Breastfeeding your sick baby

On the breast

Due to the immunity-boosting factors in breastmilk, a breastfed baby will usually be healthy and well. But if common colds, ear infections or tummy upsets hit, his feeding may be affected. He may find it difficult to suck with a blocked nose, he may refuse feeds because it is painful to nurse, or he may go on a feeding binge as though he ‘knows’ his tiny body needs a boost of antibodies to beat the bugs. Often, one of the first signs a breastfed baby is coming down with something is that he steps up his feeds and may seem to want to nurse almost continually. However minor or serious your baby’s illness is, you can almost always continue breastfeeding. If he can take anything by mouth, your milk provides perfect nutrition because it is easily digested and provides antibodies to help fight infection. If you come into contact with a bug, you will produce antibodies in your milk that protect your baby, and if he comes into contact with a bug you may not have (for instance, at childcare) the transfer of germs from your baby’s mouth to your breast will stimulate your more experienced immune system to make antibodies that will be passed in your milk to your baby. As well as keeping your baby hydrated, which is important whenever a baby becomes unwell, the comfort provided by breastfeeding is also important to your baby’s recovery. Colds and ear infections
If your baby develops a cold or ear infection and finds it difficult to breastfeed, carrying him in an upright position such as in a sling or carrier prior to feeds may help mucus drain from his nose, making sucking easier. Feeding your baby in an upright position (sit him straddled across your lap facing the breast) will reduce pressure on and pain in baby’s ears that is created when he is lying down. Using a vaporiser in the room where your baby sleeps and where you feed him will also help clear his nose. You can also clear your baby’s nose with a nasal aspirator (available at a pharmacy, see Dr Ginni Mansberg’s comments, right) but be careful not to upset him with this at feeding times as an upset baby will have difficulty feeding. If your baby cannot suck effectively, you may need to express and feed him with a spoon or cup (even young babies will often feed well from a small shot glass). Diarrhoea and vomiting
It is common for parents to become concerned about their baby’s bowel motions. A breastfed baby can normally have as many as six to eight dirty nappies in the early weeks and some of these poos can be loose, watery and occasionally even greenish in colour.

Diarrhoea in a breastfed baby can also be a side effect of medications such as vitamin supplements or antibiotics being taken by a breastfeeding mother. Occasionally, some sensitive babies will react to a new food eaten by mum or a single bottle of formula, with vomiting or diarrhoea. Of course if your baby has a temperature as well as frequent or foul-smelling bowel motions, please
see a doctor urgently. Symptoms of dehydration can include listlessness, lethargy, dry mouth, reduced urine output and fever. The best way to prevent dehydration is to offer your baby small, frequent feeds and if an oral rehydration solution is recommended by your doctor, you can and should continue to breastfeed. If you are advised to take your child off all milk products, including breastmilk, question this because as well as the antibodies in your milk that will help your baby recover, this isn’t a good time to take away the comfort of nursing, even temporarily, if it can be avoided. Any time your intuition is in conflict with your health carer’s advice, seek another opinion to work out a solution that suits you and your baby, as well as what works from a medical perspective.
Pinky McKay

On the bottle

Doesn’t your heart just break when your baby catches a cold or a tummy bug! Most sick babies will go off their food. Whether she rejects formula and other drinks depends on the baby, how sore her mouth or throat is and her illness. When your baby has a fever, she needs extra fluid to fight it, but often the fever makes her so listless she doesn’t want to suck and swallow. This can mean dehydration and your little one will feel even worse. Breastfeeding mums are always advised to simply demand-feed their babies but what do you do when your baby is bottlefeeding? As a rough guide, if your baby is sick, make up the same number of bottles as usual and do not change the way you make them up. Carefully follow the instructions on the formula package. In addition offer two bottles of water a day between feeds to rehydrate her. Mild diarrhoea
If baby has a runny tummy but is not dehydrated or listless, continue to give her the usual number of bottles of full-strength formula. You can also continue her usual solids, but offer her more carbohydrate-based foods, like rice cereal, mashed potatoes, pureed cooked fruits such as apples, mashed bananas and strained carrots. Steer clear of fruit juices because they make diarrhoea worse. More frequent diarrhoea
If she has frequent, watery bowel movements and you are starting to notice fewer wet nappies, switch her from formula to a commercially prepared oral rehydration solution (from pharmacies) for between 4 and 6 hours. Follow the instructions on the package exactly to make it up. Diarrhoea usually dehydrates a baby, making her very thirsty. Replacing that fluid is your number one concern. Routines can go out the window. Give her fluid whenever she wants it and offer frequently. If you cannot get to a pharmacy for a rehydration solution, just give her full-strength formula on demand. No other drinks besides specially-made solutions and formula are appropriate for babies with diarrhoea. Reintroducing formula
After drinking this oral rehydration solution for 4 to 6 hours, your baby will probably be hungry, so it’s time to restart full-strength formula. She may be hungrier than usual. One common side effect of viral diarrhoeal disease is temporary lactose intolerance. If the diarrhoea continues once you have reintroduced the formula, go straight to your GP. Chances are your baby will need a short stint on a special lactose-free formula. Never switch to soy-based or lactose-free formula before consulting a doctor or child health nurse. Reintroducing solids
The first foods to restart are the carbohydrate-rich foods (see left). If feeding does not start off another bout of diarrhoea or vomiting, gradually reintroduce your baby’s normal diet over 48 hours, with raw fruit and vegetables being last on the list. Colds
When baby has a blocked nose, it can be difficult for her to breathe when she drinks. Try clearing her nose with normal saline drops from a pharmacy. Some mums swear by a special nasal aspirator that basically sucks up the mucus out of baby’s nose, however there’s no medical evidence to support either its effectiveness or safety. If you choose to use one, do so carefully and only according to the instructions.
Dr Ginni Mansberg