I am new to Lactnet. I have 20 years of experience in International
Development, a MHS in International Health and a PhD in International
Nutrition. I THOUGHT I knew all about breastfeeding until I had my own son
and needed a lactation consultant.  For a variety of reasons, shifting to
working as a lactation consultant seemed like a great change make at this
point in my life, so I have been working with a group of experienced
lactation consultants and am studying for the board exams. I now have a
much better sense of how little I knew about breastfeeding management.

I had a very interesting case come up that I thought I would share.

The mother is 41 years old. Her son is 21 months old and still nursing
frequently.  She had terminated a previous pregnancy six years prior to the
birth of her son due to a chromosomal abnormality.  Despite the fact that
her husband was supportive of the decision, the emotional impact caused
difficulties in their marraige to the point that it took five years before
they were willing to try having a child again.

She ate fish 3-4 times per week, mostly consumed tuna (usually sushi) and
swordfish. A friend of hers had worked for the US government on a study of
fish and mercury levels and she became concerned and asked her physician to
test her levels. She ate sushi the day before she at the test. Her serum
levels were 40 ng/ml. She was told that 50 ng/ml was considered toxic. This
made her feel intensely guilty and worried that the chromosomal anomaly was
related.

I read Lawrence, Riordan, checked the AAP website, checked Tom Hale's book
and website, emailed Chestin Berlin and checked the Lactnet archives and
could find no clear cutoff point for when serum levels in the mother are
considered too high for her to continue breastfeeding. Hale's book
recommends that mothers who have been contaminated stop nursing.  I was not
sure whether or not "contaminated" was the same was "toxic" - and clearly
she was very close to "toxic". Some references seem to suggest that the
benefits of breast milk for brain development may compensate for any
impediment from mercury while others mention "neurologic problems".

I shared the information that I found (no quotes from Lactnet discussions -
only original articles).  We discussed the risks of a few days of
additional exposure compared to the 21 months of exposure he had already
had and the difficulties of weaning her son.  She had ocaisionally tried to
cut back on nursing because of the pressure from family and friends,
worries about being able to conceive another child (her period has not
returned - her obstetrician tested her and reassured her that her ability
to conceive was unrelated to her nursing), and occaissional difficult
nights.  Her son's response to her efforts to cut back has always been to
nurse even more frequently.

I suggested she have her son tested and herself retested. I reminded her
that although there is no way to know what effects her serum levels might
have had on her son until he was tested, her son had met his developmental
milestones and is a happy and creative boy. I suggested she seek out other
professionals to consult such as a toxicologist who might be able to
provide advice on what the serum levels mean and on chelating agents to
remove the mercury from her system and her sons. I also thought a pediatric
neurologist might be helpful if her son's levels were high so that if any
problems were found, she could start any needed interventions early. She
found a toxicologist that she liked who also highly recommended testing her
son and retesting herself.

I am happy to say that her son's serum levels were 7 ng/ml - within normal
range. Her son was tested 10 days after she was tested, so there is some
possibility that his levels were higher at the time she was tested. The
toxicologist informed her that the half life of mercury is two weeks. The
toxicologist did not recommend using chelating agents until after she
stopped nursing. I intend to talk to the toxicologist myself to learn more
about this - also because I've read a few disussions in the Lactnet
archives about chelation.

She is very happy that she did not stop nursing and is relieved that her
son's levels are OK.  She will continue to follow up with the toxicologist
for next steps.

I hope this is useful information and welcome any comments.

Susan Burger

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