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Breastfeeding Moms Breastfeeding Moms

Devastated.....I've been told to wean! :'-(

Posted by on Oct. 10, 2012 at 5:07 PM
  • 27 Replies

I am an emotional wreck. I had a doctor's appointment this morning, I have ulcerative colitis that has been left untreated (for the most part) for quite some time, (shame on me) however I was having (almost) no symptoms and considered myself to be in remission for the past 2 years. I was taking sulfasalazine at some point in my pregnancy and for the 1st few months post-partum, my OB/GYN had told me it was safe and DS suffered no adverse side effects. Around the end of August I started having awful symptoms: nausea, diarrhea, gas, constipation, bloody/mucousy stool- all characteristic of U.C. so my husband made me an appt. with the G.I. and I went in today. Well I gave the doc the rundown and he re-prescribed me sulfasalazine, which I had told him wasn't really helping (I started taking it again with the onset of syptoms) so he upped the dose and said he was pretty sure it was safe to continue nursing on it but he had to go check, so I was content for about 5 minutes until he came back to the room and said it wasn't safe and he could prescribe me anything else because I have no insurance and the other meds are at least 800 dollars a month, which we cannot afford at all, so I asked how much the sulfasalazine would be signifacantly less and then said it wouldn't matter which I took anyway since they were all in the same family, and with DS being 14 months there really wasn't a need to continue! Grrrr. I was both distraught and enraged. Unfortunaley DH was with me when I was told all of this, and I had spent so much time convincing him to let me allow DS to self-wean. Well when we got to the car we started discussing and I tried to explain than most healthcare professionals are uneducated in the area of BFing and that I would try to make some calls and check LACTMED when we got home, but DH was adamant and said that the doc must know because he went and checked, this pissed me off.... A LOT! Of course I came home and checked LactMed and it said that weaning was not necessary, and that the child should just be observed for diarrhea and possibly blood in stool, however that it was a very rare occurence. DS is about 14 months old and I will be on prednisone for a month before starting the sulfasalazine, so the doc told me to have him weaned by the time I switch from prednisone to sulfasalazine, and neither DS nor I are anywhere near ready for that. ;'-( I don't know what to do, DH understands the benefits of BFing, but says I'm not going to be doing that if it's putting chemicals in our sons body that may cause him to have health problems later on. What I found on LACTmed works for me, I'm fine with observing (don't all moms do so in any case?) and the fact that I was already taking the medication previously and DS hasn't shown any side effects makes me feel comfortable enough to continue until such a time as we are both ready to be done. I AM SO LOST, I CAN'T TAKE IT. PLEASE HELP! Any advice will be greatly appreciated. TYIA :-)

by on Oct. 10, 2012 at 5:07 PM
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Replies (1-10):
maggiemom2000
by Ruby Member on Oct. 10, 2012 at 5:12 PM

The following information comes from MEDICATIONS AND MOTHERS’ MILK by Thomas Hale, 2012.  He assigns every drug a lactation risk category:  L1, safest; L2, safer; L3, moderately safe; L4, possible hazardous; and L5, contraindicated. He also lists if a drug has been reviewed and/or approved by the American Academy of Pediatrics (AAP) for use in nursing mothers.  Possible risks to mother and baby are listed as well as possible effect on milk supply.


For more info you can call Dr. Hale’s InfantRisk hotline at (806) 352-2519

www.infantrisk.org


SULFASALAZINE (Azulfidine)

Listed as L3, moderately safe; AAP: Drugs associated with significant side effects and should be given with caution; Pediatric Concerns:  Only one reported case of hypersensitivity.  Most studies show minimal effects via milk.  Observe for diarrhea, GI discomfort.

“Sulfasalazine is a conjugate of sulfapyridine and 5-Aminosalicylic acid and is used as an anti-inflammatory for ulcerative colitis.  Only one-third of the dose is absorbed by the mother.  Most stays in the GI tract.  Secretion of 5-aminosalacylic acid (active compound) and its inactive metabolite (acetyl-5-ASA)0 into human milk is very low.  

In one study of 12 women receiving 1 to 2 grams/day of sulfasalazine, the amount of sulfasalazine in milk in patients receiving 1 gm/day was far less than 1 mg/L and approximately 0.5 to 2 mg/L in those receiving 2 gm/day.  In this study, small milk levels were found in only 2 women.  It is estimated by the authors that breastfed infants would receive approximately 0.3 mg/kg/day of sulfapyridine.  This very small amount may be regarded as negligible in considering kernicterus because sulfapyridine and sulfadazine are known to have poor bilirubin-displacing capacity.

