Should breastfeeding continue when mom is sick?

By Kelly Bonyata, IBCLC

It is very, very rare for a mom to need to stop breastfeeding for any illness. There are only a few very serious illnesses that might require a mom stop breastfeeding for a period of time or permanently. Per Dr. Ruth Lawrence, “HIV and HTLV-1 are the only infectious diseases that are considered absolute contraindications to breastfeeding in developed countries” (Lawrence & Lawrence 2001).

During any “ordinary” illness such as a cold, sore throat, flu, tummy bug, fever, mastitis, etc. you should continue to breastfeed. Just remind your doctor you are nursing so that if medications are needed he can prescribe something that is compatible with breastfeeding. Most medications are safe to take while breastfeeding, and for those that are not recommended there is almost always an alternative medication that is safe.

If mom has food poisoning, breastfeeding should continue. As long as the symptoms are confined to the gastrointestinal tract (vomiting, diarrhea, stomach cramps), breastfeeding should continue without interruption as there is no risk to the baby. This is the case with most occurences of food poisoning. If the food poisoning progresses to septicemia, meaning the bacteria has passed into mom’s bloodstream (mom would most likely be hospitalized), see this guidance from Dr. Ruth Lawrence:

“Maternal infections of the genitourinary or gastrointestinal tract do not pose a risk to infants except in the rare circumstances when septicemia occurs and bacteria might reach the milk. Even in this event, continued breastfeeding while the mother receives appropriate antibiotic therapy that is compatible with breastfeeding is the safest course for the infant. If the infecting organism is especially virulent or contagious (e.g., an invasive group A streptococcal infection causing severe disease in the mother), breastfeeding should continue after a temporary suspension during the first 24 hours of maternal therapy. Prophylactic or empiric therapy for the infant, against the same organism, may be indicated.” [source: Lawrence RM & Lawrence RA. Given the Benefits of Breastfeeding, what Contraindications Exist? Pediatric Clinics of North America 2001 (February);48(1): 235-51.]

The best thing you can do for your baby when you’re sick is to continue to breastfeed. When you have a contagious illness such as a cold, flu, or other mild virus, your baby was exposed to the illness before you even knew you were sick. Your milk will not transmit your illness to baby, but it does have antibodies in it that are specific to your illness (plus anything else you or baby have been exposed to) – they’ll help prevent baby from getting sick, or if he does get sick, he’ll probably not be as sick as you.

Withholding your breastmilk during an illness increases
the possibility that baby will get sick, and deprives baby
of the comfort and superior nutrition of nursing.

You can also take measures to prevent baby from getting sick by doing the usual things to prevent the spread of illness: washing hands often, avoid sneezing/coughing on baby, limiting face-to-face contact, etc .

When you’re sick, it can help to just tuck baby into bed beside you and nurse lying down whenever baby gets hungry. If baby starts getting sick and not wanting to nurse, then see Baby refuses to nurse when sick.

Many times moms don’t nurse frequently enough and don’t get enough fluids to keep the milk supply going. Sometimes medications can cause your milk supply to diminish, as well. To avoid a decreased milk supply, drink plenty of fluids to avoid dehydration, continue to nurse often and avoid/limit any medications that tend to decrease milk supply.

References and Additional Information

@

• Cold and Allergy Remedies Compatible with Breastfeeding
• Natural treatments for nursing moms
• Is This Safe When Breastfeeding? Menu of additional information on the safety of medications, herbs, etc. for breastfeeding moms.
• Mastitis and Plugged Ducts
• Increasing Low Milk Supply
• My baby is sick – should I continue to breastfeed?
• Breastfeeding when mom needs surgery
• Breastfeeding when baby has surgery
• Breastfeeding when mom has a disability or chronic illness

@ other websites

• When a Nursing Mother Gets Sick by Anne Smith, IBCLC
• Maternal Health by Paula Yount
• US Centers for Disease Control’s FAQ on Breastfeeding
• Breastfeeding and Cancer by Diana West, BA, IBCLC discusses diagnostic/therapeutic procedures and more.
• Breastfeeding and Influenza from the CDC
• World Health Organization Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV (2016)

References

Lawrence RM & Lawrence RA. Given the Benefits of Breastfeeding, what Contraindications Exist? Pediatric Clinics of North America 2001 (February); 48(1): 235-51.

Lawrence RA. 1997.  A Review of the Medical Benefits and Contraindications to Breastfeeding in the United States (Maternal and Child Health Technical Information Bulletin). Arlington, VA: National Center for Education in Maternal and Child Health.

Lawrence RA. Breastfeeding: A Guide for the Medical Profession, 5th ed. St. Louis: Mosby, 1999.

Mohrbacher, N. Breastfeeding Answers Made Simple, Amarillo, Texas: Hale Publishing, 2010.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 2nd ed. Boston and London: Jones and Bartlett, 1999.

Breastfeeding and Hepatitis

Hepatitis B and breastfeeding, US Centers for Disease Control and Prevention (CDC)

Breastfeeding and HTLV-1

May JT. Molecular Virology: Tables of Antimicrobial Factors and Microbial Contaminants in Human Milk. Table 7: Effect of heat treatment or storage on antimicrobial factors in
human milk. Accessed March 22, 2005.

