Cold and flu remedies that are safe while breastfeeding

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It’s that time of year again. It seems that everyone you know has a sniffle and a cough. Wondering which treatments and remedies are safe for breastfeeding mothers? Wondering which things to stay away from? My name is Carrie Bews and I’m the lactation coordinator at Confluence Health. Read on for some remedies that are safe for breastfeeding moms and babies.

General Tips:

1. REST. Getting enough rest can be nearly impossible when you have little ones to care for, but make this your #1 priority. Even if you can’t get enough SLEEP, try to find time for extra rest. Lay down while your baby is nursing. Spend extra time snuggling in bed or on the couch when baby is awake. Give yourself permission to call out for pizza, use paper plates, and let the toddler/ preschooler/ school-aged children watch extra TV! Getting yourself well again is top priority for you to go on caring for your family.

2. RELAX. Try to squeeze in some extra relaxation to nurture your body. Run a humidifier to help ease the dry air for your sore nasal passages. Ask one of your kids or your support person to rub your feet or head for a few minutes. Take a warm, steamy shower or bath. Breathe or diffuse some essential oils (see “herbs to avoid while breastfeeding.”) Take deep breaths and try to visualize your body getting stronger and healthy.

tea13. DRINK PLENTY OF FLUIDS. You can never drink enough fluids to keep up with a breastfeeding baby and a sick body! Drink lots of water, juice, Gatorade, tea…whichever non-caffeinated beverage you’re most likely to remember to drink. “Traditional Medicinals” brand makes a Mother’s Milk Tea and Throat Coat Tea. You can drink these freely — both are soothing to sore throat, help ease nasal congestion and thin mucous secretions, and they taste good, too! Therapeutic herbal teas such as these need to be brewed long, strong, and covered in order to get the most potent benefit from the herbs (see instructions on the box). Other good choices for hot tea are chamomile, and any other herbal tea (other than peppermint, or sage — see “herbs to avoid while breastfeeding.”) Even drinking hot water with a slice of lemon and a spoonful of honey is delicious and beneficial.

4. TAKE VITAMINS/SUPPLEMENTS: These may not be necessary to get well, but may be helpful as part of your overall treatment. Continuing to take a Prenatal Vitamin while breastfeeding is a good idea to nourish your body. Taking extra Vitamin C (from foods, juices, or supplements), is safe. Echinacea is generally recognized to be safe for breastfeeding mothers. Garlic is supportive to the immune system, and can be taken raw or in supplement form.

Head/Chest Congestion:

nasal11. Saline flush. One of the gentlest and safest ways to relieve nasal/ head congestion is saline nasal spray. You can purchase a prefilled bottle, such as Simply Saline, or better yet- mix your own at home and save money! NeilMed brand makes a refillable nasal spray bottle and Netti Pot sinus rinse system that are very effective and easy to use. These also come with pre-made saline solution packets that you simply mix with filtered water. Sinus flush can be uncomfortable at first, until you figure out how to do it, then it’s easy! Look for a video tutorial on YouTube for how to use a Netti Pot…it will make a big difference in nasal congestion.

2. Nasal /sinus massage: This technique works best in a warm, steamy shower. Massage your forehead, temples, and sinus areas, stroking downward toward your nostrils. This encourages decongestion and flow of mucous.

3. Steam treatment: Boil a pot of water, remove from the stove, and add a few drops of essential oil, if desired, such as lavender or lemon (see “herbs to avoid while breastfeeding”). Drape a bath towel over your head, and breathe deeply for 5 minutes. Repeat several times a day to help keep head and chest clear. Steam treatment pairs well with sinus massage.

Sore Throat/Cough:

1. Drink strong herbal tea to soothe sore throat. (see previous section for safe teas).
2. Drink hot water with lemon juice and honey to naturally soothe a cough.
3. Zinc gluconate lozenges can be taken, but avoid large amounts of zinc ingestion for more than 7 days.
4. Cough drops can be used, but avoid drops with large amounts of menthol, as it can decrease milk supply.
5. Salt water gargle: mix 1 tablespoon of salt in 8 oz. of warm water. Gargle the whole mixture- don’t swallow. This can be repeated several times a day, and helps kill bacteria in the throat.
6. Gargle with warm chamomile tea…you can drink the tea, too.

