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Supporting Lactation in Otolaryngology Patients Through Medication Optimization, Radiology Considerations, and MoreA Literature Review

To identify the key insights or developments described in this article
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Importance  The benefits of breastfeeding are well established, with the American Academy of Pediatrics and Canadian guidelines recommending exclusive breastfeeding for the first 6 months of life. However, maternal hospitalization, illness, medication use, and poor support can result in early termination of breastfeeding. Caring for breastfeeding patients in otolaryngology is a challenge because of the lack of literature regarding otolaryngology-specific medication safety, patient concerns, and inadequate education among otolaryngologists. This review highlights recent literature regarding lactation in otolaryngology patients, including medication, radiologic imaging, perioperative considerations, and subspecialty-specific considerations for lactating patients.

Observations  The majority of common medications used in general otolaryngology are safe for breastfeeding patients, including antihistamines, mucolytics, antitussives, antifungals, and decongestants. Certain analgesics and anti-inflammatories, such as tramadol, are not preferred in breastfeeding individuals. Some subspeciality-specific medications such as biologics (dupilumab) and methotrexate should be avoided. Lactating patients require special perioperative attention to ensure that optimal patient care is provided, such as managing supply, considering length of surgery, managing postoperative pain, and determining the safe amount of time until an infant can be fed.

Conclusions and Relevance  Most medications can be safely used with lactating patients. If physicians are unsure about a medication’s safety, they should consult appropriate resources prior to recommending breastfeeding cessation or to discard pumped milk.

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Article Information

Accepted for Publication: June 23, 2022.

Published Online: August 11, 2022. doi:10.1001/jamaoto.2022.2286

Corresponding Author: M. Elise Graham, MD, IBCLC, Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, PO Box 5010, 800 Commissioners Rd E, London, ON N6A 5W9, Canada (elise.graham@lhsc.on.ca).

Author Contributions: Dr Graham had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Elder, Lawlor, Graham.

Drafting of the manuscript: Elder, Graham.

Critical revision of the manuscript for important intellectual content: All authors.

Supervision: Pianosi, Lawlor, Graham.

Conflict of Interest Disclosures: None reported.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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