Contraindications to breastfeeding

Contraindications to breastfeeding from the mother's side

Breastfeeding is contraindicated in the following maternal diseases:

• oncological diseases;
• open form of tuberculosis with the release of bacilli;
• especially dangerous infections (smallpox, anthrax);
• HIV-positive status of the mother; 
• acute mental illness;
• hepatitis C in the active phase of the disease.

Contraindications to breastfeeding

Disease	Breastfeeding is contraindicated
Cardiovascular pathology	In chronic heart failure IIB (according to the Vasilenko-Strazhesko classification) / The question of the possibility of maintaining lactation and breastfeeding in case of heart failure can be decided individually, taking into account the characteristics of hemodynamics, the patient's condition under the supervision of a cardiologist. For infective endocarditis. For all acquired heart defects of stage IV and V (for stage III, exclude night feedings). For all "blue" heart defects. For all heart defects with manifestations of pulmonary hypertension. For severe heart rhythm disturbances. For rheumatic heart disease. For dilated cardiomyopathy. For stage II arterial hypertension. In severe cases, the presence of acute or severe chronic cerebrovascular accident
Kidney disease	In the presence of acute or chronic renal failure of all stages
Liver disease	In the development of liver failure, portal hypertension, dilated esophageal veins
Respiratory disease	With the development of respiratory failure stage II and further
Diabetes mellitus	In severe forms of the disease in the decompensation stage (diabetic ketoacidosis)

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Contraindications to breastfeeding from the child's side

[ 5 ], [ 6 ]

Small for gestational age newborns

Such children may have not only a low body weight for the given gestational age, but also developmental delay. This depends on the factor that acted during pregnancy. It is known that maternal hypertension in the third trimester causes a delay in the growth of the fetus, and rubella in the first trimester - a delay in growth. The greater the growth delay in a newborn during pregnancy, the greater the problems with feeding such a child. Newborns in this group often develop hypocalcemia, hypothermia, hypoglycemia. Breast milk promotes the full development of the digestive tract. 

Pathological conditions of the fetus and hypoxia of the newborn

Newborns whose condition requires observation or intensive care have a low Apgar score. Depending on the clinical condition, breastfeeding should be delayed for 48 hours. Sometimes this period can be extended to 96 hours. Hypoxia leads to a decrease in intestinal peristalsis and a decrease in the level of stimulating hormones. Such newborns may have neurological problems and do not always adequately respond to attempts at breastfeeding later. For such children, the optimal position near the mother's breast may be the ballerina or soccer ball pose. When the baby is positioned in front of the mother, the baby's head and face are stabilized by the mother's hand and are directly opposite her chest.

Gastrointestinal disorders

Gastrointestinal disorders are quite common in both breastfed and formula-fed infants. The only rule is that infants should receive breast milk if possible in case of illness. Breast milk is a physiological food that does not cause dehydration or hypernatremia. The mother of the child needs a corrective diet. Allergy to mother's milk is quite rare.

Lactose intolerance

Lactose is the main carbohydrate in milk, hydrolyzed by the hydrolytic enzyme lactose phloretine glucoside, an enzyme of the small intestine. Congenital lactose deficiency is an extremely rare disorder inherited in an autosomal recessive manner. The enzyme hydrolyzes lactose, phloretine glucoside, and glycosylceramides.

In most cases, clinical manifestations decrease at the age of 3-5 years. Prematurely born infants lack lactose tolerance. Correction of the mother's diet and introduction of lactose-hydrolyzed breast milk are necessary.

Galactosemia is a disease caused by a deficiency of galactose-1-phosphate - uridine transferase. Refers to congenital pathologies. Clinical manifestations:

• jaundice;
• vomit;
• loose stools;
• brain disorders:
• electrolyte disturbances;
• weight loss.

It is necessary to transfer the child to feeding with therapeutic artificial mixtures, because high levels of lactose in milk contribute to an increase in glucose and galactose in the child's blood.

