Should Nursing Mothers Breastfeed While Sick?

It is not uncommon for mothers to be concerned about breastfeeding when they are ill, fearing that doing so may pass an infection or pose harm to the nursing baby. In most cases, breastfeeding when you are sick will not harm your baby in any way and usually offers more advantages than disadvantages. There are, however, certain illnesses and medications that, if present or used, may prompt your healthcare provider to recommend against breastfeeding either temporarily or entirely.

Benefits

While it is true that a nursing baby is more likely to be exposed to a mother's illness simply because of their close physical proximity to her, isolation until a cold, flu, or most any other common viral infection is resolved is rarely an option. As strange as it may sound, there are some clear advantages to continuing breastfeeding in these cases.

Breastfeeding offers a baby balanced nutrition and promotes mother-child bonding. And, by and large, breastfed babies tend to have few infections and hospitalizations than those who are formula-fed.

Even if you are sick, your body is producing disease-fighting antibodies that you can pass to your baby in breast milk. This is one of the ways in which a baby's immune system function is built: through the transmission of key antibodies from mother to child.

The same holds true for other common bacterial, fungal, or parasitic infections that a mother might get. In the vast majority of cases, the disease-causing microorganism will not be passed to the baby through breast milk, although the defensive antibodies will.

Contraindications and Limitations

There are exceptions, of course, some of which require limited or permanent cessation of breastfeeding. The CDC has outlined 11 such conditions in which cessation is advised.

Breastfeeding and the use of expressed milk are permanently contraindicated when:

• A mother is diagnosed with HIV
• A mother is infected with human T-cell lymphotropic virus type I or type II (HTLV-1 or HTLV-2)
• A mother is an illicit street drug user (with the exception of narcotic drug users in a supervised methadone treatment program)
• An infant has a rare genetic disorder called galactosemia
• A mother is confirmed or suspected of having the Ebola virus

Breastfeeding and the use of expressed milk should be temporarily stopped until a healthcare provider declares it safe to proceed when:

• A mother has active herpes simplex virus (HSV) lesions on the breast
• A mother has untreated brucellosis
• A mother is undergoing diagnostic tests or treatments using radioactive drugs or implants (including PET scans and brachytherapy)
• A mother is taking certain medications

Breastfeeding should be temporarily stopped but expressed breast milk can be used when:

• A mother has active untreated tuberculosis (TB)
• A mother has gotten chickenpox (varicella-zoster virus) five days before to two days after the delivery of her baby

Medication Risks

More often than not, the risk of breastfeeding are not associated with the illness you have but rather the medications you are taking to treat or prevent it. With that said, the American Academy of Pediatrics states that, "most medications and immunizations are safe to use" while breastfeeding and pose no risk to your baby.

This is because many drugs broken down during metabolization are excreted from the body in urine or feces, with little of the active drug reaching the mammary glands. In other cases, broken-down components of a drug, called metabolites, may reach the mammary glands but have none of the activity of the active drug.

Antibiotics

One of the drug classes that cause mothers the most concern is antibiotics. Given the increased awareness about the risks of antibiotic resistance, some mothers fear that passing the drug to their babies in breast milk may cause resistance. These fears are largely unfounded.

While it is true that antibiotic drugs are passed in varying degrees through breast milk, their short-term use rarely poses any harm to the baby. The only exception may be sulfonamide (sulfa) drugs and intravenous erythromycin.

Sulfa drugs transmitted in breast milk pose risks to newborns less than 1 month old who have jaundice as the drugs can increase the availability of bilirubin in the brain, causing toxicity. Similarly, intravenous erythromycin increases the concentration of the drug in breast milk by 10-fold, posing risks to newborns under 1 month of age.

Like most other antibiotics, tetracycline antibiotics like doxycycline and minocycline are perfectly safe for short-term use in breastfeeding mothers. The same cannot be said if drugs are used for more than three weeks. If antibiotics are needed for more than three weeks, ask your healthcare provider if there other options available.

Other Drugs

There are some other classes of drugs that may pose risks, although these can vary significantly between one drug in a class and another. Among those you should speak with your healthcare provider about if you are breastfeeding or intending to breastfeed:

• Alcohol and substance abuse treatment medications like Antabuse (disulfiram), Subutex (buprenorphine), and Revia (naltrexone)
• Antidepressant, anti-anxiety, and antipsychotic drugs like Celexa (citalopram), Effexor (venlafaxine), Lamictal (lamotrigine), lithium, Prozac (fluoxetine), Valium (diazepam), and Wellbutrin (bupropion)
• Herbal remedies like fenugreek, St. John's wort, and Yohimbe
• Live vaccines, specifically smallpox and yellow fever vaccines
• Pain medications like codeine, Darvon (propoxyphene), Demerol (meperidine), Exalgo (hydromorphone), hydrocodone, Mobic (meloxicam), Oxycontin (oxycodone), and Talwin (pentazocine)

Protecting Your Baby

If you are sick and breastfeeding, you can help reduce the risk of transmission of some illnesses to your baby by:

• Washing your hands regularly
• Avoiding kissing your baby
• Disinfecting surfaces with approved sanitizers (especially changing stations, cribs, strollers, etc.)
• Coughing or sneezing into a tissue (and throwing it away immediately)
• Using hand sanitizer immediately after coughing or sneezing
• Keeping your baby away from others who might also be ill

A Word From Verywell

One of the best ways to protect yourself and your baby from influenza is to get an annual flu shot. While it may not prevent you from getting the flu, it will cause you develop flu antibodies that you can pass to your nursing baby. This can be particularly beneficial to infants as babies under 6 months old cannot be vaccinated against influenza.