Overview
Nasal congestion, runny nose, sneezing, sore throat, fever, headache, fatigue and other discomforts.
Can be caused by a variety of viral infections
Appropriate rest and symptomatic treatment with medication
Some mild cases can be cured on their own, while severe cases need treatment.
Definition
A breastfeeding cold is an upper respiratory tract infection caused by a viral infection that occurs after a woman has given birth and while she is breastfeeding her baby.
A nursing cold is not fundamentally different from a cold, except that it is limited to breastfeeding women.
Classification
Breastfeeding colds can be divided into two categories according to the characteristics of the disease and the pathogens.
Common cold
Commonly known as “cold”, also known as acute rhinitis, upper respiratory tract catarrh, is an acute catarrhal inflammation caused by viruses, mainly manifested as nasal congestion, runny nose, sneezing, sore throat, nasal congestion, runny nose and other discomforts.
Influenza
Abbreviated as influenza, it specifically refers to upper respiratory tract infections caused by influenza viruses, with an acute onset of illness, mainly characterized by high fever, headache, malaise, ocular conjunctivitis and generalized muscle aches and pains, and other symptoms of toxicity [1-2].
Morbidity
There is no authoritative data on the incidence of breastfeeding colds, and the incidence of breastfeeding common colds and influenza has its own characteristics.
Breastfeeding common cold: it often develops at the change of seasons and in winter and spring, with a more rapid onset, and the onset of the disease is not related to age, occupation, or region [1].
Lactational influenza: characterized by seasonality, contagiousness, and high morbidity [3]. The susceptible population of this disease includes all lactating women, especially malnourished and immunocompromised people, and it is more frequent in winter and spring in the northern region [4].
Etiology
The onset of breastfeeding cold is closely related to viral infection and is influenced by a variety of factors.
Pathogenic causes
Pathogens
Lactational common cold: it can be caused by a variety of viral infections, commonly including rhinovirus, respiratory syncytial virus, influenza virus, parainfluenza virus, coronavirus and adenovirus [5].
Lactational influenza: influenza virus infection is the main cause of lactational influenza [6].
There are three basic conditions that lead to epizootic epidemics.
Source of infection
Primarily other patients with influenza, and to a lesser extent, those with latent infections.
It is most contagious from 24 hours before the onset of symptoms to 2 days after the onset of symptoms.
Route of transmission
Transmission is mainly through droplets containing the virus.
It can also be spread through contact with contaminated hands and utensils.
Susceptible people
Malnourished, immunocompromised lactating women.
Women with chronic respiratory diseases, such as sinusitis and tonsillitis, are more likely to develop the disease.
Predisposing factors
A variety of factors that lead to a reduction in systemic or local defense function of the respiratory tract can induce lactation colds, and the common predisposing factors are as follows [7].
Close contact with a person who has a cold.
Exposure to rain.
Exposure to cold.
Excessive fatigue, etc.
Immunocompromised or immunosuppressive drugs, such as HIV, long-term use of hormones (e.g., methylprednisolone), etc.
Pathogenesis
The virus contacts the mucous membrane of the upper respiratory tract, which is the basis for the occurrence of colds. On this basis, the virulence of the virus and the resistance of the body together determine whether the disease will develop and its severity.
Rain, cold, sudden change of climate, overwork, etc. can reduce the local defense function of the respiratory tract, resulting in the rapid reproduction of the existing virus. Or, direct contact with patients carrying the virus, through sneezing, airborne transmission, and contaminated hands and utensils, allows the virus to invade the respiratory tract.
During breastfeeding, pregnant women may be more susceptible to infection due to frequent lifting of clothing for breastfeeding, lack of sleep, and lack of exercise.
After the epithelial cells are infected and damaged, if the body cannot destroy the virus in time, the blood vessels of the mucous membrane of the upper respiratory tract become congested and secretions increase, while inflammatory factors are released into the bloodstream, leading to the emergence of corresponding clinical symptoms.
If the virus is virulent and numerous, and the body’s resistance is poor, the symptoms will be more serious.
Symptoms
Symptoms of breastfeeding cold vary from patient to patient, and the same patient may have different symptoms at different stages of the disease.