Few if any adverse effects have been observed in most nursing infants.  However, one reported case of toxicity which may have been an idiosyncratic allergic response.”

Another study of a woman taking 1 gm or 5 aninoslaicylic acid three times daily suggests that even with high doses, 3 gm/day, the amount of transfer into milk is minimal.


melindabelcher
by mel on Oct. 10, 2012 at 5:13 PM
2 moms liked this
Whats your dh going to do unlatch him? I would just keep nursing and watch for changes. The biggest risk to him was when you were prego and taking the med
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maggiemom2000
by Ruby Member on Oct. 10, 2012 at 5:15 PM
1 mom liked this

Remind DH that there are risks to early weaniing as well. you want to choose the lesser risk, which is probably continuing to breastfeed with the meds.

Look at the benefits of continued nursing:

http://kellymom.com/ages/older-infant/ebf-benefits/

Breastfeeding contributes to your child’s NUTRITION

  • Although there has been little research done on children who breastfeed beyond the age of two, the available information indicates that breastfeeding continues to be a valuable source of nutrition and disease protection for as long as breastfeeding continues.
  • “Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant.”
    – Mandel 2005
  • In a study of 250 toddlers in western Kenya, breastmilk provided, on average, 32% of the child’s total energy intake. “Breast milk made an important contribution to the fat and vitamin A intakes of toddlers in this community.”
    – Onyango 2002
  • “Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.”
    – Dewey 2001
  • In the second year (12-23 months), 448 mL of breastmilk provides:
    • 29% of energy requirements
    • 43% of protein requirements
    • 36% of calcium requirements
    • 75% of vitamin A requirements
    • 76% of folate requirements
    • 94% of vitamin B12 requirements
    • 60% of vitamin C requirements

    – Dewey 2001

  • Studies done in rural Bangladesh have shown that breastmilk continues to be an important source of vitamin A in the second and third year of life.
    – Persson 1998
  • It’s not uncommon for weaning to be recommended for toddlers who are eating few solids. However, this recommendation is not supported by research. Research does indicate that in situations where breastfed toddlers have an increased risk of malnutrition, this appears to be due to inadequate complementary feeding or reverse causality (the mother is more likely to continue breastfeeding a child who is ill or growing poorly). In one study of 250 toddlers in Kenya, solid food intake increased after weaning, but not enough to replace all the fat, vitamin A, and niacin that the child had been getting via breastfeeding (Onyango 2002).  According to Sally Kneidel in “Nursing Beyond One Year” (New Beginnings, Vol. 6 No. 4, July-August 1990, pp. 99-103.):  Some doctors may feel that nursing will interfere with a child’s appetite for other foods. Yet there has been no documentation that nursing children are more likely than weaned children to refuse supplementary foods. In fact, most researchers in Third World countries, where a malnourished toddler’s appetite may be of critical importance, recommend continued nursing for even the severely malnourished (Briend et al, 1988; Rhode, 1988; Shattock and Stephens, 1975; Whitehead, 1985). Most suggest helping the malnourished older nursing child not by weaning but by supplementing the mother’s diet to improve the nutritional quality of her milk (Ahn and MacLean. 1980; Jelliffe and Jelliffe, 1978) and by offering the child more varied and more palatable foods to improve his or her appetite (Rohde, 1988; Tangermann, 1988; Underwood, 1985).

References

Breastfeeding contributes to your child’s HEALTH

  • The American Academy of Family Physicians notes that children weaned before two years of age are at increased risk of illness (AAFP 2008).
  • Breastfeeding toddlers between the ages of one and three have been found to have fewer illnesses, illnesses of shorter duration, and lower mortality rates  (Mølbak 1994, van den Bogaard  1991, Gulick 1986).
  • “Antibodies are abundant in human milk throughout lactation” (Nutrition During Lactation1991; p. 134). In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Lawrence & Lawrence 2011, Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991).
  • Per the World Health Organization“a modest increase in breastfeeding rates could prevent up to 10% of all deaths of children under five: Breastfeeding plays an essential and sometimes underestimated role in the treatment and prevention of childhood illness.” [emphasis added]

References

Breastfeeding contributes to your child’s INTELLECTUAL DEVELOPMENT

  • Extensive research on the relationship between cognitive achievement (IQ scores, grades in school) and breastfeeding has shown the greatest gains for those children breastfed the longest.

