WebMD Ask the Pharmacist

Moms and Newborn Babies: Ask the Pharmacist

Macary Marciniak, PharmD, BCPS, answers questions about medications and treatments for newborns, babies, and nursing mothers.

Question:

Can you take ibuprofen when you’re breastfeeding?

Answer:

Ibuprofen is a pain reliever that is part of a class of medications called NSAIDs (nonsteroidal anti-inflammatory drugs). The American Academy of Pediatrics classifies ibuprofen as “usually compatible” with breastfeeding.

However, if you are using ibuprofen for mild pain or fever, you might consider using acetaminophen (Tylenol) instead. Acetaminophen is classified as “compatible” with breastfeeding and most consider it to be the pain reliever of choice for a breastfeeding woman. To minimize the infant’s exposure to the medication, consider taking the acetaminophen or ibuprofen immediately after nursing.

Question:

For a baby, what nonprescription medications can we use for colds?

Answer:

Nonprescription cough and cold products should NOT be used in young children. These products are not effective and have the potential for severe side effects. The best choices to treat a runny nose or congestion in a baby are (1) nasal saline drops/spray, (2) a nasal bulb syringe to remove mucus and congestion, and/or (3) placing a cool mist humidifier in the child’s room.

Question:

Is Pamprin safe to take for menstrual cramps while breastfeeding?

Answer:

There are a number of different formulations of Pamprin available. As such, there are a number of different active ingredients that may be contained in these products. Any Pamprin products (or other products marketed for menstrual cramps) that contain aspirin, magnesium salicylate, or naproxen would not be recommended for a breastfeeding woman. Some Pamprin products may contain caffeine, and each dosage form (tablet) contains about as much caffeine as a cup of coffee. Since one dose is 2 tablets, this would be like drinking 2 cups of coffee. Caffeine does enter breast milk, and in large enough amounts may cause fussiness, jitteriness, and poor sleep patterns in the infant.

Pamprin may contain pyrilamine or pamabrom. Small, occasional doses of these medications should be safe. Acetaminophen, another possible ingredient in Pamprin, is definitely safe for use and is recommended for pain relief by the American Academy of Pediatrics.

Question:

I was given doxycycline after a tubal and was told to stop nursing my daughter. I have been off of it for about a week now, and was wondering if I can nurse her again?

Answer:

Doxycycline is a prescription antibiotic and breastfeeding while on this medication is generally not recommended. After a week off of the medication, it should now be entirely out of your system. It should be safe to resume breastfeeding. Also, it is very important to take the full course of the doxycycline to prevent antibiotic resistance -- a situation where the antibiotic is not as effective as it should be for the infection.

Question:

I have a 6-month-old girl, and I want to find out what would be the safest decongestant to use.

Answer:

Nonprescription cough and cold products should NOT be used in young children. These products are not effective and have the potential for severe side effects. The best choices to treat congestion would be (1) nasal saline drops/spray, (2) a nasal bulb syringe to remove mucus and congestion, and/or (3) placing a cool mist humidifier in the child’s room.

Question:

I just delivered a baby three days ago and am breastfeeding. Can I take Tylenol Cold & Flu for symptoms of coughing and a lot of sinus drainage?

Answer:

Tylenol Cold & Flu Severe contains acetaminophen (a pain reliever), dextromethorphan (a cough suppressant), guaifenesin (an expectorant), and phenylephrine (a decongestant). It is possible that the coughing is only due to the sinus drainage. Treating the sinus symptoms first would be best.

A saline nasal spray and/or use of a cool mist humidifier would be wonderful nondrug options to treat the sinus symptoms. An antihistamine would also help with a runny nose and dry out the secretions. It is possible that an antihistamine might decrease milk supply or cause some drowsiness in the infant, so I would try the nasal saline and humidifier first, and see if they help relieve your symptoms.

Tylenol Cold & Flu Severe does not contain an antihistamine, but contains many other ingredients that are not necessary for your symptoms, and it contains phenylephrine, which is not recommended in breastfeeding women. Therefore, I would not recommend this particular product for your symptoms.

Question:

My doctor just prescribed antibiotics. I’m wondering if they’re safe to take while breastfeeding?

Answer:

Some antibiotics are safe for a mother to take while breastfeeding.  However, others may not be as good of a choice, and alternatives should be explored. Unfortunately, without knowing the particular antibiotic that you were prescribed, it is impossible to answer this question.

For help with your specific medication, please contact your local pharmacist or doctor who prescribed the antibiotic.

Question:

What is the correct ibuprofen dosage for a 1-year-old, 25-pound baby being treated for earache?

Answer:

Based on your child’s weight, 5 mL of the children’s ibuprofen would be acceptable. It is important to use only the dosing device that comes packaged with the product (like a dosing syringe or dosing cup). If your product does not have one, please talk with your local pharmacist who can help you purchase one and show you how to measure the correct amount for your child.

Question:

Can a woman who is breastfeeding take doxepin?

Answer:

Doxepin is a prescription medication that can be used for depression. Drowsiness and difficulty breathing have been reported in infants whose mothers took doxepin while breastfeeding. The American Academy of Pediatrics recommends caution with this product and states it may be “of concern” with breastfeeding.

