This mom should most definitely take her cort enemas and mesalamine.  You are
quite right about the systemic absorption of steroid from the cort enema,
it's minimal.   Even if she were taking low dose oral steroids, breast
feeding would not be contraindicated.  To quote Tom Hale's book "Medications
and Mother's Milk" (1997 ed.) "Doses of 80 mg/day [of prednisone] in mothers
produce insignificant absorption in infant (<0.1% of dose). Probably not
clinically significant."

In regards to mesalamine, while it does share some chemical similarity to
aspirin it is not an aspirin product and cannot cause Reye's syndrome. While
there has been a report of diarrhea in the breast fed infant of a mother on
oral mesalamine it is usually not a problem.  I have given mesalamine
products to both my breast feeding and pregnant ulcerative colitis patients
without reservation. The systemic absorption of mesalamine from suppositories
is likely to be neglible.  I think this child would benefit more from a mom
who's feeling well on cort enemas and mesalamine suppositories than one who
is ill and dehydrated off the meds.

Peter Salomon, MD,FACG