My baby is sick – should I continue to breastfeed?

By Kelly Bonyata, IBCLC

Absolutely! Anytime a sick baby is able to take anything by mouth, it should be his mother’s milk. Mom’s milk provides antibodies specifically tailored to fight baby’s illness, and is quickly and easily digested.

Temporary weaning, besides depriving baby of antibodies to fight the illness and the most easily digestible food source available, can make life miserable for both mother and baby. Nursing is extremely comforting to an ill baby and a major part of the healing process. Mom would have to pump to maintain milk supply and then there would still be some risk that supply would drop somewhat. Not pumping would put mom at risk for breast infection and extreme discomfort.

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Colds and congestion

If baby has a cold and is congested, it can make breastfeeding difficult. However, it is almost always easier for a sick baby to nurse than to take a bottle. If your baby has a stuffy nose and is having a hard time breathing and nursing at the same time, try the following:

Keep baby as upright as possible while nursing. At night, try propping up on lots of pillows and nursing/sleeping semi-upright. Also try the Australian position (mom is “down under”) – in this position, mom is lying on her back and baby is on top (facing down), tummy to tummy with mom.
The best thing you can do to help baby’s illness end quickly is to nurse often – that way she gets lots of the antibodies that your body is making to help her fight off the illness. Frequent nursing also helps to ensure that baby is getting plenty of milk (congested babies often nurse for shorter times since it’s hard to breathe and nurse at the same time).
Use saline drops (or breastmilk) & a rubber suction bulb to clear baby’s nose before nursing (if baby won’t tolerate the bulb syringe, then the saline drops/breastmilk alone should still help).
- Put baby on your knees, face up and tilt your knees a little downhill (so baby’s head is angled away from you, toward the floor).
- Put 2-3 drops of saline in each nostril and let it sit for a minute or so.
- To suction the mucus out, squeeze the bulb part of the syringe first, gently stick the rubber tip into one nostril, then slowly release the bulb.
- If baby is really congested, you may have to do this several times a day. Do it BEFORE baby nurses; if you do it afterwards your baby may spit up everything she’s eaten because syringing can stimulate the gag reflex.
- To prepare saline drops at home, dissolve one teaspoon of salt in two cups of warm water.
Run a vaporizer or humidifier, preferably in a small closed room.
Boil a pot of water (some moms use small crock pots/potpourri pots), remove from the stove and add a few drops of essential oil (for example, eucalyptus, sage or balsam), and let the scent permeate the air. This may help relieve some head congestion.
Do NOT apply products containing peppermint oil, camphor or menthol on the face (especially in the nose) or chest of a baby or young child. There have been cases where the direct application of menthol or camphor products (for example, Vicks VapoRub™) to baby’s skin resulted in severe breathing difficulties or liver problems (see Camphor Hepatoxicity, Camphor Monograph and Menthol Toxicology).
Nurse in a steamy bathroom. To pump up the steam, run a really hot shower and set a chair outside the shower for nursing.
The US Food and Drug Administration recommends against giving over the counter cold and cough medicines to children under 2.
The Consumer Healthcare Products Association recommends over-the-counter cough and cold products not be used in children less than 4 years old due to the risk of serious and life-threatening side effects. There is also no evidence that over-the-counter cold meds actually benefit children younger than six years old. There are several well controlled studies where there has been no difference shown between children given medication and those who have not.

Sometimes moms are advised to limit or discontinue breastfeeding because milk increases mucus production. This is not good advice for two reasons:

You are not a cow and your milk is not a dairy product. So even if dairy is a problem, your milk would not be.
In addition, there is no scientific evidence that cow’s milk results in the production of more mucus unless you are allergic to dairy products.

Baby refuses to nurse when sick

Some babies may refuse to nurse when sick (particularly if something like a sore throat or pressure from an ear infection makes nursing painful for baby). If this happens, try different nursing positions – particularly those where baby is upright – and keep offering to nurse at least every hour or so. See also: What to do about a nursing strike. Rest assured that your baby will return to nursing when he feels better. Here are some things to try if baby is too uncomfortable to nurse:

feed baby expressed milk from a cup, dropper, spoon or syringe
try momsicles, or freeze your milk until it’s slushy and let baby eat it with a spoon
for older babies (over six months) who are eating solids: if baby will take solids but not nurse, add lots of breastmilk to the solids. You might also try making yogurt from breastmilk.

Vomiting and Diarrhea

Another time when moms can be unsure about whether to continue nursing is when baby has diarrhea or is vomiting. Frequent and loose stools in a breastfed baby is not necessarily diarrhea. Here is more information on normal stooling patterns for breastfed babies: What Are Baby’s Stools Supposed to Look Like? Diarrhea in a breastfed baby is diagnosed when a baby has 12-16 stools per day (or more often than the baby’s regular stool frequency), watery stools, and an offensive odor to the stools. Just one of these symptoms does not in itself mean the baby has diarrhea.