References

Breastfeeding contributes to your child’s MENTAL and SOCIAL DEVELOPMENT

  • A couple of studies have shown a positive relationship between longer breastfeeding duration and social development.
    – Duazo 2010, Baumgartner 1984
  •  “A shorter duration of breastfeeding may be a predictor of adverse mental health outcomes throughout the developmental trajectory of childhood and early adolescence.”
    – Oddy 2010
  • According to Elizabeth N. Baldwin, Esq. in “Extended Breastfeeding and the Law”:
    Breastfeeding is a warm and loving way to meet the needs of toddlers and young children. It not only perks them up and energizes them; it also soothes the frustrations, bumps and bruises, and daily stresses of early childhood. In addition, nursing past infancy helps little ones make a gradual transition to childhood.
  • Baldwin continues: “Meeting a child’s dependency needs is the key to helping that child achieveindependence. And children outgrow these needs according to their own unique timetable.”Children who achieve independence at their own pace are more secure in that independence then children forced into independence prematurely.

References

Breastfeeding your child past infancy is NORMAL

  • The American Academy of Pediatrics recommends that “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child… Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother… There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.”(AAP 2012, AAP 2005)
  • The American Academy of Family Physicians recommends that breastfeeding continue throughout the first year of life and that “As recommended by the WHO, breastfeeding should ideally continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and encouragement. It has been estimated that a natural weaning age for humans is between two and seven years. Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment, and having a sustainable food source in times of emergency. The longer women breastfeed, the greater the decrease in their risk of breast cancer.” They also note that “If the child is younger than two years of age, the child is at increased risk of illness if weaned.” (AAFP 2008)
  • The Academy of Breastfeeding Medicine affirms breastfeeding beyond infancy as the biological norm. “The average age at weaning ranges anywhere from six months to five years… Claims that breastfeeding beyond infancy is harmful to mother or infant have absolutely no medical or scientific basis,” says Arthur Eidelman, MD, president of the Academy of Breastfeeding Medicine.  “Indeed, the more salient issue is the damage caused by modern practices of premature weaning.”  The global organization of physicians further notes that“Human milk contains nutrients, antibodies, and immune-modulating substances that are not present in infant formula or cow’s milk. Longer breastfeeding duration is further associated with reduced maternal risks of breast cancer, ovarian cancer, diabetes, hypertension, obesity, and heart attack.” (ABM 2012)
  • US Surgeon General has stated that it is a lucky baby who continues to nurse until age two. (Novello 1990)
  • The World Health Organization emphasizes the importance of nursing up to two years of age or beyond (WHO 1993, WHO 2002).
  • Scientific research by Katherine A. Dettwyler, PhD shows that 2.5 to 7.0 years of nursing is what our children have been designed to expect (Dettwyler 1995).

References [see also position statements supporting breastfeeding]

MOTHERS also benefit from breastfeeding for a longer duration

  • Extended nursing delays the return of fertility in some women by suppressing ovulation (References).
  • Breastfeeding reduces the risk of breast cancer (References). Studies have found a significant inverse association between duration of lactation and breast cancer risk.
  • Breastfeeding protects against osteoporosis. During lactation a mother may experience decreases of bone mineral. A nursing mom’s bone mineral density may be reduced in the whole body by 1 to 2 percent while she is still nursing. This is gained back, and bone mineral density may actually increase, when the baby is weaned from the breast. This is not dependent on additional calcium supplementation in the mother’s diet. (References).
  • Breastfeeding reduces the risk of rheumatoid arthritis (References).
  • Breastfeeding reduces the risk of cardiovascular disease (References).
  • Breastfeeding has been shown to decrease insulin requirements in diabetic women. There is also a decreased risk of Type 2 diabetes mellitus in mothers who do not have a history of gestational diabetes (References).
  • Breastfeeding moms may lose weight easier (References).

 


TiffanyMarie80
by Tiffany on Oct. 10, 2012 at 5:15 PM
3 moms liked this

Have your husband call the infant risk hotline and talk to people there about the meds - he is upset because he heard a Dr, someone he believes he can trust, say that it wasn't safe - and yes, the Dr did "check", but what that most likely means is that he read the insert that comes from the manufacturer, and that ALWAYS says not safe. . . . even prenatal vitamins say that you should check with your Dr before taking while pregnant or nursing, and they are FOR pregnant and nursing moms  :/   Hopefully by hearing from people who know what they are talking about, who are also medically trained, he will understand that your Dr meant well but gave out bad information.  And remind him that you've nursed while on this medication before. 

