On p. 577 of the most recent Lawrence (5th ed, 1999), it says:

"... Illnesses produced by Group A Streptococcus (GAS) can be classified in
three categories: (1) impetigo, cellulitis, or pharyngitis without invasion
or complication; (2) severe invasive infection with bacteremia, necrotizing
fasciitis, myositis, or systemic illness (e.g. streptococcal TSS); and (3)
autoimmune-mediated phenomena, including acute rheumatic fever and acute
glomerulonephritis...."

"In the situation of maternal illness (extensive cellulitis, necrotizing
fasciitis, myositis, pneumonia, TSS, mastitis), it is appropriate to
separate the mother and infant until effective therapy (penicillin,
ampicillin, cephalosporins, erythromycin) has been given for 24 hours.
Breastfeeding should also be suspended and may resume after 24 hours of
therapy."

When I read this whole section, I form the impression that the indications
for suspending breastfeeding for 24 hours are taken from category (2) of the
previous paragraph - the *serious* infections, *not* the relatively benign
pharyngitis (sore throat).

On the table p. 879 it states, "Mastitis: Group A streptococcus;
Breastfeeding acceptable after 24 hours of therapy, during which milk must
be discarded."

On the table p. 883, "Streptococcus (Group A) - Cellulitis, pharyngitis,
pneumonia, myositis/fasciitis, scarlet fever."  followed by the same
statement as above - "Breastfeeding acceptable after 24 hrs....."

So, just as Bettina observed, on the table, she puts pharyngitis in with the
much more serious strep infections but in the text she seems to make
something of a distinction between less severe and more severe infections.
In either case the recommendation to stop breastfeeding for 7 days is wrong,
and extrapolating from the text I would think that if the mother is not very
sick it is probably OK for her to continue breastfeeding.  I also note that
this section in Lawrence does not have any footnotes.

At this point, if mom has pumped/dumped for 24 hours, you've got a good refe
rence to show her that she can go back to breastfeeding.  If for some reason
she is reluctant to do so, she should at least be feeding formula NOT goat's
milk which is very hard on babies' kidneys.

Mary Renard, RN, BSN, IBCLC
Vienna Virginia  USA

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