The current recommendations when vomiting or diarrhea is present in the breastfed child are as follows:

Breastfeeding should be the FIRST choice if your child can take anything by mouth. Because of the ease and rapidity with which breastmilk is digested, even if your child vomits or stools shortly after nursing, he will still have retained some of the nutrients. Other foods that are often suggested (such as Pedialyte, sports drinks, gelatins and sodas) offer little nutritional value and none of the antibodies that human milk contains.
When your breastfed child is ill you’ll want to offer more frequent feedings — this can limit the volume taken in at one time and helps to comfort and soothe a sick child. If your child is vomiting often and not keeping the milk down for long, it may be helpful to breastfeed frequently but limit the length of each nursing session (so your child takes in less milk at once). Another option is for Mom to express some milk before breastfeeding so that the milk flow is slower. RARELY does the baby who is allowed to breastfeed at will during a vomiting or diarrhea illness become dehydrated.

The use of an oral rehydration therapy such as Pedialyte is a sound recommendation for a formula-fed infant who is vomiting or who has diarrhea, but using this in place of breastmilk offers no benefit to the breastfed baby. Human milk is a natural fluid, unlike formula and other milk products, that again is easily and rapidly digested.

Forego the Pedialyte as long as baby continues to nurse well and as long as there are no signs of dehydration. If baby is showing signs of dehydration, talk to your doctor. Following are signs of dehydration:

fewer than 2 wet diapers in a 24-hour period
baby not behaving normally (more irritable, less active, sleeping more)
lethargy
listlessness
weak cry
no tears (in an infant older than 3 months)
dry mouth
skin that stays wrinkly-looking when pinched (pull up the skin on the front of the hand; it should pop easily back into place – not stay pinched or wrinkly-looking)
eyes that look sunken
cool, clammy extremities, especially the fingers and toes
fast breathing, or a heart that is beating faster than usual
fever

Babies who are allowed to continue breastfeeding through an illness such as this are less likely to become dehydrated than those who are taken off the breast. Continued nursing also provides your child with precious antibodies that will prevent the illness from worsening and speed healing. Nursing is also very comforting to your child, which is healing in itself.

Breastfed babies sometimes need oral rehydration therapy (Pedialyte, etc), though far less often than artificially fed infants. The World Health Organization recommends continuing to breastfeed during and after oral rehydration therapy. Research shows that babies lose more weight and actually have more stools during diarrhea when they are deprived of breastmilk.

Sometimes moms are recommended to withhold breastmilk “because it is a dairy product.” Breastmilk is NOT considered a dairy or milk product (mom is not a cow!).

Anytime there is diarrhea (in adults as well as babies) it can take a while for the bowel to heal and the stools to get back to normal. So even if you identify the problem and take corrective action, you may not see favorable results for a few weeks. This is because if the bowel gets irritated it is harder for the bowel to digest lactose – the undigested lactose then actually creates more irritation and runny stools… it can be tough to turn around at times. There is usually an inflammatory response with diarrhea – that is the part that takes time to heal. When the cause of the problem is removed (when baby recovers from the illness), the gut will heal even if the baby is still fed breastmilk. More here on secondary lactose intolerance.

Breastmilk vs. Pedialyte

When baby is sick, moms are sometimes told to discontinue or restrict breastfeeding and substitute an oral rehydration therapy such as Pedialyte. This outdated practice has been shown to offer no benefits to the breastfed baby, and can even delay healing.

Your milk has four things that your baby needs even more than usual when he’s sick:

Antibodies to fight this illness – you want baby to get as much of these as possible. Encourage *more* nursing rather than less. Pedialyte has no antibodies.
Liquids to keep baby hydrated. Your baby may not be eating as much because he doesn’t feel well. Sick babies are more likely to nurse than to take anything else by mouth, so nursing is important to keep baby hydrated. Keeping baby well hydrated also helps keep the mucus secretions thinned out if baby has a cold or other congestion. So again, you want to nurse *more*. Pedialyte will keep baby hydrated, but so will breastmilk.
Concentrated nutrients. Breastmilk is easily and quickly digested, so baby gets more nutrients and absorbs them faster. Pedialyte will keep baby hydrated but has little nutritional value. Again, it’s best to nurse *more* since baby may not be eating as much if he feels bad.
Comfort. Sick babies need more comforting – what better way to do this than at the breast?

See the section above for more information on the use of Pedialyte in breastfed babies – Breastfed babies sometimes do need oral rehydration therapy (Pedialyte, etc), though far less often than artificially fed infants. The World Health Organization recommends continuing to breastfeed during and after oral rehydration therapy.

Additional Information and References

@ other websites

Withdrawal of Cold Medicines: Addressing Parent Concerns from the AAP
The AAP Practice Parameter on The Management of Acute Gastroenteritis in Young Children states that “Infants fed human milk can be nursed safely during episodes of diarrhea.”
Childhood Illness Index from AskDrSears.com
Baby Health: Colds from Babycenter.com (general health information)
Working with Your Child’s Doctor by Janice Berry, from New Beginnings, Vol. 16 No. 6, November-December 1999, pp. 196-199.

References

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Clemens, J. et al. Discontinuation of bf during episodes of diarrhoea in rural Bangladesh children. Trans Royal Soc Trop Med Hygiene 1998; 82:779.

Ewer, A. et al. Gastric emptying in preterm infants. Arch Dis Child 1994; 71: F24-F27.

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Mahalanabis D, et al. Prognostic indicators and risk factors for increased duration of acute diarrhoea and for persistent diarrhoea in children. Int J Epidemiol 1991; 20: 1064.

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World Health Organization. The Treatment of Diarrhoea. A manual for physicians and other senior health workers. WHO/CDR/95.3 (10/95). Division of Diarrhoeal and Acute Respiratory Disease Control.