The use of any medication while breastfeeding is based on the benefit to the mother and potential risk to the child. If a mother is taking this medication for depression, then it is likely she needs to continue prescription medications, so I would encourage her to talk with her health care providers and see if other alternative depression medications could be an option. If the woman needs to stay on doxepin, then monitor the infant for signs of sedation or drowsiness.

Question:

Is it OK to give a 1-month-old corn syrup for constipation?

Answer:

I would not recommend corn syrup to treat constipation, particularly in a 1-month-old child. It would likely not be effective, but, in addition, is unsafe. There is a risk of botulism when corn syrup is given to children less than 1 year old.

For a child this young, I would definitely consult with your child’s pediatrician first. Likely, he/she may consider giving the child some water or fruit juice (particularly prune juice) in addition to feedings. Your child may need to be evaluated just to ensure that there are not any other medical concerns for the constipation.

Question:

I am breastfeeding, and had a prescription for hydroxyzine pamoate 25 mg for helping me sleep/anxiety that I take as needed. I am currently breastfeeding and wondered if it was safe.

Answer:

It is unknown whether hydroxyzine enters into breast milk. Using this product routinely for sleep/anxiety would be more likely to cause drowsiness in the infant. And, since this product is an antihistamine, it might also decrease milk production.

You might want to talk with your health care provider about your options. This might be the best choice to treat your sleep problems/anxiety, but there may be other alternatives that your practitioner feels might be just as effective and may have less risk for the infant.

Question:

I am breastfeeding my newborn and I have to take an iron supplement, which gives me severe constipation. Is there anything I can take to deal with this issue?

Answer:

Yes. Bulking agents like psyllium would be a great first choice (example brand name: Metamucil). There are a number of dosage forms available, including powders, capsules, and wafer bars. It would also be really important to drink lots of water and increase your intake of dietary fiber foods like whole grains, beans, fruits, and vegetables.

If that is not enough, you may want to talk with your doctor about adding a medication such as docusate (brand name: Colace). Docusate helps soften stool to make it easier to pass, and is generally considered safe while breastfeeding.

Question:

What can I give my 1-year-old daughter for runny nose, cough, and cold?

Answer:

Nonprescription cough and cold products should NOT be used in young children.  These products are not effective and have the potential for severe side effects. The best choices to treat a runny nose or congestion in a baby are (1) nasal saline drops, (2) a nasal bulb syringe to remove mucus and congestion, and/or (3) placing a cool mist humidifier in the child’s room.

Question:

Can you take Mucinex while breastfeeding?

Answer:

There are a couple of different formulations of Mucinex available. Depending on the exact product, it may contain one of more of the following active ingredients: guaifenesin (an expectorant), dextromethorphan (a cough suppressant), phenylephrine (a decongestant), and/or pseudoephedrine (a decongestant).

Guaifenesin and dextromethorphan could be recommended for short-term use while breastfeeding. However, phenylephrine or pseudoephedrine would not be recommended, as they can decrease breast milk production. Please read the active ingredients on the Drug Facts label on your product to confirm which components are in your particular product.

Question:

My baby has tubes in her ears. Is it OK to give her over-the-counter ear drops for an earache?

Answer:

There are some over-the-counter ear drops that are drying agents, often used for swimmer’s ear, and homeopathic ear drop products that are promoted for a variety of uses. I would not recommend either of these types of products, as they would not be effective for relieving pain from an earache and also should not be used in children with tubes in their ears.

An earache would best be treated with a nonprescription pain reliever like acetaminophen or ibuprofen. Talk with your child’s pediatrician about the right product and right dose for your baby.

Question:

Are there any medications for postpartum depression that are safe to take while nursing?

Answer:

Postpartum depression can be safely treated in a woman who is nursing. SSRIs (selective serotonin reuptake inhibitors) are often used to treat postpartum depression. There are a number of available SSRIs. Sertraline (Zoloft), paroxetine (Paxil), or citalopram (Celexa) could be some of the choices your provider might recommend. Depending on the medication chosen, the infant may need to be monitored for excessive sleepiness, decreased feeding, or weight loss.

Question:

How much Pedialyte do you give a 2-month-old?

Answer:

Pedialyte is a nonprescription product that helps replace fluids and nutrients lost when a child is vomiting or has diarrhea. For a 2-month-old, you should talk to your child’s pediatrician first, to be sure that he/she is comfortable with you using this product, as it is only labeled for nonprescription use in children 1 year of age or older.

For those children, you would have the child sip on the liquid (about 8 oz) -- and they could use it every 1-4 hours. Pedialyte liquid might taste best when first chilled in the refrigerator.

Question:

Should I continue prenatal vitamins while breastfeeding?

Answer:

Prenatal vitamins are very similar to multivitamins. The three elements that are most important for a prenatal vitamin (and probably differ the most from a regular vitamin) are the amounts of folic acid, iron, and calcium. It would be fine to continue prenatal vitamins while breastfeeding.

