Breastfeeding and Travel

Deciding about Travel and Breastfeeding

Travel need not be a reason to stop breastfeeding. A mother travelling with a nursing infant may find breastfeeding makes travel easier than it would be if travelling with a bottle-fed infant. A mother travelling without her nursing infant or child may take steps to preserve breastfeeding and maintain her milk supply while separated. The major factors for a mother travelling without her nursing infant or child to consider are the amount of time she has to prepare for her trip, her flexibility of time while travelling, her options for storing expressed milk while travelling, the duration of her travel, and her destination. Mothers planning travel away from a nursing infant may access information from her paediatrician or from an International Board Certified Lactation Consultant (IBCLC) at http://gotwww.net/ilca/, or from the international organisation at www.iblce.org/international%20registry.htm.

Preparation for Travel while Breastfeeding

Breastfeeding mothers may wish to find local breastfeeding support before beginning travel and keep pertinent contact information handy throughout the trip. La Leche League International has breastfeeding experts in many countries (www.lalecheleague.org).

A mother travelling with a nursing infant <6 months old need not plan on supplementing breastfeeding because of international travel. Breastfed infants do not require water supplementation, even in extreme heat environments, if the mother is adequately hydrated. A breastfeeding mother travelling without her nursing infant or child may wish to build a supply of milk to be fed to the infant or child during her absence by expressing milk and storing it for later use by another caregiver.

Depending on her destination, a mother may need to plan for milk expression without a reliable electrical power source. Expressing milk without an electrical power source is less reliable for maintaining milk supply over a long period of time than expressing milk with a hospital-grade electric breast pump. Intermittent milk expression can be successful with battery and manual breast pumps, as well as manual expression.

The destination for travel can impact decisions for milk storage. Once milk is cooled, a cold chain needs to be maintained until milk is consumed. Refrigerated milk can subsequently be frozen; however, once frozen milk is fully thawed, it should be used within 1 hour. Guidance on human milk storage is found in Table 8-4.

Table 8-4. Human Milk Storage for Healthy Infants1

Location Temperature Duration Comments
Countertop, table Room temperature (up to 77°F or 25°C) 6-8 hours Containers should be covered and kept as cool as possible; covering the container with a cool towel may keep milk cooler.
Insulated cooler bag 5-39°F or -15-4°C 24 hours Keep ice packs in contact with milk containers at all times, limit opening cooler bag.
Refrigerator 39°F or 4°C 5 days Store milk in the back of the main body of the refrigerator.
Freezer — Compartment of refrigerator 5°F or -15°C 2 weeks Store milk toward the back of the freezer, where temperature is most constant. Milk stored for longer durations in the ranges listed is safe, but some of the lipids in the milk undergo degradation, resulting in lower quality.
Freezer — Refrigerator/freezer with separate doors 0°F or -18°C 3-6 months
Freezer — Chest or upright manual-defrost deep freezer -4°F or -20°C 6-12 months

1Academy of Breastfeeding Medicine Clinical Protocol Number #8: Human Milk Storage Information for Home Use for Healthy Full-Term Infants, Academy of Breastfeeding Medicine, Princeton Junction, NJ, 2004.

Most nursing mothers may be immunised routinely, based on recommendations for the specific travel itinerary. Breastfeeding is not a contraindication to the administration of vaccines, including live-virus vaccines (see Table 8-5); however, there is a theoretical risk to the infant with the use of the yellow fever vaccine in breastfeeding mothers (See Chapter 4, Yellow Fever section). Breastfed infants should be vaccinated according to routine recommended schedules (see Vaccine Recommendations for Infants and Children).

