Outbreaks of gastroenteritis are not uncommon in situations where large numbers of people are living or interacting in close proximity. They happen regularly in senior’s care centers (particularly in the winter), children’s day cares, emergency evacuation and refugee centers. Viral gastroenteritis causes vomiting, nausea and diarrhea and is easily transmitted from person to person. In healthy adults it is a self-limiting mild to moderate infection but it can cause severe illness in the elderly, the immunocompromised and young children. We have long known that breastfed babies are far less likely to be admitted to hospital with viral gastroenteritis infections but it is only recently that we have started to understand why.
Mothers can become ill with viral gastroenteritis and their children are at risk of getting the infection from them. A study by Xi Jiang and others, which was published in 2015, looked at how breastmilk blocks the transmission of Noroviruses (the most common cause of viral gastroenteritis). In their study they tested human milk samples for a group of antigens which bind the Norovirus so that it is unable to infect the body. The majority of the human milk samples collected from health women carried this antigen group. The milk of these antigen producing mothers prevented the Norovirus (NVs) from binding to saliva samples. The researchers stated “… antigens, were present in human milk and were responsible for blocking NV binding to receptors and therefore are likely to be decoy receptors that protect breast-fed infants from NV infection.” and “In conclusion, human milk may play an important role in the immune protection of breast-fed infants against NVs”
In Rotavirus, which affects children more than adults, one study concluded “our study adds to the evidence of a protective concurrent effect of breastfeeding against rotavirus infection in infants, particularly in children 6 months and younger. Breastfeeding is important to diminish rotavirus-related gastroenteritis in infants before vaccination can be introduced.”
If mother has gastroenteritis:
If you come down with gastroenteritis you can, and should, continue to breastfeed your baby. Although you are ill your milk is providing baby with protection against the virus. There is no specific treatment for viral gastroenteritis except rest and drinking plenty of fluids. Most people will recover without complications. People with vomiting or diarrhoea should:
• Rest at home and do not attend work or go to places where others gather.
• Do not prepare food for others or care for children or the elderly. Continuing to breastfeed your baby is the only exception to this rule. These precautions should continue until 48 hours after diarrhea or vomiting ceases.
• Wash hands thoroughly with soap and running water for 10 seconds after using the toilet.
• Drink plenty of clear fluids, for example juice or soft drink diluted 1 part to 4 parts water, to prevent dehydration. Avoid undiluted fruit juice and soft drinks as they may increase dehydration and diarrhea. Rehydration drinks that replace fluids and rehydration salts are available from pharmacies. Intravenous fluids may be needed in severe cases of dehydration. Information on compatibility of rehydration salts and breastfeeding can be found HERE
• Seek medical advice in the case of severe symptoms
• The incubation period for Norovirus is 12 to 48 hours. Those who are already ill should limit their interactions with others to avoid passing on the virus which is generally active for 24 to 60 hours.
If baby has gastroenteritis (Norovirus or Rotavirus)
It is important to continue breastfeeding as your milk helps baby recover. The rule for feeding infants and children who are vomiting and having diarrhea is to feed clear fluids; breastmilk is considered to be a clear fluid in these circumstances. Frequent breastfeeding will help ensure any fluids lost through diarrhea or vomiting are replaced. The length and timing of the feeds are not important. Follow your baby’s lead and breastfeeding as often and for as long as baby wants. Breastmilk continues to provide baby with essential nutrients in a form that are easy for baby to absorb even when it seems it is all being thrown up or passing quickly to the diaper.
Babies can become dehydrated very easily especially when they are less than six months of age. Signs of dehydration are abnormal drowsiness, dry lips and mouth, sunken eyes, not peeing and cold hands and feet. Talk to your health care provider to discuss whether you should bring your child in to be examined. If your child needs IV rehydration in hospital you can continue to breastfeed as much as baby wants. More information on pediatric gastroenteritis treatment and management can be found HERE
For older babies and children who are taking fluids other than breastmilk there is some interesting new research looking at managing mild gastroenteritis with clear juice rather than an electrolyte solution HERE
If you have questions or concerns about breastfeeding your baby through any mother or baby illness call a La Leche League Canada Leader to talk over your options and strategies.