Question:

Is it OK to give my newborn baby gripe water when he is taking Nystatin oral suspension for thrush?

Answer:

Gripe water is a dietary supplement that has been suggested for use in infants with stomach ailments. The ingredients in gripe water can vary but it may contain sodium bicarbonate, ginger, fennel, and/or chamomile.

In general, I would not recommend this product for use in a child. First of all, dietary supplements are not approved by the Food and Drug Administration (FDA). As such, the product may not actually contain the ingredients on the label and it is possible ingredients that aren’t mentioned on the label may be in the product. This concerns me, particularly when you are considering giving this product to a newborn.

And, if the gripe water contains ginger and/or chamomile, there is a risk of increased bleeding from these ingredients. If you are trying to treat stomach discomfort that may be caused by gas, I would suggest trying simethicone drops (example brand name: Mylicon) as these are FDA-approved and can be used safely in newborns.

Question:

Are Amicar and breastfeeding OK?

Answer:

Amicar is a prescription medication that can be used to control bleeding in people with coagulation disorders. It is not known whether this medication may enter into the breast milk, so women should use it with caution during breastfeeding.

The use of any medication while breastfeeding is based on the benefit to the mother and any potential risk to the child. You may want to consult with your obstetrician-gynecologist and/or primary care provider to ensure that he/she/they are comfortable with you taking this product while breastfeeding.

Question:

Is a teaspoonful of amoxicillin for a 14-pound infant too much?

Answer:

Amoxicillin is a common antibiotic for young children. It is dosed by age and weight, and there are various strengths of amoxicillin available as a suspension. It is difficult to answer your question completely, because I don’t know which product your child was given.

However, based on general dosing of amoxicillin, 1 teaspoonful would be a common amount, and should not be too much. Also, it is very important to take the full course of the amoxicillin to completely clear the infection and prevent antibiotic resistance -- a situation where the antibiotic is not as effective as it should be for the infection.

Question:

I have an 11-month-old who was diagnosed with RSV and prescribed a breathing treatment. I gave her one treatment, and during the treatment, her eyes rolled up in her head. Is this a side effect?

Answer:

This sounds very concerning. A child’s eyes rolling back in her head is not a normal occurrence. While I am not sure exactly what breathing treatment your daughter was prescribed, this medical issue is not likely a side effect of a medication. I would encourage you to take your daughter to the emergency room right away so that she can be examined and the cause of this issue determined.

Question:

Is there a plant-based birth control? I am breastfeeding, and don’t want to use chemicals.

Answer:

I am not aware of a plant-based birth control that is available by prescription (and, as such, would be approved by the Food and Drug Administration). If you are concerned with the active ingredients that may be present in a prescription product, then you might consider non-hormonal methods of contraception such as condoms, a diaphragm, a cervical cap, the sponge, or a copper intrauterine device (IUD).

Question:

I just had a baby and am taking Tylox pain medicine. Can I breastfeed?

Answer:

Tylox is a prescription pain reliever that contains acetaminophen and oxycodone. Acetaminophen may safely be taken while breastfeeding. Oxycodone is excreted into breast milk and has been said to be moderately safe while breastfeeding. The infant may have some extra sleepiness or drowsiness or poor feeding.  If this is noted, please contact the pediatrician right away.

Question:

Can you take Claritin for allergies while breastfeeding a 2-month-old?

Answer:

Claritin is a non-sedating antihistamine and is safe to use in breastfeeding. It is possible that Claritin (and other antihistamines) may decrease the amount of breast milk a mother can produce. If this is a concern, or you believe this has occurred after starting Claritin, then you should stop the medication. Your milk production should then increase.

Question:

Is it OK for my fiancee to breastfeed while she is on Vicodin?

Answer:

Vicodin is a prescription pain reliever that contains acetaminophen and hydrocodone. Acetaminophen may safely be taken while breastfeeding. Hydrocodone is excreted into breast milk and has been said to be moderately safe while breastfeeding. The infant may have some extra sleepiness or drowsiness or poor feeding. If this is noted, please contact the pediatrician right away.

Question:

Is there a safe laxative that can be used while breastfeeding?

Answer:

Yes. Bulking agents like psyllium would be a great first choice (example brand name: Metamucil). There are a number of dosage forms available, including powders, capsules, and wafer bars. It would also be really important to drink lots of water and increase your intake of dietary fiber foods like whole grains, beans, fruits, and vegetables.

Question:

I heard that Infant Tylenol will no longer be available over-the-counter. What should I do now for my child?

Answer:

Very recently, the Consumer Healthcare Products Association (the organization that represents manufacturers of over-the-counter products) decided not to produce an infant version of acetaminophen (brand name: Tylenol). Now, there will only be a children's formulation. This decision was made in hopes of lowering the numbers of dosing errors. The infant version was more concentrated than the children's version and, unfortunately, it was very difficult for parents to give the correct amount to their children.

You should check with your child's pediatrician to determine how much of the children's version you should give your child. Dosing of children’s acetaminophen is based on the weight of the child. Also, be sure to use the dosing device packaged with the product, in order to give the correct amount to your child.

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