Posted in Breastfeeding and Childcare

Resources for the safe use of medications in pregnancy and lactation

All too often, breastfeeding mothers are told to stop breastfeeding because they need to be on a medication that is thought to be harmful to the baby. Or mothers are advised to “pump and dump” – feed their baby an alternative (donor milk/formula), express their own milk and throw it away in order to maintain their milk supply while on the prescribed drug.  For many, this interruption which usually occurs during the early few weeks when breastfeeding is being established, is sufficient to sabotage the entire effort.

To be fair, the information on drugs in breastfeeding that has been available to most doctors in the past is quite limited. Many doctors will give the advise that they give because they feel it is the safest one for the baby. After all, most drug labels warn against their use during lactation. And since carrying out research on breastfeeding mothers and their infants is frowned upon by the scientific community, there has not been a lot of data available on the true safety of these drugs.  This puts mothers who need treatment and doctors who want to provide it, in a challenging situation.

The study of the transfer of drugs from mother to baby through her breast milk is a complex one. Not all medications are the same, and their transfer and effects depend on many factors. In general, most drugs that nursing mothers ingest will show up in their breast milk. However, the amount found in breastmilk is usually not more than 1% of the dose ingested by the mother.  (Lawrence R.  Breastfeeding: A Guide for the Medical Profession. 2011) That amount of drug is generally too small to be of any real consequence.

Thankfully, there are more resources available to us now than in the past. There is a more concerted effort to identify which medications are truly harmful to a nursing infant, and there are more resources and references available to mothers and medical professionals alike.

1. In August 2013, the American Academy of Pediatrics published an update to its guidelines in the article The Transfer of Drugs and Therapeutics into Human Breast Milk: An Update on Selected Topics.  In essence, the AAP states that most medications are likely safe for breastfeeding mothers. There is some debate regarding the AAP stand on galactagogues like domperidone (see Dr. Jack Newman’s comments on this here) but for the most part, it is a helpful reference.

2. The online resource LactMed is free to use and has a handy downloadable app.  Simply type in the name of the drug you are searching for and it will bring up the available information.

3. Dr. T.W. Hale, author of Medications and Mother’s Milk, has recently released a new app for the iphone and android called InfantRiskCenter.  The app costs $9.99 to download and is the most comprehensive database I’ve seen so far. The format is great – simple and easy to read, and there is information is specific to your trimester in pregnancy or the age of the baby you are nursing.

These resources were really made for the use of medical professionals, so please do not self-medicate or self-diagnose. But if you are a nursing mother and being told to stop breastfeeding because you need to take a medication that is deemed “safe” or “probably safe” by one of these references, please share it with your doctor.

Posted in Breastfeeding and Childcare, Health

The root of the MMR-Autism debate

I found this great graphic article through a friend. It is a wonderfully concise yet thorough explanation of the MMR-Autism controversy, beginning with Dr. Andrew Wakefield’s now-debunked “landmark study”. It explains how and why he faked his results, and what the consequences of his irresponsible actions have been. A good read for those who are still confused, or who still believe there is a link between Autism and the MMR vaccine.

Click on the link below to read the article.

The facts in the Case of Dr. Andrew Wakefield – Darryl Cunningham

Breast Anatomy and the Letdown Reflex

Click to see the video: Breast Anatomy and the Letdown Reflex

I haven’t posted anything in ages but today I was watching a video on Khan Academy and found this cool video that very clearly explains breast anatomy. There is a subsequent video that goes through the Letdown Reflex as well. It is a bit technical (they are made by the Stanford School of Medicine) but is the simplest and clearest one I have seen so far. Sharing them here for those who may find the information useful!

Posted in Health

The science (or lack of) behind vitamins and supplements

In medical school, I was part of a group of students that performed experiments on a traditional herbal remedy for cough and asthma. We took an herb that was used by traditional Philippine healers in the treatment of chronic cough conditions, worked with our Department of Pharmacology and used a standardized liquid preparation of the herb to treat a specific type of asthma in children.  The study showed that the herb worked as well as standard drugs.  The experience taught me a lot. I learned that because the therapeutic potential of nature is great, there is a need to study these remedies scientifically – to prove what works and what doesn’t; to unearth any potential harm (there are naturally-occuring toxins/poisons just as there are naturally-occuring cures); and that in order to provide a consistent effect, one must create a preparation that is consistent (is it 1 or 5 or 100 leaves of a plant that will make you better?).  I also learned that some ‘natural’ remedies can have very potent effects and many of them should really be considered as drugs.  To say they aren’t so is simply deceiving.

