A good idea with special problems:
When the decision is made to travel with an infant, breast-feeding reduces many of the concerns about nutrition and hygiene and, when appropriate, should be encouraged. It should be continued as long as possible because of its safety and the resulting lower incidence of infant diarrhoea.
THE PLUSES
Breast milk has nutritional and anti-infective properties and does not require reconstitution, sterilizing of bottles or the availability of clean water. It offers excellent nutrition for the infant, even when the mother has diarrhoea and considerably reduces the incidence of gastrointestinal infections. Supplementary feeding is usually not needed for the very young child but older infants will require powdered milk products and boiled water.
The atmospheric pressure changes during flight often produce pain and suffering in young children with eustachian tube malfunction. Breast-feeding provides comfort and relief when alternative feeding may be difficult to obtain.
THE MINUSES
Unfortunately, the flow of milk may be reduced by disruptions to eating and sleeping patterns, as well as other stressors. Mothers may need to increase their fluid intake, especially in the presence of diarrhoea, avoid excess alcohol and caffeine, and, as much as possible, avoid exposure to tobacco smoke.
Breast-feeding in public is considered offensive in some cultures.
VACCINES
There is no evidence of risk to the breast-feeding baby if the mother is vaccinated with either a live or inactivated vaccine. However, the CDC in Atlanta recommends the avoidance of the yellow fever vaccine (Stamaril, Arilvax) in nursing mothers because of a theoretical risk for transmission of the live vaccine virus to the infant. There is no data available for FluMist, the live intranasal influenza vaccine (available in the US).
Breast-feeding does not adversely affect immunisation and is not a contraindication to the administration of any vaccine to the baby.
FOOD AND WATERBORNE ILLNESS during breast-feeding
A nursing mother with travellers' diarrhoea should not stop breast-feeding, but should increase her fluid intake.
MALARIAL PROPHYLAXIS
Nursing mothers should take the usual adult dose of antimalarial appropriate for the country to be visited, with the knowledge that data on safety to the infant are lacking.
It must also be understood that the amount of medication in breast milk will not protect the infant from malaria who will require his or her own prophylaxis.
The drugs
Data are available for some antimalarial agents on the amount of drug excreted in breast milk of lactating women.
1. There is very limited information about the use of doxycycline (Doryx, Doxy, Vibramycin) in lactating women. Although most experts consider the theoretical possibility of adverse events to be remote, doxycycline is usually best avoided when breast-feeding.
2. Very small amounts of chloroquine(Chlorquin) and mefloquine(Lariam) are excreted in the breast milk of lactating women. Little information is available and these drugs are therefore best avoided, although the amount of drug transferred is not thought to be harmful to a nursing infant.
3. Proguanil (Paludrine) is excreted in human milk in small quantities, but it is not known whether atovaquone is excreted in human milk. Because data are not yet available on the safety and efficacy of the atovaquone/proguanil combination (Malarone) in infants weighing <11 kg, it is not currently recommended for the prevention of malaria in women breast-feeding infants weighing <11 kg.
4. Information is not available on the amount of primaquine(Primacin) that enters human breast milk; the infant should be tested for G6PD-deficiency before primaquine is given to a woman who is breast-feeding.
THE PLUSES