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 Episode 245 The flu and breastfeeding

on the recommendations of the CDC as to how breastfeeding moms should approach the care of their baby if they have been diagnosed with the flu.

The original handout which is basically titled: Influenza. This statement has recently been going around the internet is from 2011 and on the bottom of the page it states that it was last reviewed and updated on January 19th 2018. I will have a link to the handout in the show notes for this Episode #245, which you can get from going to: allaboutbreastfeeding.biz/podcast and then look for Episode #245.

I am not going to read the whole article. I am just going to read a few parts of the article and then give you my comments on this topic.

According to the CDC:

Based on 2011 recommendations concerning influenza in the healthcare setting, mothers with influenza should temporarily not breastfeed their newborns; however, they can provide expressed breast milk to their newborns via a healthy caregiver. Mothers with influenza can transmit the virus to their newborns when they are in close proximity to each other, such as when breastfeeding or bottle feeding.

In response to the question: Is it safe for mothers with influenza to breastfeed their newborns?

The CDC response:

Sick mothers should be encouraged to express their milk for healthy caregivers to feed to their newborns. Since the flu is spread from person-to-person via respiratory droplets or touching, they feel that mothers who are close proximity to their newborns, are at increased risk of severe complications from influenza.

The CDC goes on to say:

Breast milk remains the best source of nutrition for the infant, providing protection through antibodies and other immunological factors. As such, mothers who are separated from their infants should be encouraged to regularly express their breast milk during this separation to provide milk for the infant and to maintain their milk supply. Prior to expressing breast milk, mothers should wash their hands well with soap and water and ensure they follow recommendations for expressing breast milk safely. Wearing disposable gloves and a disposable face mask while expressing and handling breast milk may reduce the risk of spreading influenza from an infectious mother to her infant. Expressed breast milk should be fed to the infant by a healthy caregiver who does not have influenza, if possible.

Let’s take a look at a reference from the CDCs website which is dated November 19th, 2016

It is titled: When should a mother avoid breastfeeding?

They state that there are rare exceptions when human milk is not recommended.

Breastfeeding is not advisable if one or more of the following conditions is true:
1.An infant is diagnosed with galactosemia, a rare genetic metabolic disorder
2.The infant whose mother:
has been infected with HIV
Has untreated active TB
Is taking antiretroviral medications
Is infected with Human T-cell Lymphotropic firus type 1 or 11
Is using or dependent upon an ilicit drug
Is taking prescibed cancer chemotherapy agents
Is undergoing radiation therapies

It also states that there might be other circumstances where the physician will need to determine a moms safety with breastfeeding on a case by case basis. Nowhere in this statement does it say that mothers who have been diagnosed with the flu should not be breastfeeding their baby.

I thought it would be helpful for you to be making an informed decision when deciding how to go about feeding your baby if you are diagnosed with the flu. Take all of the above into consideration, along with the fact that in their 2016 statement, the CDC does not say to avoid breastfeeding your baby if you have the flu. It is easy for the public, for caring moms who read these statements to not be sure about how to proceed feeding their breastfed babies when they have the flu. As I said, I have received a number of inquiries as far as how they should proceed. Is it safe to breastfeed my baby? I just found out I have the flu. This is sending some moms into panic mode as they realize they do not have a freezer stash of milk for their baby.

Here are some of my thoughts on this subject.

If it was not safe to breastfeed your baby if you have been diagnosed with the flu, I imagine there would be flyers all over your pediatric office stating so. How many of you have been counseled at any time during your pediatric visits and are told that if you have the flu, you should not be breastfeeding your baby? For those who have been told this, have you also been told –

1 – The flu is spread in the droplets that come from coughs and sneezes. The flu is not spread through breastmilk. Once mom has been exposed to the flu, her body goes to town making antibodies to help you fight the flu. These antibodies are in your milk and it is of the utmost importance that you continue breastfeeding so that your baby has access to these antibodies. Your breastmilk is exactly what your baby needs as it will help keep your baby from getting sick and/or reducing their symptoms. Your breastmilk is the best defense you have.

Okay – so now that we all agree that your breastmilk is the best thing for your baby, here are a few things for you to consider –

2 It makes no sense at all to remove a baby from its mothers so someone else can feed your baby your milk. There is no reason for you to be pumping your milk and putting it in a bottle for someone else to feed your baby. Why?? The CDC is making a pretty big assumption that the person you are giving the baby to, does not have the flu nor has been ex posed to the flu.