Phenylketonuria is a disorder of the amino acid phenylalanine metabolism, in which it accumulates due to the lack of an enzyme. A child with phenylketonuria has a low birth weight, microcephaly, and congenital heart disease. Phenylalanine levels in breast milk range from 29 to 64 mg per 100 ml. Newborns with this pathology require breast milk supplemented with Lofenalac formula (low phenylalanine content).

Breast milk has a low phenylalanine content compared to artificial mixtures. The prognosis for mental development is favorable if treatment is started early and the blood phenylalanine level does not exceed 120-300 mmol/l. It is possible to introduce thick food no earlier than 6 months.

Cystic fibrosis

Breastfeeding is carried out with the addition of proteolytic enzymes. In severe cases, hydrolyzed mixtures can be used.

[ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ]

Enteropathic acrodermatitis (Danbolt-Closs syndrome)

Acrodermatitis enteropathica is a rare, unique disease, transmitted by an autosomal recessive type, characterized by a symmetrical rash around the mouth, genitals, in the area of the folds of the limbs. The rash is acute vesiculobullous, eczematous, often secondary infection with C. albicans occurs.

The disease is observed during weaning, accompanied by diarrhea, hair loss, agitation, low zinc levels in the blood. Human milk contains less zinc than cow's milk. Treatment should include zinc preparations in the form of gluconate or sulfate.

[ 12 ]

Down syndrome

Newborns with Down syndrome are not always able to suckle effectively. The mother and medical staff need help to teach the child to latch on correctly and adequately. The position of the child near the mother's breast should be used, which provides support for the child, taking into account the hypotonia of its muscles, which is corrected by coordinated movements of the mother. A pillow can be used to correct the position of the child. A pediatrician, cardiologist, geneticist, nurse and other medical experts provide assistance to the mother in caring for the child. Breastfeeding is especially important for such children, because they are prone to infection and have an increased level of development of generalized infection.

[ 13 ], [ 14 ], [ 15 ]

Hypothyroidism

Newborns with hypothyroidism need to be breastfed because milk has high levels of thyroid hormones.

Adrenal hyperplasia

Newborns who received breast milk during the neonatal period had a lower frequency of regurgitation and a stable clinical condition.

Breastfeeding a newborn with perinatal pathology

If a sick newborn baby does not receive breast milk, then:

• a longer course of the disease is observed, especially in perinatal infections and sepsis;
• high level of complications of invasive therapy;
• the child loses more weight and takes longer to regain it;
• a longer period of infusion therapy and partial parenteral nutrition is required;
• the newborn does not receive immunobiological protection factors with the mother's milk, which determines both a longer duration of the disease and a greater volume of medication, including antibacterial and immunoreplacement therapy;
• there is no psycho-emotional contact with the mother, the child does not receive emotional pleasure from feeding. Today it is known that contact between the mother and a sick newborn child helps improve the blood circulation in the child's brain;
• the amount of breast milk in the mother decreases;
• A newborn may refuse to suckle after feeding with expressed milk.

Endorphins, the level of which increases in the case of psycho-emotional contact between mother and child, reduce vascular spasm, including the brain, intestines, lungs, which may be one of the mechanisms for improving the results of intensive care and nursing of premature babies and infants with perinatal pathology who received breast milk in constant contact with the mother,

If a sick child continues to suckle or feed on mother's milk, this makes it possible to:

• maintain optimal water-electrolyte balance;
• reduce the duration of the child’s treatment and the length of his stay in hospital;
• reduce the volume of invasive procedures, namely infusion therapy, parenteral nutrition;
• reduce the number of medications (economic effect for healthcare institutions);
• reduce the iatrogenic impact on the child;
• get emotional pleasure and psychological comfort while feeding;
• maintain and resume lactation in a mother during breastfeeding;
• ensure immunobiological homeostasis of the child's body.

[ 16 ], [ 17 ], [ 18 ], [ 19 ]