Medications generally regarded as safe:

The following information is derived from the 2017 edition of Dr. Thomas Hale, PhD’s, book: Medications and Mother’s Milk.

1. Treat only the symptoms you HAVE. A single medication will be safer than a combination medicine.
2. Short-acting medications (6 hours or less) are generally better than long-acting varieties.
3. Use nasal sprays instead of oral medications when possible.
4. Take medications only as needed.
5. It may be best to take medications right AFTER nursing, to give your body the most time to utilize and metabolize the medication before the next feeding session (depending on how long your baby breastfeeds at a session).

Pain Medications: 

1. Tylenol (Acetaminophen) and Advil (Ibuprofen) are considered safe while breastfeeding. Take these medications for fever, headache, nasal swelling/ stuffiness. Take as directed.
2. Aleve (Naproxen) is considered “less-safe” for breastfeeding, due to its longer half-life and possible effect on baby’s cardiac system, GI tract, and kidneys. If you choose to use Aleve, consider short-term, infrequent, and occasional use only.
3. Aspirin use is discouraged in children due to the risk of Reye’s syndrome. Although the risk is probably low, the use of aspirin is also discouraged in nursing mothers because of this potential risk.

Cough/Throat Medications:

1. Sore throat sprays or lozenges (such as Chloraseptic) are generally considered safe, as are cough drops, (but avoid excessive amounts of cough drops containing menthol, as it can reduce milk supply).
2. Cough medications such as Robitussin, Delsym, and Benylin are considered safe while breastfeeding, but always check the specific active ingredients on each brand. The following specific ingredients may be included:
a. Dextromethorphan (Safest- choose this ingredient 1st)
b. Guaifenesin (Safer- choose this ingredient 2nd)
c. Codeine (Moderately safe- choose this ingredient 3rd)

EYE DROPS designed for cold/ allergy symptoms are considered safe and compatible with breastfeeding.

NASAL SPRAYS OR GELS are generally considered safe and compatible with breastfeeding. Of the nasal medications available for treatment of allergy symptoms, nasal steroids (such as Flonase) are considered to be the most effective and safest to use while breastfeeding.

Short-acting nasal decongestant sprays are preferable (such as those containing Phenylephrine). Long-acting ingredients such as oxymetazoline, are not the first choice for breastfeeding mothers.

Decongestants:

The following information is adapted from the site Kellymom.com: Cold and Allergy Remedies Compatible with Breastfeeding, updated November 2016.

Both pseudoephedrine and phenylephrine are generally considered to be safe for the breastfed baby, but pseudoephedrine may reduce milk supply.

Pseudoephedrine & milk supply: Thomas Hale Ph. D., a renowned breastfeeding pharmacologist (Breastfeeding Pharmacology), notes that “breastfeeding mothers with poor or marginal milk production should be exceedingly cautious in using pseudoephedrine” and that “it is apparent that mothers in late-stage lactation may be more sensitive to pseudoephedrine and have greater loss in milk production” (Medications and Mother’s Milk, 2012 edition).

Dr. Hale is referring to this study: Aljazaf K, et. al. Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk. Br J Clin Pharmacol. 2003 Jul;56(1):18-24.

If you do take pseudoephedrine and notice a drop in milk supply (many moms do not, but research shows that it can decrease milk supply by as much as 24%), simply stop the medication and take measures to increase milk supply – the problem should resolve fairly quickly.

Be very cautious about taking pseudoephedrine on a regular basis, as it has the potential to permanently decrease your milk supply. Regular use of pseudoephedrine (120 mg/day) has occasionally been used to decrease milk production in moms with overproduction, where the usual methods to regulate milk production were not working.

