Medications for patients who are lactating and breastfeeding: a decision tree

➢ Breastfeeding rates have increased dramatically in Canada, from lows in 1963 (38%) and 1973 (36%) to current national initiation rates averaging 89%. About 22% of breastfed children continue nursing after 9 months of age. 3 Canada's Infant Feeding Joint Working Group has stated that " Breastfeeding— exclusively for the first six months, and continued for up to two years or longer with appropriate complementary feeding—is important for the nutrition, immuno-logic protection, growth, and development of infants and toddlers. " 4 Breastfeeding also has benefits for patients , and the benefits for both patient and child are dose related (i.e., the benefits increase with increased breastfeeding). With higher rates of breastfeeding initiation and duration and with the recommendation to continue breastfeeding for 2 years or longer, lactat-ing and breastfeeding patients are increasingly seen in many areas of health care, including emergency departments , radiology suites, surgical departments, and other nonobstetric settings. We developed a decision tree to provide guidance when patients who are lactating and breastfeeding need medications (Figure 1). This decision tree applies to any patient who is lactating (i.e., producing milk) and breastfeeding a baby or child of any age, as well as to any patient who is expressing or pumping milk to be used for feeding immediately or stored for future use or donation. For the purpose of this decision tree, " medication " is an all-inclusive word referring to any drug used for treatment and any diagnostic agent, hormone, vaccine, herb, over-the-counter product, chemothera-peutic agent, or other substance. The action of " prescribing " encompasses all uses of medications in the course of patient care, whether on the basis of a written prescription or a recommendation or if required as an agent for diagnosis or treatment. This decision tree has been designed for use by health care providers, especially those who do not specialize in lactation and breastfeeding but who provide care for patients who are lactating and breastfeeding. We recognize that babies and children who receive breast milk need to be kept healthy and safe, which means they should not be exposed to contraindicated medications through breast milk. At the same time, continued breastfeeding contributes to children's health and safety , and clinicians who are prescribing medications for patients should consider the risks associated with not breastfeeding. 8 The decision tree does not deal with specific medications ; rather, it has been designed for use …