Main symptoms
Common cold during breastfeeding
The main manifestation of the upper respiratory tract kata symptoms, such as sneezing, nasal congestion, runny nose, the initial stage may also have a dry, itchy or burning sensation of the throat, or even a sore throat or hoarseness, fatigue.
Influenza during breastfeeding
Most of them present with acute onset of symptoms such as high fever, headache, generalized muscle aches, and malaise [2].
Other symptoms
Common cold during lactation
May present with tearing, dull taste, dyspnea, cough, small amount of cough sputum and other symptoms.
There is usually no fever and systemic symptoms, or only low-grade fever.
In severe cases, in addition to fever, systemic symptoms such as malaise and discomfort, chills, aching limbs, headache, and loss of appetite may be present [1].
Influenza during lactation
Mild upper respiratory kata symptoms may be present, including dry cough, nasal congestion, and runny nose.
In some patients, it may be accompanied by conjunctival congestion, retrosternal discomfort, and gastrointestinal symptoms such as vomiting, abdominal pain, diarrhea, or constipation.
In uncomplicated cases, the course of the disease is mostly self-limiting, with body temperature gradually subsiding and systemic symptoms improving after 3 to 4 days, but coughing and fatigue can be prolonged for many days.
Complications
Complications of common cold during breastfeeding are rare, and complications of breastfeeding influenza are relatively common, several of which are described below [2].
Pneumonia
If a breastfeeding cold is prolonged or severe, the virus may spread to the lungs, causing viral pneumonia, or the barrier effect of the respiratory system may be reduced and bacterial infection may occur, causing bacterial pneumonia.
Mild signs and symptoms are usually similar to those of a cold or flu, but they last longer and are often characterized by fever, muscle aches, malaise, cough, and sputum.
Acute Respiratory Distress Syndrome
If a breastfeeding cold is more severe and causes a serious lung infection, it may further lead to acute respiratory distress syndrome.
The earliest symptom is increased respiration. As the disease progresses, progressively worsening dyspnea with tightness in the chest, severe breath-holding, coughing, coughing up phlegm, irritability, anxiety, and sweating may occur.
In addition, complications such as viral myocarditis, acute kidney injury, sepsis, infectious shock, and multiple organ dysfunction syndrome may occur if the condition is severe.
Consultation
Department of Medicine
Respiratory medicine
If the clinical symptoms of breastfeeding cold are mainly respiratory symptoms, including nasal congestion, runny nose, cough and sputum, etc., you should consult a respiratory medicine department promptly.
If some smaller hospitals do not have a respiratory department, you can consult the general medicine department or general medicine department.
Infection
If there is a recent influenza epidemic and the systemic symptoms are obvious, such as high fever, headache, generalized muscle pain and fatigue, etc., you may consult the Department of Infectious Diseases promptly.
Gastroenterology
If gastrointestinal symptoms such as vomiting, abdominal pain, diarrhea, etc. occur, consult the Department of Gastroenterology.
Preparation
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips for medical treatment
Do not take any medication without authorization and stop breastfeeding your child before the consultation.
Preparation List
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
What were the first symptoms? Such as headache, nasal congestion, runny nose, sneezing, etc.?
When did they start? Are they worse now, or have they gotten better?
Was there a fever before the visit and what was the highest temperature?
Are there any accompanying systemic symptoms such as muscle aches, fatigue, loss of appetite, etc.?
Any other discomfort?
List of medical history
Any recent history of rain, cold, or exertion?
Has any family member been infected with influenza recently?
Are there any underlying diseases such as hypertension, diabetes, coronary heart disease, asthma, etc.?
When did you give birth and are you currently breastfeeding? Is there any history of drug allergy?
Has treatment been given, what medications have been used, and what were the results?
Checklist
Test results of the last six months, which can be brought to the doctor’s office
Laboratory examination: including blood analysis, pathogenetic testing.
Physical examination: results of general physical examination.
Imaging examination: X-ray chest film or CT chest examination.
Medication List
Medications used in the last 3 months, if available in boxes or packages, bring them with you to the doctor’s office.
Antiviral drugs: oseltamivir, zanamivir, paramivir.
Antipyretics and analgesics: acetaminophen, aspirin, ibuprofen.
