Triangle Breastfeeding Alliance, Inc.

http://www.cdc.gov/h1n1flu/infantfeeding.htm

This document updates previously posted information for parents about infant feeding and novel H1N1 flu (swine flu).  It now more clearly addresses parents who are formula feeding as well as breastfeeding, suggests that parents sick with novel H1N1 flu (swine flu) find someone who is not sick to feed the baby, and provides more detailed strategies for breastfeeding mothers to maintain breastfeeding throughout the course of infection. This document is based on current knowledge of the novel H1N1 flu outbreak in the United States, and may be revised as more information becomes available.

What is this new flu virus?

This novel H1N1 flu virus (sometimes called “swine flu”) was first detected in people in April 2009 in the United States. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

What can I do to protect my baby?

Take everyday precautions such as washing your hands with plain soap and water or using an alcohol-based hand rub before feeding your baby.  More tips on good health habits for preventing sickness from the flu virus can be found at this website:  http://www.cdc.gov/flu/protect/habits.htm.  In addition, try not to cough or sneeze in the baby’s face while feeding your baby, or any other time you and your baby are close. If possible, only family members who are not sick should care for infants.  If you are sick and there is no one else to care for your baby, wear a facemask, if available and tolerable, and cover your mouth and nose with a tissue when coughing or sneezing.  For more information, see the Interim Recommendations for Facemask and Respirator Use.

Is it ok to for me to feed my baby if I am sick?

Infants are thought to be at higher risk for severe illness from novel influenza A (H1N1) infection and very little is known about prevention of novel H1N1 flu infection in infants. If you are breastfeeding or giving your baby infant formula, a cautious approach would be to protect your baby from exposure to the flu virus in the following ways:

• Ask for help from someone who is not sick to feed and care for your baby, if possible.
• If there is no one else who can take care of your baby while you are sick, try to wear a face mask at all times when you are feeding or caring for your baby.  You should also be very careful about washing your hands and taking everyday precautions to prevent your baby from getting flu (http://www.cdc.gov/flu/protect/habits.htm).  Using a cloth blanket between you and your baby during feedings might also help.
• If you are breastfeeding, someone who is not sick can give your baby your expressed milk.  Ideally babies less than about 6 months of age should get their feedings from breast milk.  It is OK to take medicines to treat the flu while you are breastfeeding.

Does breastfeeding protect babies from this new flu virus?

There are many ways that breastfeeding and breast milk protect babies’ health.  Flu can be very serious in young babies.  Babies who are not breastfed get sick from infections like the flu more often and more severely than babies who are breastfed.

Since this is a new virus, we don’t know yet about specific protection against it. Mothers pass on protective antibodies to their baby during breastfeeding.  Antibodies are a type of protein made by the immune system in the body.  Antibodies help fight off infection.

If you are sick with flu and are breastfeeding, someone who is not sick can give your baby your expressed milk.

Should I stop breastfeeding my baby if I think I have come in contact with the flu?

No.  Because mothers make antibodies to fight diseases they come in contact with, their milk is custom-made to fight the diseases their babies are exposed to as well.  This is really important in young babies when their immune system is still developing.  It is OK to take medicines to prevent the flu while you are breastfeeding.  You should make sure you wash your hands often and take everyday precautions (http://www.cdc.gov/flu/protect/habits.htm).  However, if you develop symptoms of the flu such as fever, cough, or sore throat, you should ask someone who is not sick to care for your baby.  If you become sick, someone who is not sick can give your baby your expressed milk.

Is it okay to take medicine to treat or prevent novel H1N1 flu while breastfeeding?

Yes.  Mothers who are breastfeeding and taking medicine to treat flu because they are sick should express their breast milk for bottle feedings, which can be given to your baby by someone who is not sick.  Mothers who are breastfeeding and are taking medicines to prevent the flu because they have been exposed to the virus should continue to feed their baby at the breast as long as they do not have symptoms of the flu such as fever, cough, or sore throat.

If my baby is sick, is it okay to breastfeed?

Yes. One of the best things you can do for your sick baby is keep breastfeeding.

• Do not stop breastfeeding if your baby is sick. Give your baby many chances to breastfeed throughout the illness.  Babies who are sick need more fluids than when they are well.  The fluid babies get from breast milk is better than anything else, even better than water, juice, or Pedialyte® because it also helps protect your baby’s immune system.
• If your baby is too sick to breastfeed, he or she can drink your milk from a cup, bottle, syringe, or eye-dropper.

