I’m sitting here with clogged, achy ears…and kicking myself. Is my own abundance of caution to blame for the current pain in my head?
Allow me to explain: Last month, after getting the distinct sensation that my ears had gone swimming in a deep pool but forgot to invite the rest of my body, I visited an otolaryngologist (don’t worry, I can’t pronounce it either), also known as an ear, nose and throat doctor.
He promptly diagnosed me with an ear infection, despite my protestations that “Hey, I’m not a kid. Don’t only kids get those?” Apparently, at some point, my inner child and my inner ear had themselves a little party and left quite the mess when mama wasn’t paying attention. Side note: Inner child, you are SO grounded.
The doc prescribed me an antibiotic to fight the infection and a prescription nasal spray as well as a couple of over-the-counter meds to ease the congestion he said was making the problem worse. My first question was: “Are they safe for breastfeeding?”
His answer, basically, was yes but added that I could check with my pediatrician’s office to make sure. Then he said something that surprised me: “They might disagree with me. They tend to be overly cautious about medications.”
I was skeptical — how can anyone be too cautious when the health of a child is at stake? — but then, one month later, lo and behold, the American Academy of Pediatrics warns that many breastfeeding women are “wrongly advised to stop taking necessary medications.”
“Not all drugs are present in clinically significant amounts in human milk or pose a risk to the infant,” the academy said in a statement announcing its new report, “The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics,” published online this week. The report, the AAP said, reaffirms “the recommendation that most medications and immunizations are safe during lactation.”
What drugs are worth the worry?
“Certain classes of drugs can be problematic, either because of accumulation in breast milk or due to their effects on the nursing infant or mother,” the AAP said. “The most common products of concern include pain medications, antidepressants, and drugs to treat substance/alcohol abuse or smoking cessation.”
The academy also publicized the existence of an interesting tool: LactMed, an online database of drugs maintained by the National Institutes of Health that can help doctors figure out how to advise breastfeeding women.
As it happened, my ENT proved prescient with respect to his warning: While my pediatrician’s office cleared me to use the antibiotic and the two over-the-counter drugs, they advised against the prescription nasal spray.
So I didn’t take it…and here I am, one month later, with another ear ache.
I looked up the drug on LactMed and here’s what the entry said, “Although not measured, the amounts of inhaled corticosteroids absorbed into the maternal bloodstream and excreted into breastmilk are probably too small to affect a breastfed infant. Reviewers and an expert panel consider inhaled corticosteroids acceptable to use during breastfeeding.”
The NIH warns, however, against using info on the LactMed site as gospel. At the end of the nasal spray entry, you’ll find the following disclaimer: “Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation.”
The disclaimer notwithstanding, the information certainly made me think twice about my original decision to follow the pediatrician’s orders and skip the spray.
I’m going to make another appointment with my ENT. Maybe he’ll prescribe a stronger antibiotic. Maybe he’ll prescribe the nasal spray again.
Maybe this time, I’ll actually take it.
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Photo via morgueFile.