OK this does not make sense to me.  This baby can be exposed to 100% of huge 
maternal does during pregnancy but not to 2% of the dose via breastmilk 
afterward.  THis baby went through withdrawel and absolutely should have been 
breastfed during this period of time while infant blood levels and maternal milk 
levels were assessed. Any medication excreted during the first week would have 
helped soften the symptoms of withdrawel.
 But now, while I agree that this mother is on huge levels of this medication 
one still has to wonder if the risks of formula outweigh the risks of 
breastfeeding while on this medication.  However, when people have been on this med 
for so long they metabolize it quickly and milk levels could be lower then 
expected.  To truly make an assessment we need more info.  What is the estimated 
dose of this medication based on her intake?  What are her milk levels when the 
medication is at its peak? What are her milk levels right before the next 
dose?  Its orally available to the infant at 50% of the milk level.  This mother 
should insist that milk levels are checked.  Hale finds that based on the 
usual dose of 5-10mg every 4-7 hours they were 5-226 micrograms if her levels are 
similar then at least partial breastfeeding should be considered.  Infant 
serum levels can then be checked to further eval the risks of long term exposure.  
Christine Betzold NP IBCLC MSN  www.thebfclinic.com

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