP and Rotavirus. Those of you really savvy about vaccinations might see the problem already. I didn’t realize it at the time, but the rotavirus vaccine is not recommended after the baby reaches the age of 32 weeks (about 8 months).

My baby was overdue for her third and final dose of RotaTeq. I had put it off because we were on the waiting list for the Hib vaccine, which is in short supply and must be rationed out by pediatricians. In hindsight I realize I should have proceeded on schedule with my daughter’s other vaccinations, and I should have re-read the information about each vaccine, rather than relying on my previous decision to approve that vaccination. My initial reasoning was that I have had rotavirus before, and I had never been so sick in my life! Read more

Test your knowledge of how alcohol affects breast milk with these 8 questions! The trivia was derived from studies compiled on the LactMed database as of April 2009. For information about drinking and breastfeeding, see this article on alcohol and the controversial Milkscreen test. For current information on drugs and lactation, visit the LactMed database.

Answer these 8 questions and compare how you did with the answers below.

1. Nursing after 1 or 2 drinks (including beer) causes the infant to:
a) increase milk intake.
b) decrease milk intake.
c) Milk intake remains unaffected.

2. Nursing or pumping within one hour before ingesting alcohol:
a) does not affect the level of alcohol in the milk.
b) increases the level of alcohol in the milk.
c) decreases the level of alcohol in the milk.

3. Breastmilk alcohol levels are:
a) the same as blood alcohol levels.
b) higher than blood alcohol levels.
c) lower than blood alcohol levels.

4. While food consumption can delay the peak of breastmilk alcohol levels, the peak generally occurs:
a) one hour after ingestion of alcohol.
b) two hours after ingestion of alcohol.
c) three hours after ingestion of alcohol.

5. When a baby nurses after a mother consumes alcohol, the baby sleeps:
a) better.
b) worse.
c) the same.

6. True or false: The American Academy of Pediatrics rates alcohol as “usually compatible with breastfeeding.”
a) True.
b) False.

7. What minimum level of alcohol consumption affects infants negatively and is associated with shortened duration of breastfeeding?
a) Any alcohol consumption.
b) Casual alcohol consumption (1 drink per day).
c) Daily heavy use (more than 2 drinks daily).

8. One study estimated that a breastfed infant received a certain percentage of the mother’s weight-adjusted dosage of alcohol when she consumed 1.5 drinks. That percentage was:
a) between 0.5 to 3.3% of the mother’s weight-adjusted dosage.
b) between 3.3% to 5.0% of the mother’s weight-adjusted dosage.
c) between 5.0% to 8.3% of the mother’s weight-adjusted dosage.

The Answers

1. b. Nursing after 1 or 2 drinks can decrease the infant’s milk intake by 20 to 23% in the 3-4 hours after ingestion of alcohol. However, the infants increase the number of feedings over the next several hours and total milk consumption over 20 hours is the same. Smart babies!
2. c. Nursing or pumping within one hour before drinking alcohol may slightly decrease the amount of alcohol in the milk.
3. a. Breastmilk alcohol levels closely parallel blood alcohol levels.
4. a. Breastmilk alcohol levels peak approximately one hour after ingestion of alcohol, although food consumption can delay the peak.
5. b. Babies slept more frequently for shorter periods of time during the 3.5 to 4 hours after alcohol intake.
6. a. True, the AAP category is “usually compatible with breastfeeding.”
7. c. Heavy drinking is dangerous. Casual drinking is unlikely to cause short- or long-term effects particularly if the mother waits 2 to 2.5 hours per drink before nursing.
8. a. The study showed the breastfed infant received between 0.5 to 3.3% of the adjusted dose.

How did you do? What surprised you the most?

As I researched the local agricultural fairs in which my daughters might like to participate, I learned that January is National Oatmeal Month! Somehow for a breastfeeding blogger, everything relates to breastfeeding, and National Oatmeal Month is no exception. It begged the question, does oatmeal increase milk supply? I knew that the answer could be found in the new book The Breastfeeding Mother’s Guide to Making More Milk by Diana West, IBCLC, and Lisa Marasco, M.A., IBCLC. The authors note that oat straw and its grain, oats, have long enjoyed a reputation as a galactagogue. In a section on lactogenic foods, they say:

Oatmeal is popular with North American mothers. Steel-cut or rolled oats are more nutritious and likely to be more effective than instant. Oats are also high in fiber, as is brown rice and most other whole grains and dried beans.

p. 173. So, given that oatmeal is nutritious and easy to incorporate into a healthful diet, it looks like we file this one under “Can’t hurt and might help.”

