Introduction
Almost all mothers can breastfeed successfully, which includes initiating breastfeeding within the first hour of life, breastfeeding exclusively for the first 6 months and continuing breastfeeding (along with giving appropriate complementary foods) up to 2 years of age or beyond.
Exclusive breastfeeding in the first six months of life is particularly beneficial for mothers and infants.
Positive effects of breastfeeding on the health of infants and mothers are observed in all settings. Breastfeeding reduces the risk of acute infections such as diarrhoea, pneumonia, ear infection, Haemophilus influenza, meningitis and urinary tract infection (1). It also protects against chronic conditions in the future such as type I diabetes, ulcerative colitis, and Crohn's disease. Breastfeeding during infancy is associated with lower mean blood pressure and total serum cholesterol, and with lower prevalence of type-2 diabetes, overweight and obesity during adolescence and adult life (2). Breastfeeding delays the return of a woman's fertility and reduces the risks of post-partum haemorrhage, pre-menopausal breast cancer and ovarian cancer (3).
Nevertheless, a small number of health conditions of the infant or the mother may justify recommending that she does not breastfeed temporarily or permanently (4). These conditions, which concern very few mothers and their infants, are listed below together with some health conditions of the mother that, although serious, are not medical reasons for using breast-milk substitutes..
Whenever stopping breastfeeding is considered, the benefits of breastfeeding should be weighed against the risks posed by the presence of the specific conditions listed.
INFANT CONDITIONS
Infants who should not receive breast milk or any other milk except specialized formula
Infants with classic galactosemia: a special galactose-free formula is needed.
Infants with maple syrup urine disease: a special formula free of leucine, isoleucine and valine is needed.
Infants with phenylketonuria: a special phenylalanine-free formula is needed (some breastfeeding is possible, under careful monitoring).
Infants for whom breast milk remains the best feeding option but who may need other food in addition to breast milk for a limited period
MATERNAL CONDITIONS
Mothers who are affected by any of the conditions mentioned below should receive treatment according to standard guidelines.
Maternal conditions that may justify permanent avoidance of breastfeeding
HIV infection:
2 if replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS) (
6).
Maternal conditions that may justify temporary avoidance of breastfeeding
Severe illness that prevents a mother from caring for her infant, for example sepsis.
Herpes simplex virus type 1 (HSV-1): direct contact between lesions on the mother's breasts and the infant's mouth should be avoided until all active lesions have resolved.
Maternal medication:
- —
sedating psychotherapeutic drugs, anti-epileptic drugs and opioids and their combinations may cause side effects such as drowsiness and respiratory depression and are better avoided if a safer alternative is available (7);
- —
radioactive iodine-131 is better avoided given that safer alternatives are available – a mother can resume breastfeeding about two months after receiving this substance;
- —
excessive use of topical iodine or iodophors (e.g., povidone-iodine), especially on open wounds or mucous membranes, can result in thyroid suppression or electrolyte abnormalities in the breastfed infant and should be avoided;
- —
cytotoxic chemotherapy requires that a mother stops breastfeeding during therapy.
Maternal conditions during which breastfeeding can still continue, although health problems may be of concern
Breast abscess: breastfeeding should continue on the unaffected breast; feeding from the affected breast can resume once treatment has started (
8).
Hepatitis B: infants should be given hepatitis B vaccine, within the first 48 hours or as soon as possible thereafter (
9).
Hepatitis C.
Mastitis: if breastfeeding is very painful, milk must be removed by expression to prevent progression of the condition(
8).
Tuberculosis: mother and baby should be managed according to national tuberculosis guidelines (
10).
- —
maternal use of nicotine, alcohol, ecstasy, amphetamines, cocaine and related stimulants has been demonstrated to have harmful effects on breastfed babies;
- —
alcohol, opioids, benzodiazepines and cannabis can cause sedation in both the mother and the baby.
Mothers should be encouraged not to use these substances and given opportunities and support to abstain.
References
- 1.
Technical updates of the guidelines on Integrated Management of Childhood Illness (IMCI). Evidence and recommendations for further adaptations. Geneva: World Health Organization; 2005.
- 2.
Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analyses. Geneva: World Health Organization; 2007.
- 3.
- 4.
Resolution WHA39.28. Infant and Young Child Feeding; Thirty-ninth World Health Assembly; Resolutions and records. Final; Geneva. 5–16 May 1986; Geneva: World Health Organization; 1986. (WHA39/1986/REC/1), Annex 6: 122–135.
- 5.
- 6.
HIV and infant feeding: update based on the technical consultation held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV Infection in Pregnant Women, Mothers and their Infants, Geneva, 25–27 October 2006. Geneva: World Health Organization; 2007. [23 June 2008].
http://whqlibdoc.who.int/publications/2007/9789241595964_eng.pdf.
- 7.
Breastfeeding and maternal medication: recommendations for drugs in the Eleventh WHO Model List of Essential Drugs. Geneva: World Health Organization; 2003.
- 8.
- 9.
Hepatitis B and breastfeeding. Geneva: World Health Organization; 1996. (Update No. 22)
- 10.
Breastfeeding and Maternal tuberculosis. Geneva: World Health Organization; 1998. (Update No. 23)
- 11.
Background papers to the national clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn; Commissioned by the Ministerial Council on Drug Strategy under the Cost Shared Funding Model; NSW Department of Health, North Sydney, Australia. 2006.
- 1
Reference: WHO/UNICEF. Acceptable medical reasons for use of breast-milk substitutes. World Health Organization, Geneva, 2008.
- 2
The most appropriate infant feeding option for an HIV-infected mother depends on her and her infant's individual circumstances, including her health status, but should take consideration of the health services available and the counselling and support she is likely to receive. When replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS), avoidance of all breastfeeding by HIV-infected women is recommended. Mixed feeding in the first 6 months of life (that is, breastfeeding while also giving other fluids, formula or foods) should always be avoided by HIV-infected mothers.
- 3
Mothers who choose not to cease their use of these substances or who are unable to do so should seek individual advice on the risks and benefits of breastfeeding depending on their individual circumstances. For mothers who use these substances in short episodes, consideration may be given to avoiding breastfeeding temporarily during this time.
- 4
