Breastfeeding and Travel

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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 bottle-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), or from the international organization.

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 traveling with a nursing infant older than 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 traveling 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.

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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 immunized 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. 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 less than 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 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.

Traveling 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 travelers' diarrhea, and thus it is often recommended that a nursing mother try, if reasonable, to continue to breastfeed until returning home. 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. The use of oral rehydration salts (ORS) is fully compatible with breastfeeding.

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