- Maternal infant attachment is important. Breastfeeding is encouraged when appropriate.
- Caloric needs may be as high as 150 to 250 cals/kg/day
- Frequent small volumes of hypercaloric (22-24 cal/oz) feeding may help minimize hunger and improve growth.
- Soy or "specialized formula" (e.g., Enfamil Gentlease or Similac Sensitive) may improve feeding tolerance.
Encourage breastfeeding for mothers engaged in the following
- Stable Methadone maintenance or Subutex (buprenorphine) regardless of dose
- Substance abuse treatment program who have the endorsement of their counselor/treatment provider
- Plan to continue in substance abuse treatment in the postpartum period
- Negative maternal urine toxicology testing at delivery, except for prescribed medications
- Consistent prenatal care
Breastfeeding is discouraged or contraindicated in the following
- No prenatal care
- Medical contraindication to breastfeeding (such as HIV)
- Relapsed into illicit/licit substance misuse/abuse 30 days prior to delivery
- Inability to engage in substance abuse treatment or in treatment but not able to consent for counselor contact
- Positive maternal urine toxicology testing for illicit substances at delivery
- No confirmed plans for postpartum substance abuse treatment
- No confirmed plans for pediatric care
- Demonstration of behavioral qualities or other indicators of active substance use
Use of selective Serotonin Reuptake Inhibitors can be associated with adverse events
Review with MD prior to allowing breastfeeding
(Refer to CHOP on-line formulary for medication specific lactation recommendations)