The study of drugs and chemicals in Medicine has given me a deep respect for all things pharmacological, whether they are totally synthetic or “completely derived from nature”.  As such, I have always approached supplements with the same caution that I approach medicines.  And whenever patients and friends ask whether they should start a supplement or medicine, I always ask  1) What effect are you hoping to achieve?  2) Is it something you need?  3) Is there evidence that it actually works?  4) Can it cause any harm?  (If the side effects are worse than the condition you are trying to treat, what’s the point?)

Why take something you don’t need? And just because a little of something is good for you does not mean a lot of the same thing is even better.   Why take a pill when you can go straight to the source? (eat a fruit or a vegetable vs ingesting the equivalent of 100 lbs of that 1 food concentrated into a tiny pill 3 times a day).  Sure I would love to be stronger, healthier, more beautiful.  I would love to have better eyesight, more brain power, stronger bones.   Yes I would love to shed 10 lbs or 20, the faster the better, but even the most convincing ads for fat burners, no matter how “natural”, make me hesitate.  I will always be wary of things that claim to be harmless simply because they are 100% derived from nature, and preparations that claim to be effective with no real evidence that proves they are so.

Here is a really good discussion between Medscape’s Editor-in-Chief, Dr. Eric Topol, and Infectious Disease Expert Dr. Paul Offit on Dr. Offit’s new book, “Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine”.  He tackles food supplements – megavitamins, fish oils and the like – and discusses the industry that produces and promotes them.   I am especially interested in the discussion on studying the positive effects of age-old healing practices so we can “evoke these behaviors at lowest risk, lowest burden, and lowest cost.”  There is a lot of food for thought here!

Click on the link to watch the full interview.  Do You Believe In Magic?

Posted in Books for Kids

Sophia recommends: “Buzz Boy and Fly Guy” by Tedd Arnold


Sophia says:

A boy named Buzz wrote a story called ‘Buzz Boy and Fly Guy’.  The story was about him and his pet fly.  They were superheroes.  In the story Buzz woke up and he was the same size as Fly Guy.  Fly Guy told Buzz Boy that pirates took their house to a dragon cave in the night while they were sleeping (I am guessing that Fly Guy had a midnight snack and that’s how he found out).  They fought the pirates, they got out of the cave, and made friends with the dragon.  The dragon flew their house back home.

I liked the book because they were able to get out of the pirate ship and they became friends with the dragon.  I think other kids will like the book too because it’s a good book!  



Posted in Breastfeeding and Childcare

Why mix feeding during a disaster is a very bad idea

This is my third post on this topic and my original post on protecting babies during emergencies contains greater detail but I felt the need to emphasize just a few points.

1. Formula is never safer than breastfeeding, and the dangers of formula feeding greatly increase in situations where families are displaced (natural disasters, war, etc).

2. A mother who begins mix feeding during a crisis situation will most likely continue mix feeding even when the crisis is over.  Mix feeding results in a decreased demand on the mother to produce breastmilk, which results in a decreased supply.  This makes returning to exclusive breastfeeding after the event more difficult and less likely.

3.  Mothers who receive free infant formula may not have to worry about purchasing formula during the time they are receiving donations but once they return to their homes they will have to continue to purchase formula until their infant turns 1.  Few Filipino families can afford to do this without sacrificing other basic needs.

4.  Mothers who are displaced are more likely to prepare formula improperly (dilute the powder) in order to make it last longer.  This puts the infant at risk of malnutrition.

5.  Infants who are formula-dependent require an uninterrupted supply of formula and clean water.  This is difficult to ensure during times of disaster particularly when the duration of displacement is uncertain.   Exclusive breastfeeding ensures that babies have a protected source of nutrition to which they have full access.

Protecting breastfeeding and supporting displaced mothers so that they continue to breastfeed is not cruel.  It is in the best interest of both mother and child. 

Posted in Books for Kids

Sophia recommends: “Clarence Goes Out West and Meets a Purple Horse” by Jean Ekman Adams

SophieSophia says:

Clarence is a pig who goes on a trip to a ranch.  He takes a bus and gets to the ranch too late for dinner.  He forgets his pillow but remembers his cloud hat.  The next day he has a big breakfast and meets Smoky, the purple horse.   Smoky teaches Clarence to ride him and they become good friends.  Smoky told Clarence that the ranch was going to sell him, so Clarence bought him with all his bus money. He rode Smoky back home and they became best friends.

I like this story because the pig and the horse became best friends.  The book made me feel sad at first, but happy in the end.

I really liked this book and I think other kids will like it also.”   9780873587532