Antihistamines:

Mom’s use of sedating antihistamines (including Benadryl and Chlor-Trimeton products) are generally regarded to be compatible with breastfeeding, but always double-check the active ingredients as they can vary greatly. Monitor your infant for possible drowsiness if you use this type of antihistamine. The non-sedating antihistamines (below) are generally preferred and are less likely to sedate baby.

The ingredients of Claritin, Claritin-D, Clarinex, Allegra, Allegra-D, and Zyrtec are generally regarded to be compatible with breastfeeding (again – always double-check the active ingredients). Loratadine (Claritin) has been studied and the amount of loratadine that passes into breastmilk is extremely low. Claritin-D and Allegra-D have the decongestant pseudoephedrine added (see above about possible effect on milk supply). Dr. Hale has said that he prefers the non-sedating antihistamines (even though they are long-acting) over the sedating allergy medications.

Milk supply: A common concern is that the sedating antihistamines might lower milk supply but, per Dr. Thomas Hale, there is no current research supporting this belief – only some anecdotal reports. If you feel that your supply has decreased, it could simply be a byproduct of decreased nursing frequency or dehydration due to your illness.

If you feel that a medication is the cause of a sudden drop in milk supply, then stop taking (or decrease your use of) the medication – if the med is indeed the cause, then supply should increase again soon after you stop taking it. When using an antihistamine, it can be helpful to step up your fluid intake quite a bit. As with any medication, take it only as needed, and discontinue use as soon as you can.

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*Herbal remedies, specifically essential oils, have gained popularity in recent years. These oils have been considered to be helpful by many people, but should be used with caution in the breastfeeding mother, and with young children in general.

*Many reputable brands of essential oils are considered to be “Certified pure therapeutic grade,” meaning that they are very potent and strong. Essential oils should ALWAYS be diluted before use on children or babies. Always check with your child’s doctor before using a new form of treatment on your child, even a natural treatment.

Herbs that may decrease milk supply:

The following information is from the website Kellymom.com.

Using large amounts of the following herbs and other natural remedies should be avoided while nursing because they have been known to decrease milk supply. The amounts of these herbs normally used in cooking are unlikely to be of concern; it’s mainly the larger amounts that might be used therapeutically that could pose a problem (the following bold herbs have been most commonly seen used by mothers without realization that they may affect milk supply). However, some moms have noticed a decrease in supply after eating things like dressing with lots of sage, sage tea (often recommended when moms are weaning), lots of strong peppermint candies or menthol cough drops, or other foods/teas with large amounts of the particular herb. These herbs are sometimes used by nursing mothers to treat oversupply, or when weaning.

  • Black Walnut
  • Chickweed
  • Herb Robert (Geranium robertianum)
  • Lemon Balm
  • Oregano
  • Parsley (Petroselinum crispum)
  • Peppermint (Mentha piperita)/Menthol
  • Periwinkle Herb (Vinca minor)
  • Sage (Salvia officinalis)
  • Sorrel (Rumex acetosa)
  • Spearmint
  • Thyme
  • Yarrow

Herbs that may be harmful to mom and/or baby

Other herbs should be avoided while nursing due to their potential for harming mom and/or baby. Here are a few herbs that are generally considered to be contraindicated for nursing mothers. This is by no means a complete list:

  • Bladderwrack
  • Buckthorn
  • Chaparral
  • Coltsfoot (Farfarae folium)
  • Dong Quai (Angelica Root)
  • Elecampane
  • Ephedra / Ephedra sinica / Ma Huang
  • Ginseng (Panax ginseng)
  • Indian Snakeroot
  • Kava-kava (piper methysticum)
  • Petasites root
  • Phen-fen, herbal
  • Rhubarb
  • Star anise
  • Tiratricol (TRIAC)
  • Uva Ursi
  • Wormwood

(Want to learn more about lactation services at Confluence or how to donate your breast milk? Check out this post from last year.)

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