Navigating Breastfeeding: Risks and Realities After Chemical Exposure

🟢 Nerve agent exposure (sarin, tabun, or VX) breast feeding should be stopped until after treatment is complete. It is currently unknown whether nerve agents can cross into breast milk. There is also a lack of safety data regarding medications used for treatment. Oximes specifically aren’t recommended for nerve agent treatment in poisoned infants until after 1 year old. 

🟢 Cyanide exposure or treatment halting breast feeding for 15 days is recommended. There is baby goat literature showing cyanide can cross into breast milk. Although hydrogen cyanide metabolizes in the body in about one hour, a metabolite, thiocyanate remains in the blood for 2.7 days and can cross into breast milk. Hydroxocobalamin is considered safe for breast feeding women, but other treatments like sodium nitrite and thiosulfate are not. 

🟢 Mustard / Lewisite blister type agents, breast feeding should be stopped. In the case of mustard type agents, it is a highly lipid soluble agent. In the case of Lewisite, both the agent and treatments can cross into breast milk. Lewisite contains arsenic which is obviously toxic.  

For many of these agent exposures, halting breast feeding is ideal and safest but must be compared to the availability of a breast milk substitute. A theoretical risk of agent transmission / drug treatment side effect through breast milk may be less significant than being unable to feed an infant. As always, sometimes the tactical situation drives all care.