It was bound to happen eventually. We made it all the way to the third week of school before my first grader and preschooler brought home the first colds of the season. I reminded my preschooler not to kiss or touch the baby (if anything she gives her a little too much love) but I knew we were history when she accidentally sneezed on Nicole.

At 10 weeks, Nicole is weathering the cold just fine. She’s generally as happy as ever, and she quite enjoys the sneezes! *sneeze* *coo*! The only time she gets upset is when she wants to nurse but she can’t breathe through her nose. The situation got quite desperate when I’d pulled over the car and stopped in a parking lot to nurse. It was 99 degrees Fahrenheit (so much for fall!) on the blacktop and I was alternately trying to nurse her and soothe her by walking around. It was an exercise in frustration for both of us, until I remembered the tip Sinead mentioned on this post about breast milk curing pink eye. She said breast milk can help clear a stuffy nose, much like saline nose drops. I tried it and it worked like a charm! Nicole nursed herself to sleep, I popped her back in her car seat, and we drove on our merry way!

Just a quick reminder that the latest edition of the drug and lactation guide Medications and Mothers’ Milk is available starting today! According to the publisher:

Some of the new features added to Medications and Mothers’ Milk 2008, thirteenth edition include:
- More than 70 new drugs.
- Rigorous updates to hundreds of drugs and tables.
- Updated tables on radiocontrast agents.
- Updated tables on cold and cough remedies.

Buy Medications and Mothers’ Milk now!

Yesterday the U.S. Food and Drug Administration issued a warning against the use of Mommy’s Bliss Nipple Cream, marketed by MOM Enterprises, Inc. to nursing mothers for treatment of cracked and sore nipples. The packaging specifically states that it is not necessary to remove the cream before nursing, but two ingredients in the cream may be harmful to nursing infants. The FDA describes the dangers of chlorphenesin and phenoxyethanol:

Chlorphenesin relaxes skeletal muscle and can depress the central nervous system and cause respiratory depression (slow or shallow breathing) in infants. Phenoxyethanol is a preservative that is primarily used in cosmetics and medications. It also can depress the central nervous system and may cause vomiting and diarrhea, which can lead to dehydration in infants.

Mothers should discontinue use of the product and watch for the following signs of infant distress (and seek immediate medical assistance for any of these symptoms):

~ decrease in an infant’s appetite
~ difficulty in awakening the child
~ limpness of extremities
~ decrease in an infant’s strength of grip
~ a change in skin color.

Mothers using the cream may suffer from dermatitis as well.

The FDA says consumers are strongly encouraged to report adverse events related to this product or any FDA approved product to MedWatch, the agency’s voluntary reporting program, by e-mail at www.fda.gov/medwatch/report.htm, or by phone at 800-332-1088, or by fax to 800-332-0178. Consumers may also mail reports of adverse events to MedWatch, Food and Drug Administration, 5600 Fishers Lane, Rockville, MD, 20852-9787.

Thanks to Marijke at the new b5media pregnancy blog, Womb Within, for the information on this story!

In honor of Mental Health Month, the Health and Wellness Channel focuses on mental health topics today. The good news is that breastfeeding protects maternal mental health. According to a study by Kathleen Kendall-Tackett in the International Breastfeeding Journal:

Breastfeeding has been shown to reduce stress and protect maternal mood. Breastfeeding also reduces stress of babies of depressed mothers and protects them from the harmful effects of maternal depression. Treatment approaches that are anti-inflammatory have efficacy in treating depression. These include EPA and DHA, exercise, cognitive therapy, herbal anti-depressants such as St. John’s wort, and standard antidepressants.

Unfortunately, many breastfeeding mothers will get poor medical advice from their doctors about the benefits and risks of traditional anti-depressant medications or alternative depression treatments while breastfeeding.

Treatment Options for Postpartum Depression in Breastfeeding Mothers

Check out these resources for information:

~ the study quoted above: Kendall-Tackett, K. “A New Paradigm for Depression in New Mothers: the Central Role of Inflammation and How Breastfeeding and Anti-Inflammatory Treatments Protect Maternal Mental Health.” International Breastfeeding Journal. 2007, 2:6 (March 30, 2007).

~ Thomas W. Hale Ph.D.’s Medications Forum

~ the lactation and medication LactMed database

~ the American Academy of Pediatrics Transfer of Drugs and Other Chemicals into Human Milk

~ Kellymom.com on alternative treatments for postpartum depression

~ Kellymom.com on psychiatric medications and breastfeeding

Technical Resources for Medical Professionals and Others:

~ Depression In New Mothers: Causes, Consequences, And Treatment Alternatives by Kathleen Kendall-Tackett, Ph.D., IBCLC; see La Leche League book review here.