Cruz-s-mommy
by Amanda on Oct. 10, 2012 at 5:37 PM

Lol, too funny. I can't even do this myself, DS has what I refer to as "the unBREAKable latch." I can never get him off, he has to be the one to let go. Even if I wanted to, I couldn't wean DS in one month, I am still providing at least 90% of his nutrition and the process would just be too abrupt.

I am more concerned with it creating marital problems than anything and DH is very tempermental. It's just that we've worked so hard to get to where we are now, I don't want to send everything in reverse, I'm just trying to present the info in the most convincing way so DH  will be comfortable with DS nursing. It's like I feel like I have to convince the doc and have him tell DH there are no risks, but that is highly unlikely, especially since with all things in life come risks.

Quoting melindabelcher:

Whats your dh going to do unlatch him? I would just keep nursing and watch for changes. The biggest risk to him was when you were prego and taking the med


WhitleyLyles
by on Oct. 10, 2012 at 6:45 PM

noway I would stop then

I wouldkeep on and watch for changes closely.

MonicaV1982
by on Oct. 10, 2012 at 6:53 PM
2 moms liked this

If DH is disrespectful enough to try and control your choices as a grown woman then you should really reevaluate your relationship. I'm not saying fathers should have no input, but from what I read this crosses the line.

Quoting Cruz-s-mommy:

Lol, too funny. I can't even do this myself, DS has what I refer to as "the unBREAKable latch." I can never get him off, he has to be the one to let go. Even if I wanted to, I couldn't wean DS in one month, I am still providing at least 90% of his nutrition and the process would just be too abrupt.

I am more concerned with it creating marital problems than anything and DH is very tempermental. It's just that we've worked so hard to get to where we are now, I don't want to send everything in reverse, I'm just trying to present the info in the most convincing way so DH  will be comfortable with DS nursing. It's like I feel like I have to convince the doc and have him tell DH there are no risks, but that is highly unlikely, especially since with all things in life come risks.

Quoting melindabelcher:

Whats your dh going to do unlatch him? I would just keep nursing and watch for changes. The biggest risk to him was when you were prego and taking the med



tabi_cat1023
by Group Mod - Tabitha on Oct. 10, 2012 at 7:30 PM
1 mom liked this

There are risks in everything but imagine the risk of going into the winter season without the immunities from breastmilk!? Thats a major risk there!

larissalarie
by Platinum Member on Oct. 10, 2012 at 9:27 PM
1 mom liked this
If your relationship if so rocky that you not "obeying" him will set things off, I'm sorry to say that your relationship isn't going to stay "good" for long.

You've done your homework, tell him until he does the same he doesn't get a say so, then give him the Lactmed's website or app and the infant risk hotline's number and tell him to make his own calls. Also point or that even "dangerous" meds usually don't matter at your child's age, but you've already breastfed him on this medication (and he formed in pregnancy exposed to the "chemicals", sheesh, what's more dangerous than that?) when he was much younger and more vulnerable, it just doesn't make sense to object now.


Quoting Cruz-s-mommy:

Lol, too funny. I can't even do this myself, DS has what I refer to as "the unBREAKable latch." I can never get him off, he has to be the one to let go. Even if I wanted to, I couldn't wean DS in one month, I am still providing at least 90% of his nutrition and the process would just be too abrupt.


I am more concerned with it creating marital problems than anything and DH is very tempermental. It's just that we've worked so hard to get to where we are now, I don't want to send everything in reverse, I'm just trying to present the info in the most convincing way so DH  will be comfortable with DS nursing. It's like I feel like I have to convince the doc and have him tell DH there are no risks, but that is highly unlikely, especially since with all things in life come risks.


Quoting melindabelcher:

Whats your dh going to do unlatch him? I would just keep nursing and watch for changes. The biggest risk to him was when you were prego and taking the med


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MonicaV1982
by on Oct. 10, 2012 at 10:27 PM

I also want to point out that a marriage is a union between two consenting and loving adults. Part of this is coming to a consensus and respecting the inherent rights and feelings of each other. I'd have him call the infant risk line. Keep looking for other meds that could be compatible. In the end it is your body.

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