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Denise Punger MD FAAFP IBCLC

Breastfeeding Success Stories

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Breastfeeding on a Medication not Studied Before


Mother and Baby (6 months) came to me for information regarding the safety of breastfeeding while on medication for Grave’s disease (hyperthyroid). Several medications for thyroid are approved for breastfeeding mothers by the American Academy of Pediatrics. The medications considered “safe” caused a life threatening, drop in the mother’s white blood cell count, but was reversible upon discontinuation. However, now her thyroid was functioning incorrectly. The side effects of the medicine limited her options to a medication which I had very little data about safety—a concentrated solution of iodine. In fact I had contradictory advice within the international lactation community actually discouraging the use of this medication which her surgeon eventually prescribed.


Being that the baby was no longer an infant and the short term use of the medication, the mother decided to continue breastfeeding as long as we checked the drug breast milk levels and the baby’s thyroid levels once a week. The mother was on the medication for three weeks. The baby’s blood test remained normal. The iodine does get into the breast milk.  The thought of this bothers a lot of specialists. However iodine is also in formula! And her milk iodine level while on the medication was comparable to the amount in formula; Even less than some brands! After three weeks of treatment, the mother’s thyroid and blood count were stable and she had her thyroid removed. She is recovering well.


Thyroid surgery, as is most surgery, is compatible with breastfeeding but, the anesthesiologist still sternly warned the mother not to breastfeed for 24 hours following surgery. More intimidation and inaccurate information for this mom to deal with! Mothers can breastfeed post c-section and following most surgery as soon as the mother is awake. This is well documented. It was very important for this mom to continue breastfeeding as a way to help her heal from a repeat emergency cesarean section.


Thanks to James J. Vopal, D.D.S., M.D., a Dual Board Certified Surgeon at The Breast Care Center of the Treasure Coast, willing to collaborate on her care and share his expertise and thanks to Martin Memorial labs who tested the milk levels weekly without a flinch to help complete this care. An international lactation journal has shown interest in publishing the lab data and the details. Future dyads in the same situation may have more options available to them.


The surgeon and mother are also commended for following through with the surgery while the hospital had been ordered to evacuate for a hurricane. WHEW!!!!


This thriving baby has been exclusively breastfed through all of this!



Failure to Thrive


I met Mother and Baby (6 weeks-old) out in the community. As I was admiring this breastfeed baby, I noticed the baby to be on the thin side. I questioned the weight. The baby had not regained birth weight at 6 weeks old. Failure to thrive is one of the most concerning things I see. We just take for granted that babies grow.  Even thin babies may have dimples on their thighs and have the wrinkled-up look. It is not always easily identifiable unless you actually weigh the baby or know what to look for.  The mom brought the baby in the office the next day. In my own training we would have panicked and immediately given formula, IV fluids, and look for disease by doing a lot of invasive testing. With my interest in lactation, it made sense to me to evaluate milk transfer first.  In another situation I may have wanted a failure to thrive baby admitted to the hospital. I had the advantage of meeting the mom out in the community, so I knew her extended family and knew she had support. The baby was not dehydrated so I knew I didn’t have to use formula or IV immediately. After getting a medical history on both mother and baby and doing a physical exam, my suspicion of disease causing the baby not to gain weight was low.  I observed the mother breastfeeding and thought the baby just wasn’t getting enough in. After making a few breastfeeding suggestions in the office, this improved. We adjusted position and latch and talked about how to get more high fat milk into the baby. I advised her to nurse all the time and talked about how to get more high fat milk into the baby. I advised her to nurse all the time including at night, side by-side, (dare I say… “co-sleep”). I discouraged pacifiers which are non-nutritive sucking. And we discussed ways to increase milk supply. Mother had the baby weighed in three days. Things had turned around quickly. After a few weeks, he continues to grow and thrive without artificial milk or supplements. The mother’s milk supply is adequate and baby was spared much invasive testing.


It is an honor for me to work with this family through this challenging situation. I appreciate their willingness to share so that others can learn how difficult situations can be handled.




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Denise Punger MD FAAFP IBCLC
4640 S. 25th Street
Ft. Pierce, Florida, 34981
Copyright 2005