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  3. Mothers on Medication or with Infectious Illness — Drug Safety & Guidelines
Course Content
Why Breastfeeding Matters (10 minutes)
Health and developmental benefits for infants Maternal benefits (physical and mental) Economic and community-level advantages Common myths and culturally specific misconceptions
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Health & Developmental Benefits for Infants from Breastfeeding
Maternal Benefits of Breastfeeding (Physical and Mental)
Economic and Community-Level Advantages of Breastfeeding
Common Myths and Culturally Specific Misconceptions about Breastfeeding
Newborn Feeding Cues & Anatomy (20 minutes)
Early vs. late hunger cues and what they mean Normal newborn feeding patterns and stomach capacity Brief breast anatomy (lobes, ducts, nipple, areola) in plain language Signs of effective feeding (swallowing, contentment, diaper output)
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Early vs. Late Hunger Cues in Infants
Normal Newborn Feeding Patterns and Stomach Capacity
Breast Anatomy (in Plain Language)
Signs of Effective Feeding in Breastfed Babies
Positions & Achieving a Good Latch (40 minutes)
Position options: cradle, cross-cradle, football/clutch, side-lying Stepwise approach to help baby latch (prepare — attach — assess) Signs of a good vs. poor latch (comfort, nipple shape, audible swallowing) Small-person adaptations (premature, small mouth, tongue-tie considerations) Safe positioning for mothers with C-section recovery
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Position Options for Breastfeeding
Stepwise Approach to Help Baby Latch
Signs of a Good vs. Poor Latch
Small-Person Adaptations in Breastfeeding
Safe Positioning for Mothers with C-Section Recovery
Protecting & Building Milk Supply (25 minutes)
Establishing supply in the first days and weeks (frequency, skin-to-skin) Night feeds and cluster feeding explained Lifestyle and medical factors that reduce supply (e.g., certain medications, stress) Relactation and increasing milk supply safely Nutrition and hydration myths vs. evidence
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Establishing Milk Supply in the First Days and Weeks
Night Feeds and Cluster Feeding
Lifestyle and Medical Factors That Reduce Supply
Relactation and Increasing Milk Supply Safely
Nutrition and Hydration Myths vs. Evidence in Breastfeeding
Expressing & Storing Breastmilk (20 minutes)
Hand-expression steps and common mistakes Choosing and using pumps (manual vs. electric) — practical tips Safe collection, labeling, storage, thawing and warming guidelines (low-resource options included) Cleaning and hygiene for bottles and storage containers Feeding expressed milk to infant (cup, spoon, paladai, bottle considerations)
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Hand-Expression Steps and Common Mistakes
Choosing and Using Breast Pumps (Manual vs. Electric)
Safe Breast Milk Handling
Cleaning and Hygiene for Bottles and Storage Containers
Feeding Expressed Milk to Infants
Common Problems & Practical Solutions (25 minutes)
Causes of sore nipples and immediate relief techniques Managing engorgement and preventing blocked ducts Recognising mastitis vs. normal engorgement and when antibiotics may be needed Low weight gain: assessment steps and feeding plan adjustments Non-judgmental approach to supplementation and safe short-term options
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Causes of Sore Nipples and Immediate Relief
Managing Engorgement and Preventing Blocked Ducts
Recognising Mastitis vs. Normal Engorgement
Low Weight Gain — Assessment and Feeding Plan Adjustments
Non-Judgmental Approach to Supplementation
Returning to Work or School; Feeding Outside the Home (15 minutes)
Creating an express-and-feed routine (timing, containers, transport) Practical storage and transport tips for different commute types Rights and workplace basics (general guidance; encourage local legal verification) Communicating with caregivers and preparing safe feeder notes Emotional coping and practical fallback plans
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Creating an Express-and-Feed Routine
Practical Storage & Transport Tips for Expressed Breast Milk by Commute Type
Rights and Workplace Basics for Breastfeeding Mothers
Communicating with Caregivers and Preparing Safe Feeder Notes
Emotional Coping and Practical Fallback Plans
Special Situations (20 minutes)
Feeding preterm or low-birthweight infants: kangaroo care, cup or tube feeding basics Managing twins/multiples: tandem feeding tips and time-saving routines Mothers on medication or with infectious illness: how to check drug safety and local guidelines (HIV, TB, etc.) Using donor milk or milk banks (where available) — safety basics
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Feeding Preterm or Low-Birthweight Infants
Managing Twins/Multiples — Tandem Feeding Tips and Time-Saving Routines
Mothers on Medication or with Infectious Illness — Drug Safety & Guidelines
Using Donor Milk or Milk Banks — Safety Basics
When to Seek Help & Building a Support Network (15 minutes)
Red flags for baby and mother (e.g., poor weight gain, fever, severe pain) Where to seek help: clinic, CHW, lactation consultant, emergency care Building a support network: partners, family, peer counsellors, community groups Using telephone/text supports, community groups, and referral pathways
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Red Flags for Baby and Mother
Where to Seek Help for Breastfeeding Challenges
Building a Support Network for Breastfeeding Mothers
Using Telephone/Text Supports, Community Groups, and Referral Pathways
Wrap-up, Resources & Final Assessment (15 minutes)
Key takeaways and common pitfalls to avoid Next steps: seeking local support, advanced training options How to use course materials beyond the course (groups, sharing, peer support) Final 20-question multiple-choice quiz (80% pass mark)
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Key Takeaways and Common Pitfalls to Avoid
Next Steps — Seeking Local Support & Advanced Training Options
How to Use Course Materials Beyond the Course
Final 20-question multiple-choice quiz (80% pass mark)
How to Breastfeed — Self-Paced, Evidence-Based Course for African Moms