Cough suppressants: codeine, dextromethorphan, etc.
Expectorants: ambroxol, bromhexine, acetylcysteine.
Diagnosis
The diagnosis of breastfeeding cold is mainly based on clinical manifestations, but other diseases must be excluded, and sometimes it is necessary to consider the diagnosis in combination with the history, laboratory tests, physical examination, and so on.
Diagnosis
Medical history
It is during the breastfeeding period.
Before the onset of illness, there is often a history of rain, cold, fatigue, immunocompromise, immunosuppression, or contact with influenza patients or influenza infected areas.
Clinical manifestations
Common cold during lactation: predominantly characterized by the aforementioned upper respiratory kata symptoms [1].
Influenza during lactation: mostly presenting as acute onset of illness, dominated by the aforementioned systemic symptoms, accompanied by obvious seasonality and epidemiology.
Laboratory tests
Routine blood tests
Purpose: Mainly used to determine the presence of infection and suggest the category of infection.
Significance: Elevated white blood cell and neutrophil counts are often indicative of bacterial infection. Normal or slightly decreased white blood cell and neutrophil counts and a significantly increased lymphocyte ratio are often indicative of viral infection.
Viral Nucleic Acid Test
Purpose: To check for the presence of viruses in the body.
Meaning: If the nucleic acid test for influenza A virus and influenza B virus is positive, influenza can be confirmed.
Precautions: Keep your mouth clean two hours before the nucleic acid test to avoid contamination by stray bacteria. There is also a chance of false negative results.
Sputum culture test
Purpose: The main purpose is to determine whether the patient who coughs up sputum has a bacterial infection, and also to conduct a drug sensitivity test.
Significance: Some patients can find out the type of bacteria that are secondary to the infection and discover antibiotics that are sensitive to the pathogens.
Precautions: Sputum culture should take care to retain the sputum coughed up in the early morning when waking up, and the mouth should be rinsed before sputum sampling to reduce the content of stray bacteria in the mouth.
Chest X-ray
Purpose: The main purpose is to observe whether lung infection is present.
Significance: If combined with lung infection, lung infection disease may be shown as white patchy changes on the chest X-ray.
Precautions: Care should be taken to remove metal objects, such as dentures, metal buttons, metal necklaces, watches, etc.; do not move your body during the chest CT examination to avoid artifacts.
Chest CT examination
Purpose: Mainly to check whether there is infection in the lungs.
Significance: It is more distinguishable than chest X-ray. Combined lung infection can be shown as white patchy changes on chest CT.
Precautions: Same as chest X-ray.
Diagnostic Criteria
Common cold during breastfeeding
Diagnosis is mainly based on typical clinical symptoms and confirmed on the premise of excluding other diseases [9].
Influenza during lactation
The diagnosis is confirmed by a positive nucleic acid test for influenza virus when the aforementioned symptoms are present [10].
Differential diagnosis
Acute bacterial sinusitis
Similarities: Both may present with nasal congestion, runny nose, headache and fever.
Differences: Acute bacterial sinusitis is caused by Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus, Escherichia coli, and Escherichia coli, and mixed infections are often seen in the clinic. Symptoms are often aggravated after a cold. Acute sinusitis may be accompanied by fever and generalized discomfort.
Allergic rhinitis
Similarity: sneezing, itchy nose, nasal congestion, runny nose and other symptoms.
Differences: Allergic rhinitis symptoms appear after contact with allergens (e.g., pollen), and the symptoms can be recovered after the attack. Only nasal symptoms, usually no fever, cough and other symptoms, the course of the disease is long, often recurrent or seasonal aggravation.
Lung infection
Similarities: both can be characterized by cough and sputum; laboratory tests may show elevated white blood cells.
Differences: Chest X-ray and chest CT for colds usually do not show high density shadows in the lungs; lung infections can show high density shadows in the same way.
Treatment
Aim of treatment: to reduce symptoms, shorten the course of the disease and cure it as soon as possible.
Treatment principle: early diagnosis, early treatment, appropriate rest, symptomatic treatment and no abuse of antiviral drugs.
General treatment
Appropriate rest, bed rest is recommended for patients with fever, severe condition or weak body.
