A 24-year-old female came to clinic with her 1 month old healthy child. She had seasonal allergic rhinitis in the past and her symptoms that are now flaring up with itchy water eyes, itchy nose with clear rhinorrhea, and dark circles under her eyes.
She previously took loratadine with good symptomatic relief, but she is breastfeeding and is worried about using it again.
The past medical history reveals a normal, spontaneous vaginal birth with no complications pre- or post-natally.
The pertinent physical exam shows a normal healthy infant.
The diagnosis of a healthy infant with an appropriately-concerned breastfeeding mother was made.
The physician checked the LactMed database from the National Library of Medicine whose summary stated: “Because of its lack of sedation and low milk levels, maternal use of loratadine would not be expected to cause any adverse effects in breastfed infants. Loratadine might have a negative effect on lactation, especially in combination with a sympathomimetic agent such as pseudoephedrine.”The mother was re-assured with the information, but was also told to monitor the infant and her milk supply and if there were changes to re-contact the physician.
Breastfeeding provides the best possible food for an infant.
Some advantages include providing good nutrition for the infant, low in cost, no preparation is needed and breastfeeding is instantly available.
Breast feeding also helps mothers get back into overall physical shape and helps the uterus to tighten and return to normal size more quickly
Breastfeeding may promote positive feelings towards the child and self.
The disadvantages include that only the mother can breastfeed which takes time and energy and other family members may feel left out.
There are a few medical reasons for not recommending breast-feeding such as when the mother is extremely ill and is unable to recover herself and breastfeed concurrently, or she needs to take
certain medications that may pass into the milk and could be dangerous for the infant.
Also if the mother has certain health conditions, such as Human Immunodeficiency Virus Syndrome (HIV), which could put her infant at risk, breastfeeding may not be advised.
Note: The risk of acquired HIV through breastmilk is higher than the risk of infant morbidity and mortality in developed countries and breastfeeding is generally not recommended for women with HIV in developed countries.
However, in underdeveloped countries the risk of acquired HIV through breast milk is lower than the general infant morbidity and mortality risk and therefore breastfeeding is generally promoted for women wth HIV in underdeveloped countries.
Drug information is one of the most common information needs of pediatricians and pediatric health care providers.
Drug information for lactating women and its potential side-effects on the lactation process and the infant is often not readily available.
The National Library of Medicine however publishes TOXNET Toxicology Data Network (http://www.toxnet.nlm.nih.gov/cgi-bin/sis/search)which includes 15 different databases that can be searched including information on hazardous materials and household products.
It also includes LactMed Drug and Lactation Database (http://www.toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT) which is “A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.”Drug name synonyms can also be searched concurrently (i.e. a search for the proprietary name of Claritin® will retrieve loratadine, the generic name)
Questions for Further Discussion
1. What environmental exposures should pregnant and lactating women be cautious of?
2. What are some standards that can be used to help determine high-quality Internet information?
3. What is the risk of an infant acquiring HIV from a mother who is breastfeeding?
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Information prescriptions for patients can be found at MEDLINEplus for this topic: Breast Feeding
and at Pediatric Common Questions, Quick Answers for this topic: Breastfeeding
To view current news articles on this topic check Google News.
Shelov SP, Hanneman RE. American Academy of Pediatrics Caring for Your Baby and Young Child Birth to Age 5. Bantam Books New York NY. 1993;68-69.
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effecively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
5. Patients and their families are counseled and educated.
6. Information technology to support patient care decisions and patient education is used.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.
16. Learning of students and other health care professionals is facilitated.
25. Quality patient care and assisting patients in dealing with system complexities is advocated.
Donna M. D’Alessandro, MD
Associate Professor of Pediatrics, Children’s Hospital of Iowa
July 11, 2006