3 In fact, if the person who is going to feed your baby is someone else l iving in your space, it is likely they have been exposed to the flu also and are just not showing signs of it yet. How many times has one person gotten the flu in your household and noone else gets it? Of course, this does happen, however, it is more likely that it will make its way through the whole household.

4 If a mom who has been breastfeeding her baby, switches to pumping and bottlefeeding, the CDC is making an assumption that mom has a good quality pump that will keep up her supply & that she will be able to keep up a pumping schedule. Moms who are sick with the flu, may not be able to sit up and pump, but they can surely lay down and feed their baby.

5 – The CDC is also assuming that your baby will take a bottle. We all know that there are some breastfed babies who will not drink milk from a bottle. Some moms have tried like crazy to get their baby to take the bottle, but they just won’t have it. Some moms have never tried yet. Can you imagine taking a baby away from the only food source it has known and the frustration level of having someone else try and make them take a bottle out of nowhere? This will be quite stressfull for your baby.

Some moms who pump may have plenty of milk for their baby at breast, but may not pump enough. This means that instead of giving heir baby all their milk, they are having to look for donor milk during a very stressful time. Or they might need to give their baby formula. The last thing a mom wants to do is expose her exclusively breastfed baby to formula, during a time when the flu is going around and she wants her baby to be as healthy as possible. Taking away moms milk with antibodies and instead giving milk that has no antibodies,,, just does not make any sense.

What about the emotional stress of a baby being separated from its mother and feedings abruptly very different then what they are use to. What about Moms supply dropping because of a lack of baby/breast stimulation. If the baby does take to the bottle, there is also a risk that after a few days of bottlefeeding, your baby may give you a hard time going back to the breast.

There is so much wrong with this picture. None of it makes any sense.
Removing a baby from its moms unnecessarily creates a dangerous and heart-breaking situation (as moms’ milk supplies plummet and babies start experiencing nipple confusion, etc. and then all these moms start down the path of early or abrupt weaning)

In making the best educated decision for you and your baby, keep in mind
1. Most bacterial infections and viruses are usually most infectious before noticing any symptoms. Your baby has already been exposed to these infections days before you even feel sick.
2. How amazing is it that the exact thing that your needs can get to your baby through your milk. Why on earth would we ever want to deny your baby from getting these 100 percent of these antibodies that are specifically meant to fight the flu, directly through your milk?
3. Remember, your milk already contains so many antibodies that your baby gets every single feeding, in addition to the ones your body starts making once you have been exposed to a virus.

I recognize that this information is coming directly from the CDC and it is understandable for you to assume this is accurate information. However, before you stop breastfeeding your baby just because you have the flu, think about this logically. Ask yourself if it truly makes sense to begin pumping and handing your baby over to someone else to feed. It will likely be much more of a strain for you to pump on a regular basis, then it will be to just put your baby to your breast.

With all this talk about the flu, my hope is, of course, that you do not get the flu this season. Take the usual hand washing and face touching precautions that you know you should, keep breastfeeding and enjoy your baby! Until the next show, bye bye

CDC Statement:

https://www.cdc.gov/breastfeeding/disease/influenza.htm

Related Resources
Zapata, LB; Kendrick, JS; Jamieson, DJ; et al. (2012). Prevention of Novel Influenza Infection in Newborns in Hospital Settings: Considerations and Strategies During the 2009 H1N1 Pandemic. Disaster Med Public Health Preparedness; 6:97-103.
Rasmussen, SA; Kissin, DA; Yeung, LF; et al. (2011). Preparing for Influenza after 2009 H1N1: Special Considerations for Pregnant Women and Newborns. American Journal of Obstetrics & Gynecology; 204(6 Suppl 1):S13-20

Lori J. Isenstadt, IBCLC

Lori j Isenstadt, IBCLCLori Jill Isenstadt, IBCLC is a huge breastfeeding supporter.  She has spent much  of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years.  Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant.  She has been helping moms and babies with breastfeeding for over 25 years.  Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges.  She is an international speaker, book author and the host of the  popular itunes podcast, All About Breastfeeding, the place where the girls hang out.  You can reach Lori by email at: [email protected] or contact her via her website:  allaboutbreastfeeding.biz/contact

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