At the same time, quit smoking, drink more water, and eat a light diet.
Keep nose, throat and mouth clean and wash hands frequently.
Patients should be isolated from infants to avoid them getting sick.
Suspension of breastfeeding is recommended.
Medications
Antipyretic and analgesic drugs
Commonly used drugs include: acetaminophen, aspirin, ibuprofen.
The effect of drugs: through reducing prostaglandin synthesis, so that the central thermoregulation point downregulation, resulting in peripheral vasodilatation, sweating and heat dissipation and play a role in antipyretic.
Drug precautions: acetaminophen needs to be used with caution under medical supervision during breastfeeding; ibuprofen and aspirin are in principle contraindicated in pregnant women and nursing mothers, and breastfeeding women should suspend breastfeeding when taking them.
Cough suppressants
Commonly used drugs include: codeine, dextromethorphan and so on.
The role of the drug: direct inhibition of the center to play the role of cough suppression.
Precautions for use: Breastfeeding should be suspended when used during lactation.
Expectorants
It is not a routine drug, and is only considered to be used when the patient has a lot of phlegm or thick phlegm.
Commonly used drugs include: Ambroxol, Bromhexine, Acetylcysteine.
How the drugs work: Through different mechanisms, they dissolve the sticky phlegm.
Precautions for use: Breastfeeding should be suspended when used during lactation.
Antiviral drugs
Antiviral drugs are not routinely used. Antiviral treatment is generally not needed for common cold, while early antiviral treatment is recommended for influenza.
Commonly used drugs: Oseltamivir phosphate, Zanamivir, Paramivir and so on.
The effect of the drug: for influenza A virus, influenza B virus, etc. have better antiviral effect.
Precautions for use: Oseltamivir phosphate can be used during breastfeeding without stopping breastfeeding; Zanamivir and Paramivir need to suspend breastfeeding for one week when used in breastfeeding women.
Prognosis
The overall prognosis of breastfeeding colds is good, but the prognosis of the disease is closely related to the individual’s physical condition, the timeliness of treatment, and the regularity of treatment.
Cure
Untreated
The vast majority of breastfeeding colds are self-limiting, usually mild, of short duration, and can be cured on their own, with a good prognosis.
However, a small number of frail patients with underlying diseases, especially those with serious complications, cannot be cured by themselves.
Influenza virus infection during breastfeeding is prone to cause severe cases, which are more difficult to recover from.
After treatment
Most breastfeeding common colds recover quickly with treatment, while a small number of breastfeeding women recover more slowly.
Most breastfeeding influenza viral infections are cured with treatment, or their progression is slowed; a few can progress to severe cases with the possibility of death.
Prognostic factors
Prompt treatment, regular therapy, good patient compliance, and good individual patient response to drug therapy can lead to a better prognosis.
Hazards
Breastfeeding colds can cause women who are breastfeeding to experience cold and flu symptoms that interfere with normal life.
The woman who may suffer from depression, disturbed sleep, and loss of appetite, which may affect the production of breast milk.
Some of the medications used to treat breastfeeding colds can be secreted into the milk, requiring the suspension of breastfeeding, and may even cause a woman’s breasts to become swollen and painful.
A person who is breastfeeding with a cold can easily transmit the flu virus to the baby.
The flu can be life-threatening in severe cases.
Daily
Daily Management
Eat a balanced and light diet, avoid spicy, stimulating and greasy food.
Take rest and get enough sleep.
Quit smoking and avoid passive smoking.
Pay attention to adding clothes and keeping warm, avoid cold wind and rain.
Relax and avoid anxiety.
Sickness monitoring
Breastfeeding colds need to be monitored for changes in the previously mentioned symptoms during recovery.
Monitor body temperature.
Watch the baby for similar symptoms.
Prevention
The following measures can help reduce the risk of developing a breastfeeding cold.
Take care to wear a mask.
Wash hands frequently, drink plenty of water, maintain nasal hygiene and avoid dirty hands touching mouth, eyes and nose.
Avoid exposure to cold, rain and overexertion.
Avoid close contact with other people who have a cold.
Eat a balanced diet, get enough sleep, exercise and strengthen your body.
Quit smoking.
Consider getting vaccinated against influenza in advance.