Breastfeeding and Codeine

Earlier this week, the Federal Drug Administration (FDA) announced that it is making changes to the labels of two different types of opioid medications. Prescription pain medications that contain codeine or tramadol will now be required to carry labels warning that children under 12 shouldn’t use them. The FDA now also strongly recommends that breastfeeding mothers don’t use them and that children between 12 and 18 limit their use of medications with both opioids.

The FDA explained that it’s demanding the changes due to the risks of life-threatening breathing problems that the medications can pose to children. Some children and some mothers are what’s called “ultra-rapid metabolizers,” which means that their bodies break down the medication at a much faster rate than others, leaving dangerously high levels in their bodies. Children under 12, obese adolescents, those who have medical conditions (such as sleep apnea), and breastfeeding infants are at particular risk. There’s no way to tell who’s an ultra-rapid metabolizer — meaning that if you’re breastfeeding, you could unknowingly pass on the opioids to your baby through your breast milk. That’s why the FDA is issuing the warnings for everyone.

Many mothers are sent home from the hospital with a prescription for Tylenol-3, which does contain codeine, for both vaginal and C-section deliveries. But the new labels for Tylenol-3 will include a “stronger warning recommending against their use in nursing mothers,” states the FDA.  While the new warning labels will not affect over-the-counter cough syrups or cold medicines, the FDA is also encouraging parents to check any non-prescription medications they have in the home, as they could still contain codeine as an ingredient.

“We understand that there are limited options when it comes to treating pain or cough in children, and that these changes may raise some questions for health care providers and parents,” the FDA said in a statement. “However, please know that our decision today was made based on the latest evidence and with this goal in mind: keeping our kids safe.”

So what’s an in-pain mom or a mom of a hacking, miserable infant to do? If you’re pregnant, talk to your doctor or midwife about a post-birth pain management plan. If you plan on breastfeeding and want to avoid codeine or tramadol, find out what other options are available to you and what you can do if your pain is not controlled. Some doctors will recommend ibuprofen for pain control, although it can carry a risk for bleeding.

For postpartum perineal pain, try a homemade ice pack (you can DIY with clean frozen condoms), witch hazel pads (available OTC), sitz baths, and of course, your trusty squeezable bottle for quick clean-ups after using the restroom. You can also ask your doctor or labor and delivery nurse if they have any postpartum “pillows” that you could take home — some hospitals offer those inflatable pillows that help you sit more comfortably after birth.

Managing pain after a C-section, however, will require some type of medication, especially in the first few days, so definitely talk to your doctor if you hope to breastfeed. Try to arrange help for when you come home from the hospital, as the less lifting, twisting, and turning you do, the better you will be able to manage your pain. It’s also incredibly important to do some light walking as soon as possible after surgery to help ease gas pain. Gas pain can be more painful than the incision pain for some women, so keeping active will help move the gas through your stomach.

And if you’re dealing with a baby who has a cold or a cough, stay away from medications and especially anything with codeine in it — studies have shown that most cough medicine on the market is not effective for children under 4, anyway. If your baby is over 1, try honey to soothe a cough or a sore throat. Here are a few more tips to help your little one feel better (along with lots of hugs and kisses):

  • Monitor mucus. A stuffed-up nose can be uncomfortable for your baby, making it difficult for her to breathe and for both of you to sleep. Use a suction bulb to gently extract the excess mucus.
  • Heighten humidity. Use a cool-mist humidifier in your baby’s room. Moist air can reduce congestion and make breathing easier. In a pinch, you can also turn on the shower, close the bathroom door, and sit with baby for a few minutes — breathing in the steamy air will help clear out his nose.
  • Elevate his crib. Elevate the head of the crib by positioning a couple of pillows or other supports under the mattress to make breathing easier. (Never put any pillows or soft bedding materials in your baby’s crib.)


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