Table 8-5. Vaccination of breastfeeding mothers

Vaccine / Immunobiologic Precautions for breastfeeding
Immune globulins, pooled or hyperimmune None
Diphtheria-Tetanus None
Hepatitis A Data on safety in breastfeeding are not available; it is unlikely that vaccination would cause untoward effects in breastfed infants. Consider immune globulin rather than vaccine.
Hepatitis B None
Influenza None
Influenza Vaccination with inactivated influenza vaccine is encouraged when feasible for children aged 6-23 months and their close contacts and caregivers.
Japanese encephalitis Data on safety in breastfeeding are not available; vaccine should not be routinely administered.
Measles None
Meningococcal meningitis None
Mumps None
Pneumococcal Data on safety in breastfeeding are not available; it is unlikely that vaccination would cause untoward effects in breastfed infants.
Polio, inactivated None
Rabies Data on safety in breastfeeding are not available; however, this vaccine is commonly given to breastfeeding mothers without any observed untoward effects in breastfed infants.
Rubella None
Tuberculosis (BCG) Data on safety in breastfeeding are not available.
Typhoid (ViCPS) Specific information concerning use during breastfeeding is not available. However, the vaccine may be used when risk of exposure to typhoid fever is high.
Typhoid (Ty21a) Specific information concerning use during breastfeeding is not available. However, the vaccine may be used when risk of exposure to typhoid fever is high.
Varicella None
Yellow fever Vaccination of nursing mothers should be avoided because of the theoretical risk for transmission of 17D virus to the breastfed infant. When travel to high-risk yellow fever-endemic areas cannot be avoided or postponed, nursing mothers can be vaccinated.
Vaccinia (Smallpox) Women who are breastfeeding should not be given this vaccine. If there is a smallpox outbreak, recommendations on who should get vaccinated may change.

Breastfeeding mothers should take the usual adult dose of the antimalarial drug appropriate for the itinerary. Nursing mothers with infants weighing <11 kg (approximately 24 pounds) should not take atovaquone/proguanil (Malarone) for prophylaxis. Data are limited on the use of doxycycline during breastfeeding; however, most experts consider its short-term use compatible with breastfeeding. Primaquine is contraindicated during lactation unless both the mother and breastfed infant have normal G6PD levels. It is critical to note that breastfed infants require their own antimalarial medication if travelling to an endemic area. Mother's milk does not provide malaria protection, even when the mother is taking an adequate medication and dose for herself.

Travelling with a Breastfed Infant

Infants are particularly susceptible to painful pressure due to eustachian tube collapse as a result of pressure changes during air travel. Breastfeeding during ascent and descent often relieves this discomfort.

No special precautions are necessary for airport security screenings while breastfeeding. Breast milk does not need to be declared at US Customs when returning to the United States. Electric breast pumps are considered personal items during air travel and may be carried on and stowed underneath the passenger seat, similar to a laptop computer, purse, or diaper bag.

Breastfed infants are protected from travellers' diarrhoea, and thus it is often recommended that a nursing mother try, if reasonable, to continue to breastfeed until returning home. A nursing mother with travellers' diarrhoea should increase her own fluid intake and frequency of breastfeeding; she should not stop breastfeeding because of travellers' diarrhoea. The use of oral rehydration salts (ORS) is fully compatible with breastfeeding.

In addition to the usual contents of the travel health kit (see Chapter 2), breastfeeding mothers may wish to include an antifungal cream, which can be used to treat periareolar yeast.

Bibliography
  • American Academy of Paediatrics. The transfer of drugs and other chemicals into human milk. Paediatrics 2001; 108(3):776-789.
  • CDC. Protection against viral hepatitis: Recommendations of the Immunisation Practices Advisory Committee (ACIP). MMWR Morbid Mortal Wkly Rep 1990; 39 (RR-2);1-26.
  • CDC. Recommendations of the Advisory Committee on Immunisation Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR Morbid Mortal Wkly Rep 2002; 51 (RR-2):1-36.
  • Lawrence RA. Breastfeeding: A guide for the medical profession. 4h ed. Mosby: New York, 1994.
  • Marmet C. Technique for Manual Expression of Breastmilk. http://www.lactationinstitute.org/MANUALEX.html
  • Nikem VC, Hofmeyr GJ. Secretion of the antidiarrhoeal agent loperamide oxide in breastmilk. Eur J Clin Pharmacol 1992; 42(6):695-696.
  • Popkin BM, Adair L, Akin JS, Black R, Briscoe J, Fledger W. Breast-feeding and diarrhoeal morbidity. Paediatrics 1990, 86(6):874-882.
  • Sachdev HPS, Krishna J, Puri RK, Satyanarayana L, Kumar S. Water supplementation in exclusively breastfed infants during summer in the tropics. Lancet 1991, 337(8747):929-933.

- Katherine Shealy

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