Social Networking

by:  Joan Levy and Mary Overfield

Nurse Practitioners are in a unique position to promote the benefits of breastfeeding while treating a diverse population of patients in a variety of settings. There are numerous opportunities to tout the benefits of breast milk for the baby (increased immunity for a variety of illness and lower incidence of many diseases, most notably diabetes and obesity); for the mother (lower incidences of many diseases, most notable breast, ovarian and uterine cancers); for both parents (cost effective, always available); for employers (less time lost to illness for parents of breastfeeding infants) and for our society (decreased health care costs and less negative environmental impact).

Bring up the topic of breastfeeding whenever it is appropriate –

During a prenatal physical, you can assure a woman that her breasts are perfectly suited for nursing her baby. Ask her what she has heard about breastfeeding and target your education accordingly. Do remember to include the father/support person during this educational process.

If an older patient mentions he has a brand new grandbaby due soon, you can encourage him to be supportive of breastfeeding, stressing the health benefits for mother and baby.

Have breastfeeding posters and art work in your practice setting –

When patients see visual representations of breastfeeding, your support is evident. They say one picture is worth a thousand words!

Provide handouts about breastfeeding as a component of your patient education materials -

Handouts can acquaint your patients with the latest research about the health benefits for both the mother and baby; stress the importance of the father/partner and grandparent role in supporting breastfeeding, etc.

Educate your colleagues –

In your practice, you can offer “Lunch and Learn” in-services, put up posters in the break room and have copies of interesting articles available for circulation.

Advocate at your professional organizations for breastfeeding to be a conference session topic and the subject for continuing education credits.

Educate the public –

Serve as a resource or help start a community-based group for breastfeeding mothers.

Encourage the NC legislature to have breastfeeding included in the public school K – 12 curriculums, as is available in NY and TX (available on the web for review and use).

Offer to be a guest speaker in science and family life classes, at after-school clubs and scout meetings. Be a presenter at educational offerings in churches, synagogues and mosques.

Encourage your patients and instill confidence that breastfeeding is attainable for families -

The encouragement of her nurse practitioner may be a major reason a mother is willing to breastfeed her baby. Knowing that you believe she can do it and that you think it is the very best for her health as well as her baby’s health can be huge incentives.

While acknowledging breastfeeding is best for babies, patients can be bewildered as to how fit breastfeeding into their busy lifestyles. As health care providers, nurse practitioners can “normalize” breastfeeding by addressing this as the expected manner in which babies are fed. Answers to typical questions about the challenges of breastfeeding and/or returning to work will help mothers develop the confidence to breastfeed whether a stay-at-home mother or a working professional.

Know where to go for help with breastfeeding –

Resources for the nurse practitioner and/or patient can include: other healthcare providers, the hospital or birth center where the mother delivered, the Women, Infants and Children Special Supplemental Nutrition Program (WIC), private practice certified lactation consultants, community breastfeeding support groups and internet websites.

Telephone help:

La Leche League Helpline* 1-877-452-5324

NC Family Health Resource Line* 1-800-FOR-BABY (1-800-367-2229)

National Women’s Health Information Center* 1-800-994-9662

*In Spanish as well as English                        TDD 1-888-220-5446

NC Women’s Hospital Breastfeeding Warmline 919-966-4148

Helpful internet websites include:

www.4women.gov/breastfeeding

www.lalecheleague.org

www.mombaby.org

www.promom.org

www.usbreastfeeding.org

www.sph.unc.edu/breastfeeding

www.ncbfc.org

Two recent presenters at the Wake County/Central Nurse Practitioner Council – Joan Levy and Mary Overfield – are also more than willing to support nurse practitioners efforts as they advocate for breastfeeding. Joan is a NC State Certified Lactation Educator working at Duke Medicine, overseeing the Perinatal Education Program. Mary is an International Board Certified Lactation Consultant who is co-owner of Breastfeeding Education Resources, Inc. You can reach them at: joan.levy@duke.edu and/or mary_overfield@yahoo.com

Note – World Breastfeeding Week (WBW), August 1-7, 2009, is a great outreach vehicle for the breastfeeding movement, being celebrated in over 120 countries. The theme for World Breastfeeding Week 2009 is “Breastfeeding: A Vital Emergency Response. Are you ready?” It is a timely theme in light of recent hurricanes, tsunamis, and earthquakes and another reason to advocate for breastfeeding. We unfortunately learned too many lessons about the importance of breastfeeding during disaster services in the aftermath Hurricane Katrina – mothers who were dependent on formula and clean water were at a distinct disadvantage during this time.

Social Networking