“HTLV-1 (all cell-associated) is destroyed within 20 minutes at 56°C (or 10 minutes at 90°C), or by freezing at -20°C for 12 hours. Cell associated HIV provirus DNA is destroyed by bringing milk to the boil. Boiling milk destroys the immunoglubulins, lactoferrin, lysozyme and the milk’s bacteriostaic activity, but not the peptide beta defensin-1.”

S Hino, S Katamine, T Miyamoto, H Doi, Y Tsuji, et al. Association between maternal antibodies to the external envelope glycoprotein and vertical transmission of human T-lymphotropic virus type I. Maternal anti-env antibodies correlate with protection in non-breast-fed children. J Clin Invest. 1995 June; 95(6): 2920–2925.

Journal articles on HTLV & Breastfeeding

Breastfeeding and HIV

May JT. Molecular Virology: Tables of Antimicrobial Factors and Microbial Contaminants in Human Milk. Table 7: Effect of heat treatment or storage on antimicrobial factors in
human milk. Accessed March 22, 2005.

“HIV is destroyed by milk pasteurisation. HIV-1 is reduced ten-fold at 56°C for 121 seconds and at 62.5°C for 10 seconds in liquid.”

AnotherLook at breastfeeding and HIV/AIDS “AnotherLook is a nonprofit organization dedicated to gathering information, raising critical questions, and stimulating needed research about breastfeeding in the context of HIV/AIDS.”

Mother to Child Transmission information at UNAIDS.org

Survival and Health Benefits of Breastfeeding Versus Artificial Feeding in Infants of HIV-Infected Women: Developing Versus Developed World by Louise Kuhn, Ph.D. and Grace Aldrovandi, M.D. (December 2011)

New Studies Point To Reduced Risk Of Postnatal HIV Transmission During Breastfeeding (12/1/05) press release from the World Alliance for Breastfeeding Action (WABA)

Breastfeeding – Guarding Maternal & Child Health in an HIV & AIDS World – Summary from the WABA Symposium on Breastfeeding and HIV & AIDS, Washington D.C. USA, 2 July 2005.

Breastfeeding and HIV International Transmission Study Group. Mortality Among HIV-1-Infected Women According to Children’s Feeding Modality: An Individual Patient Data Meta-Analysis. J Acquir Immune Defic Syndr. 2005 Aug 1;39(4):430-438.

Kuhn L, Trabattoni D, Kankasa C, et al. Alpha-defensins in the prevention of HIV transmission among breastfed infants. J Acquir Immune Defic Syndr. 2005 Jun 1;39(2):138-42.

 HIV transmission through breastfeeding : a review of available evidence. WHO, 2004.

HIV and Infant Feeding. A guide for health-care managers and supervisors WHO, 2003. (ISBN 92 4 159123 4)

HIV and Infant Feeding. Guidelines for decision-makers. WHO 2003. (ISBN 92 4 159122 6)

WABA/UNICEF Colloquium on HIV and Breastfeeding (20-21 September 2002) includes various papers and transcripts of the proceedings

 Mothers and babies and HIV: What is the risk of breastfeeding? by Pamela Morrison IBCLC (Updated Jan 2002)

Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, Coovadia HM; South African Vitamin A Study Group. Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS. 2001 Feb 16;15(3):379-87.

 Position Paper on HIV and Infant Feeding from the International Lactation Consultant Association

Heat treatment of expressed breastmilk (62.5C for 30 minutes) destroys the HIV virus. A simple method called Pretoria Pasteurisation (see below) has been found to result in undetectable levels of HIV-1 virus in expressed breastmilk.

HIV in breastmilk killed by flash-heating by Sarah Yang, from UC Berkeley News

Jeffrey BS. New, simple local method for pasteurising HIV-positive mothers’ breast milk. MRC News (Medical Research Council of South Africa) August 2000; 31 (4): 23-24.

Improvement of the nutritional status of infants. from Research Highlights, Maternal and Infant Health Care Strategies Research Unit, Medical Research Council of South Africa (November 2001).

“In this study, breast milk is pasteurised by the process of passive heat transference by taking boiling water, placing breast milk in a container in the water, and allowing it to cool. We have found that if 500ml of water in a one litre aluminium cooking pot is boiled, and between 50ml and 150ml of breast milk is placed in a standard peanut butter jar in the water, the milk heats up to between 59°C and 63°C for approximately 15 minutes. This process is called Pretoria Pasteurisation and is very inexpensive, requiring almost no technological support. Thus, almost any mother can pasteurise her own milk.

“The next step was to check if this process destroys HIV. This study has been successfully completed and no living virus could be demonstrated in breast milk from either HIV-infected mothers who expressed their breast milk, or in HIV naive breast milk spiked with HIV.

“Over and above killing the virus, a significant advantage of this inexpensive method is that about 80% of the essential ingredients (antibodies, vitamins, etc.) of breast milk are unaffected.”

Jeffrey BS, Mercer KG. Pretoria pasteurisation: a potential method for the reduction of postnatal mother to child transmission of the human immunodeficiency virus. J Trop Pediatr 2000 Aug;46(4):219-23.