Concerns of breastfeeding mothers

If you have a cold
Absolutely continue to breastfeed. Although you are exposing your baby to your germs, you're also protecting him with your antibodies.

Vegetarians and vitamin supplements
If you are a lacto-ovo-vegetarian who enjoys both dairy and egg foods, breastfeeding will not pose dietary concerns beyond those of all nursing mothers. If you are a vegan who eats no animal products then vitamin B12 supplements for both you and your baby are crucial. Health Canada recommends that nursing women who are vegans take a 1.5 mcg vitamin B12 supplement daily. Some babies of vegan mothers who haven't taken a vitamin B12 supplement during pregnancy or while nursing, and who haven't given their baby a B12 supplement have suffered major neurological problems before their first birthday.

The Canadian Paediatric Society and Health Canada recommend that breastfed babies of vegan mothers receive a daily B12 supplement. For infants, the Canadian Pharmaceutical Association recommends 0.3 mcg daily, beginning in the second week of life and continuing until at least the second birthday. This B12 supplement is in addition to the vitamin supplements recommended for all breastfed babies.

Medications
Chances are, any drug you take will pass into your milk. Fortunately, the average residue in breastmilk is less than I per cent of the mother's dose. There are few medications that cause a mother to give up breastfeeding, but if you're unsure whether to take a drug while nursing, discuss your concerns with your doctor, your pharmacist or a drug information centre. One centre devoted to pregnant and breastfeeding mothers and health-care providers is the MotherRisk Clinic at The Hospital for Sick Children in Toronto (416) 813-6780.

Over-the-counter drugs
Most over-the-counter drugs are safe when used according to manufacturer's directions. However, it's best to check with your physician or pharmacist before self-medicating. For pain relief, acetaminophen rather than acetylsalicylic acid (aspirin) is recommended. For pain accompanied by inflammation, ibuprofen can be taken.

Prescription drugs
When you take prescription drugs, minimize your child's exposure to them by taking the medication after she has breastfed, or just before she's ready to sleep. You should not breast-feed if you are taking any of the following prescription drugs:

• bromocriptine
• cyclophosphamide
• cyclosporine
• doxorubicin
• ergotamine
• lithium
• methotrexate
• phencyclidine

Non-prescription drugs
Because there have been no studies on the effects of illegal drugs or so-called recreational drugs like marijuana on breastmilk, the MotherRisk program at The Hospital for Sick Children recommends that any women using drugs not breast-feed.

Herbal remedies
Many herbal remedies contain pharmacologically active ingredients. In fact, many prescription drugs come from herbs. If you're taking herbal remedies, stay within recommended dosages and monitor your baby for side-effects. Some herbal teas (those not containing alkaloid herbs) are considered safe while you're breastfeeding. But, as with any food or drink, avoid excessive intake. If the tea contains sage, for example, a large amount can reduce your supply of milk.