1. Introduction

Many mothers worry if their medications or illnesses will harm their babies during breastfeeding. In most cases, breastfeeding is still safe and highly recommended. The key is to:

  • Check drug safety with reliable sources.

  • Follow local and international guidelines (especially for HIV and TB).

  • Balance the risks of drug transfer in milk with the proven benefits of breastfeeding.

2. Medications and Breastfeeding

  • Most common medicines are safe. Small amounts pass into breast milk, but usually not enough to harm the baby.

  • Examples generally safe: Paracetamol, ibuprofen, most antibiotics (e.g., penicillin, amoxicillin).

  • Medicines to avoid or use cautiously: Chemotherapy drugs, lithium, certain anti-thyroid and anti-seizure drugs.

  • Always check: Dose, duration, and baby’s age/health. Premature infants may be more sensitive.

3. Infectious Illnesses and Breastfeeding

HIV

  • WHO guidance (2021): Mothers with HIV are encouraged to exclusively breastfeed for the first 6 months if they are on effective antiretroviral therapy (ART) and both mother and baby receive appropriate medical support.

  • Risk of HIV transmission is greatly reduced with ART.

  • Formula feeding may only be recommended if it is Acceptable, Feasible, Affordable, Sustainable, and Safe (AFASS) — which is not the case in many African settings.

Tuberculosis (TB)

  • Mothers on TB treatment (e.g., rifampicin, isoniazid) can breastfeed safely once treatment has started.

  • If mother has untreated active TB, breastfeeding should be delayed until treatment begins, but expressed milk may be fed with precautions.

  • Infants usually receive preventive medicine (isoniazid) if mother has TB.

Other illnesses (e.g., COVID-19, flu, hepatitis)

  • COVID-19: WHO recommends breastfeeding with mask and hand hygiene.

  • Hepatitis B: Safe to breastfeed if infant is vaccinated at birth.

  • Hepatitis C: Breastfeeding safe unless mother has cracked/bleeding nipples.

4. How to Check Medication Safety

5. Steps for Mothers and Caregivers

  1. Do not stop medicines suddenly without medical advice.

  2. Check safety with trusted sources.

  3. Practice infection control (e.g., hand washing, mask use if respiratory infection).

  4. Stay adherent to treatment — maternal health is essential for baby’s health.

  5. Seek local guidelines: National HIV/TB programs often have breastfeeding-specific recommendations.

End of Lecture Quiz

Q1. True or False: Most antibiotics are unsafe during breastfeeding.

  • Answer: False

  • Rationale: Many antibiotics (like penicillin, amoxicillin) are safe; only a few require caution.

Q2. What is the main condition for safe breastfeeding with HIV?
A. The mother avoids breastfeeding completely
B. The mother is on effective ART
C. The baby is formula-fed from birth
D. The baby has no exposure

  • Answer: B. The mother is on effective ART

  • Rationale: ART reduces HIV transmission risk and allows safe breastfeeding.

Q3. Which reliable online resource provides up-to-date information on drug safety in breastfeeding?
A. Wikipedia
B. LactMed (NIH)
C. Facebook groups
D. Local pharmacy leaflet only

  • Answer: B. LactMed (NIH)

  • Rationale: LactMed is a trusted scientific database for drug safety in lactation.

Curated Resources

Key Takeaways

  • Most medications are compatible with breastfeeding.

  • HIV: Safe to breastfeed on ART with medical supervision.

  • TB: Safe after starting treatment; infants need preventive medicine.

  • Always verify drugs with reliable databases or health professionals.

  • Local/national guidelines should guide final decisions.

Call to Action

  • Mothers: Never stop treatment without advice; check drug safety before making changes.

  • Health workers: Provide clear, non-judgmental counseling and up-to-date local guidance.

  • Communities: Reduce stigma — informed support helps both mother and baby thrive.

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Ushauri Mama - Your MNCH Guide