My 1999 edition [/note: 10 years old/] of "Breastfeeding: A Guide for 
the Medical Profession" by Ruth and Robert Lawrence states that a 
diagnosis of Group A Streptococcus pharyngitis calls for pumping and 
dumping for the first 24 hours, until 24 hours of effective therapy 
(antibiotics) are delivered.

The infant or toddler who is at home with his or her mother _will 
already have been substantially exposed to the illness, between 2 to 5 
days_, perhaps longer. The incubation, or latency period, is one in 
which there may be no outward symptoms; however, the directive to pump 
and dump assumes that the child is directly exposed through breastmilk. 
Since coughing or sneezing would not be necessary for transmission, it 
seems we can assume the latency period is also a contagious period for 
this route of transmission.

In any case, it is a certainty that the mother will be substantially 
symptomatic before seeking medical help, so that _the child will also 
have been substantially exposed through droplet transmission_, likely 
for days prior to the mother's diagnosis and treatment. By this time the 
mother will have had an immune response which she imparts to the baby 
through her breastmilk.

/Principal questions:/

Will there be any gain from withdrawing immune protection and 
eliminating one route of exposure; _while continuing all other routes of 
exposure_?   (For the at-home mother and child, isolation precautions 
are unlikely to be feasible.)

According to Todar's online textbook of bacteriology, "/S. pyogenes/ is 
usually an *exogenous secondary invader*, following viral disease or 
disturbances in the normal bacterial flora." If it is, in fact, an 
common and opportunistic pathogen which causes illness secondary to 
other immune insult, would it be more prudent to maintain normal immune 
function in the infant, rather than interrupt it?

Does epidemiological data show that interrupting breastfeeding 
mid-illness for 24 hours does in fact result in substantially reduced 
rates of transmission to, and severe illness in, the child?

Finally, what is actual practice?

Arly Helm, MS, IBCLC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome