The common cold often presents a dilemma for a breastfeeding mother seeking relief from a cough or sore throat. Over-the-counter (OTC) medications, including cough drops, pose a safety question because active ingredients can potentially pass into breast milk and affect the nursing infant. The general principle for any medication while breastfeeding is to use the lowest effective dose for the shortest duration. Understanding the ingredients in cough drops is necessary before use, as what passes into the milk supply is paramount.
Understanding the Risks of Common Cough Drop Ingredients
Most standard cough drops contain demulcents, which are soothing agents that create a protective film over the irritated mucous membranes of the throat. Ingredients like pectin, honey, and simple sugars are generally considered safe for use during lactation. Pectin, a soluble fiber derived from fruits, is not absorbed systemically and therefore cannot be excreted into breast milk.
Menthol is a popular ingredient in many lozenges, providing a cooling sensation and mild anesthetic effect. While very small amounts of menthol may pass into breast milk, its use in moderation is regarded as safe. Menthol is derived from peppermint oil, and excessive consumption of peppermint products has been anecdotally associated with a decrease in milk supply in some women. Therefore, mothers should avoid consuming large quantities of menthol-containing cough drops.
Specific Ingredients Requiring Caution
Cough drops containing cold medications or high concentrations of certain supplements require a cautious approach. Dextromethorphan (a cough suppressant) and Guaifenesin (an expectorant) are active pharmaceutical ingredients found in some medicated lozenges. Studies indicate that Dextromethorphan passes into breast milk in very low amounts, making it acceptable for short-term use. Guaifenesin is also thought to be safe because the amount transferred into breast milk is unlikely to harm the infant, though formal studies on its excretion are limited.
Topical anesthetics, such as Benzocaine, are included in lozenges to numb a sore throat and are often considered good options for breastfeeding mothers. Benzocaine is poorly absorbed systemically, making it unlikely to affect the infant through breast milk. However, lozenges containing this ingredient should not be used as a topical gel or spray on the breast or nipple. Direct ingestion by the infant has been associated with a rare but serious blood disorder called methemoglobinemia. Cough drops fortified with high levels of zinc should be used sparingly, as the Tolerable Upper Intake Level for lactating women is approximately 34 to 40 mg per day.
Non-Medicated Alternatives for Soothing Coughs
A variety of non-medicated strategies can effectively soothe a cough and sore throat, bypassing any concern about milk transfer. Increasing fluid intake is an effective measure, as adequate hydration helps thin mucus and moisten the throat. Warm liquids like herbal teas with honey and lemon are particularly soothing and can help relieve irritation.
Inhaling steam from a hot shower or a bowl of hot water can break up congestion and moisturize the airways, offering relief from a cough. Using a warm saltwater gargle several times a day can reduce inflammation and discomfort in the throat. A humidifier in the bedroom can also help keep the throat and nasal passages moist, which may reduce the severity of night-time coughing.