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CDC Health Information for International Travel 2008

Chapter 8
International Travel with Infants and Young Children

Breastfeeding and Travel

Deciding About Travel and Breastfeeding

Travel need not be a reason to stop breastfeeding. A mother traveling with a nursing infant may find breastfeeding makes travel easier than it would be if traveling with a formula-fed infant. A mother traveling 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 traveling 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 traveling, her options for storing expressed milk while traveling, the duration of her travel, and her destination. Mothers planning travel away from a nursing infant may access information from her pediatrician or from an International Board-Certified Lactation Consultant (IBCLC). Mothers may find an IBCLC in their area at http://www.access.gpo.gov/nara/cfr/waisidx_03/42cfr71_03.html, http://gotwww.net/ilca/ or http://www.iblce.org/old/.

A mother who travels without her nursing infant or child may find her milk supply somewhat diminished upon her return. This does not need to be a reason to stop breastfeeding. A mother who returns to her nursing infant or child can continue breastfeeding and supplement as needed until her milk supply returns to its prior level. Often, after returning from travel, a nursing infant or child will help bring her milk supply to its prior level. Occasionally, however, nursing infants or children who are separated from their mother for an extended time have difficulty transitioning back to breastfeeding.

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 (http://www.lalecheleague.org).

A mother traveling with a nursing infant younger than 6 months old need not plan to supplement breastfeeding because of travel (1). Breastfed infants do not require water supplementation, even in extreme heat environments (2). While traveling, the best way to both maintain a mother’s milk supply and ensure ideal nutrition and hydration for the child is frequent, unrestricted nursing opportunities. Breastfeeding also protects the infant from water that is possibly contaminated.

A breastfeeding mother traveling without her nursing infant or child may wish to produce and store a supply of milk to be fed to the infant or child during her absence by another caregiver. Building a supply to be fed in her absence takes time and patience and is most successful when begun gradually, many weeks in advance of her departure. It is also important to consider that infants who have never consumed milk from a bottle or cup need opportunities to practice this skill with another caregiver prior to the mother’s departure.

Maintaining Lactation During Travel

A breastfeeding mother traveling without her nursing infant or child who does not build a supply of milk to be fed in her absence can still maintain her milk supply while she is traveling. These efforts will help maintain her breastfeeding relationship for when she and her infant or child can be together again.

Milk expression approximately every 3-4 hours for infants less than 6 months old, less frequently for older infants and children, helps a mother maintain her milk supply and provides milk that she may choose to bring home for her infant or child. A mother who will be separated from her infant or child for a long period of time while traveling might have a difficult time maintaining lactation. In general, separation of a week or less does not pose a major problem for a mother wishing to maintain breastfeeding while separated from her infant or child. This time is more flexible as the child becomes older and complementary foods play a larger role in the child’s diet.

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 (hand) expression. Manual (hand) expression is the most hygienic way to collect milk. Mothers planning on travel to locations without reliable electrical power should learn and practice manual expression techniques well before travel is to begin.

The destination for travel can impact decisions for milk storage. Expressed milk should be stored in clean, tightly sealed containers. Any container that may be cleaned well with hot, soapy water and that seals tightly and reliably may be used. Once milk is cooled, a cold chain needs to be maintained until the milk is consumed. Refrigerated milk can subsequently be frozen; however, once frozen milk is fully thawed, it should be used within 1 hour.

Handling expressed breast milk does not require special medical precautions. Breast milk may be stored in any refrigerator or other location where other foods would be safe and may be stored with other foods. Breast milk requires no special labeling, it is not considered a biohazard, and the universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens (known widely as “Universal Precautions”) do not apply to it (3). Guidance on human milk storage is found in Table 8-5.

Immunizations and Medications for Breastfeeding Mothers During Travel

IMMUNIZATIONS

Most nursing mothers may be immunized routinely, based on recommendations for the specific travel itinerary. Neither inactivated nor live vaccines administered to a lactating woman affect the safety of breast-feeding for mothers or infants. Breast-feeding does not adversely affect immunization and is not a contraindication for any vaccine (5). However, there is a theoretical risk to the infant with the use of yellow fever vaccine in breastfeeding mothers. Vaccination of nursing mothers should be avoided because of the theoretical risk for the transmission of 17D virus to the breastfed infant. When travel of nursing mothers to high-risk yellow fever-endemic areas cannot be avoided or postponed, such persons can be vaccinated (see Chapter 4) (6). Breastfed infants should be vaccinated according to routine recommended schedules.

MEDICATIONS

Breastfeeding mothers should take the usual adult dose of the antimalarial drug appropriate for the itinerary. Nursing mothers with infants weighing less than 5 kg (approximately 11 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 traveling 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.

TABLE 8-5. Human Milk Storage for Healthy Infants (4)

LOCATIONTEMPERATUREDURATIONCOMMENTS
Countertop, tableRoom 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 bag5-39° F or -15-4° C24 hours Keep ice packs in contact with milk containers at all times, limit opening cooler bag.
Refrigerator39° F or 4° C5 days Store milk in the back of the main body of the refrigerator.
Freezer—Compartment of refrigerator

 

Freezer — Refrigerator/freezer with separate doors

Freezer — Chest or upright manual defrost deep freezer

5° F or -15° C

 

0° F or -18° C

-4° F or -20° C

2 weeks

 

3-6 months

6-12 months

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.

Traveling with a Breastfed Infant

A mother traveling with a nursing infant or child may wish to consider a sling or other soft infant carrier for use while traveling. This helps maintain breast-feeding by increasing opportunities for unrestricted nursing and increasing skin-to-skin contact with the child, while also protecting the child from environmental hazards and easing the burden of carrying a child. 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.

X rays used in airport screenings have no effect on breastfeeding, breast milk, or the process of lactation (7). Expressed breast milk does not need to be declared at US Customs when returning to the United States. However, recommendations regarding the carrying of liquids on board aircraft are subject to change and should be checked prior to travel. Breast pumps are usually 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. It is always prudent to check current airline security guidelines.

A nursing mother with travelers’ diarrhea should increase her own fluid intake and frequency of breastfeeding; she should not stop breastfeeding because of travelers’ diarrhea. Breastfed infants are protected from travelers’ diarrhea both because breastfeeding protects them from consuming contaminated items and because a nursing mother does not pass on travelers’ diarrhea to her infant via breastfeeding. 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 infections.

References

 

  1. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. Pediatrics. 2005;115:496-506.
  2. Sachdev HPS, Krishna J, Puri RK, Satyanarayana L, Kumar S. Water supplementation in exclusively breastfed infants during summer in the tropics. Lancet. 1991;337:929-33.
  3. CDC. Perspectives in Disease Prevention and Health Promotion Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis b virus, and other bloodborne pathogens in health-care settings. MMWR Morbid Mortal Wkly Rep. 1998;37:377-88.
  4. Eglash A, Chantry C, Howard C. Human milk storage. Academy of Breastfeeding Medicine 2006. Protocol #8 (2004). Available from: http://bfmed.org/ace-files/protocol/milkstorage_ABM.pdf (PDF 48 KB/3 pages) [accessed 26 March 2007]
  5. CDC. General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm [accessed 26 March 2007.]
  6. CDC. Yellow fever vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep. 2002;51:1-36.
  7. Lawrence RA. Breastfeeding: A guide for the medical profession. 4th ed. New York: Mosby; 1994.
KATHERINE SHEALY

 

  • Page last updated: February 15, 2008
  • Content source:
    Division of Global Migration and Quarantine
    National Center for Preparedness, Detection, and Control of Infectious Diseases
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