~ The latest edition of the drug and lactation guide Medications and Mothers’ Milk by Thomas W. Hale, Ph.D.

More on Mental Health

For more posts on mental health, see the mental health theme day round-up by Alicia at Mental Health Notes.

Your Experience

Breastfeeding mothers, please feel free to leave a comment about your personal experience with depression. As always, I remind mothers to consult a physician when considering any treatment (traditional or alternative) while breastfeeding.

Welcome to the April Carnival of Breastfeeding, “Thrush and Mastitis and Blebs, oh my!” This month several contributors share their experiences with different breastfeeding challenges and offer links and resources for overcoming those challenges. First I will talk about using gentian violet or grapefruit seed extract as alternative remedies for thrush, but make sure to read on for links to the other contributions at the end!

Oversupply

When my first daughter was born, I struggled with oversupply. In theory oversupply sounds great because it eliminates any worry about having enough milk for the baby. In reality, it can cause a lot of problems including painful engorgement, an overactive letdown (which can cause the baby to choke, sputter, and pop off the breast), a foremilk-hindmilk imbalance (leading to green and gassy stools), plugged ducts, and mastitis.

I wish I had known more about correcting oversupply in the first place. In the end it took about 12 weeks for my supply to regulate.

Plugged Ducts

Off and on over that first year, I experienced several plugged ducts:

~ Kellymom on Plugged Ducts and Mastitis
~ NEW BEGINNINGS article on Plugged Ducts

I became adept at hand-expressing to remove the little white milk plug that was blocking the milk duct. One time, though, I found that I had damaged the nipple skin at the site of the plug, and the sore simply would not heal. I tried Lansinoh and I tried expressing breast milk on the nipple and letting it air dry. The white, cracked sore did not go away.

Thrush

Eventually I spoke to a La Leche League leader, who suggested I consult my doctor to see whether it could be thrush. I wasn’t in terrible pain and my baby didn’t have white patches in her mouth, but thrush can exist without such symptoms or signs. My gynecologist first prescribed Nystatin for me and my baby, and when that didn’t work, we moved on to Diflucan. (I also sanitized all of my clothing and any toys or other items that had been in my baby’s mouth). When Diflucan didn’t work either, I began to suspect I didn’t have thrush (that’s what I think in retrospect), or I had a stubborn case.

Gentian Violet and Grapefruit Seed Extract

I started looking for alternative remedies for thrush, and happened upon information about using Gentian Violet:

~ Using Gentian Violet - Dr. Jack Newman
~ Thrush Remedies including Gentian Violet (see also the warning on its use) — AskDrSears.com

Gentian violet is purple and does indeed stain your nipples, baby’s mouth, and clothing. I bought a few pink/purple outfits and put my baby in them for the duration of our treatment! Whether or not I actually had thrush, this is the product that finally helped my nipple heal.

Later on I learned about grapefruit seed extract and its antimicrobial properties. I tried Nutribiotic - GSE Liquid Concentrate anytime I had an open sore, or my baby developed a yeasty diaper rash. I also take it internally when I’m battling a bout of plugged ducts and/or mastitis. It’s also an effective cleaner! Just make sure you dilute it. Plain sterile water works for topical applications, and a little orange juice (or grapefruit juice!) works well to mask the bitter taste when you take it internally. A small bottle of GSE seems expensive ($10.50 or so on-line or at a natural foods store) but a little goes a long way and I still have my original bottle four years later.

~ Grapefruit Seed Extract for Treatment of Thrush - AskLenore.com
~ Identifying and Treating Thrush (with GSE) - Dr. Jay Gordon

It’s convenient that these remedies do not require a prescription, but as always, consult your physician, your child’s physician, and/or a pharmacist before using any medication.

Other Participants in the Carnival

~ Tongue Tie - Motherwear Breastfeeding Blog
~ Supplementing - Mama’s Magic
~ Oversupply, Blebs, Plugged Ducts, and Mastits - Half Pint Pixie
~ Plugged Ducts and Mastitis - Speech Act
~ Low Milk Supply and the Mini-Pill - Tales of Life with a Girl on the Go
~ Getting Rid of Thrush - Nurturing Notes
~ Sore Nipples, Engorgement, and Medications - BreastfeedingMums
~ Surviving Mastitis - Blessed Nest Perch
~ Supplementing during the First Week - Hobo Mama