Breastfeeding provides an infant with essential calories, vitamins, minerals, and other nutrients for optimal growth, health, and development. Breastfeeding is beneficial to both a mother and her infant and also offers an important opportunity for the pair to bond. Learn more about breastfeeding and certain maternal and infant illnesses and conditions.

Breast milk is healthy for most infants, including those with birth defects. Mothers who provide breast milk to an infant with a birth defect may need extra support to establish and maintain milk production.

Infants born with birth defects can have a range of physical and developmental abnormalities, from very mild to more severe. Breast milk is still important nutrition for these infants, and in fact, may be especially beneficial for infants with certain birth defects who are often at higher risk for developmental delays and respiratory and other infections. Breastfeeding can also help to strengthen jaw and facial muscles, which could benefit babies with low muscle tone.

However, due to these infants’ physical and developmental differences, mothers may face some challenges in establishing and maintaining breastfeeding. Providers should work to ensure that mothers of infants with birth defects have adequate support to maximize their ability to provide them with breast milk.

How might birth defects affect breastfeeding mothers and babies?

Several of the most common birth defects, including Down syndrome, cleft lip and/or palate, and congenital heart disease, can affect an infant’s ability to breastfeed due to the associated physical and developmental features.

• Infants with Down syndrome (Trisomy 21) can have hypotonia (low muscle tone) which can lead to abnormal or weakened control of the oropharyngeal structures, contributing to an uncoordinated and/or weak suck, or difficulty swallowing, similar to those experienced by premature infants.
• In infants born with a cleft lip and/or a cleft palate, the oral cavity cannot be adequately separated from the nasal cavity during feeding, which can make it difficult to create the suction needed to breastfeed successfully. This may result in the infant getting tired easily while breastfeeding or requiring a longer time to feed, which can affect growth and nutrition status. Other difficulties may include nasal regurgitation (milk comes out of the nose) and aspiration (milk enters the airway).
• Some infants born with a congenital heart defect or disease may not be able to feed at the breast right after birth due to complications, such as hypoxia (low levels of oxygen in the blood). Once these babies are stable, breastfeeding is usually possible and beneficial.

Is it safe for an infant born with a birth defect to breastfeed?

Yes, with adequate support. Depending on the type and severity of the birth defect, some infants will be able to feed at the breast, while others may need to receive breast milk from a bottle or other feeding device, such as a supplemental nursing system (a feeding device delivering supplemental milk at the breast via tubing), cup, or syringe. Mothers of infants with some birth defects will likely need extra support in establishing and maintaining breastfeeding. These infants will also need to be closely monitored to be sure they are receiving enough calories to gain enough weight.

For most infants with birth defects, breast milk is still the optimal source of nutrition.

Most mothers who have had breast surgery are able to produce some milk. Some surgeries impact milk production more than others.

Is it safe for a mother to breastfeed her infant if she has silicone breast implants?

Research is limited; however, there have been no recent reports of clinical problems in infants of mothers with silicone breast implants. In 2001, the American Academy of Pediatrics (AAP) issued a statement regarding the Transfer of Drugs and Other Chemicals into Human Milk, indicating that the Committee on Drugs felt there was insufficient evidence to justify classifying silicone implants as a contraindication to breastfeeding.

Can a mother breastfeed after breast or nipple surgery?

Usually. Most mothers who have had breast or nipple surgery are able to produce some milk, but not all of these mothers will be able to produce a full milk supply for their infants. Having a full milk supply is not necessary for a successful breastfeeding experience because it is possible to supplement in a way that supports breastfeeding.

Breast Augmentation, lift, and reduction:

Breast augmentation, lift, and reduction procedures have the potential to affect the nerves and ducts within the breast, thus impacting lactation. Breast implants below the muscle usually affect milk production less than implants above the muscle. Incisions around the areola and surgical techniques that include completely detaching the areolae and nipples are more likely to cause reductions in milk production. Over time, ducts that were severed during surgery may grow back together or form new pathways, and nerves may regain functionality, enabling the mother to produce milk. A scar around the whole areola following breast reduction does not indicate complete detachment because it may have remained connected to tissue containing nerves, ducts, and blood supply. The amount of milk made will depend on the number of connected ducts and functionality of the nerves that enable lactation, as well as other factors apart from the surgery, such as hormones and milk removal. Babies of mothers who have had breast surgery should be carefully monitored for adequate weight gain. Mothers may need support to increase milk production and/or to supplement with pasteurized donor human milk or formula.

Mastectomy:

Women who have been treated for breast cancer with partial or total mastectomy may have reduced capability to breastfeed or produce breast milk. Partial or total mastectomy can result in removal of breast tissue and damage to essential nerves involved in lactation. Women with total mastectomy of one breast should plan for unilateral breastfeeding. Women with partial mastectomy and radiation therapy should expect significantly reduced milk production on the affected side(s). A single breast can produce enough breast milk for healthy infant growth. However, dyads should be followed closely for adequate infant weight gain. Further guidance is outlined in the Academy of Breastfeeding Medicine’s clinical protocol on Breast Cancer and Breastfeeding.

Women may have varied experiences with breastfeeding after breast cancer treatment and may encounter a range of social and psychological challenges. Providers may need to address psychosocial challenges when supporting the infant feeding decisions of women who have had breast cancer.

Hypoplastic breasts:

Some mothers may have had underdeveloped (hypoplastic) breasts prior to having breast surgery. Mammary hypoplasia, or insufficient glandular tissue, is characterized by breasts that appear tubular, widely-spaced, or significantly asymmetrical, leading some women with this condition to seek reconstructive surgery. Mothers who have had hypoplastic breasts may not be able to produce enough milk (primary lactation failure) and will need lactation support to learn how to stimulate production and/or how to supplement with pasteurized donor human milk or formula.

Can transgender parents who have had breast surgery breastfeed or chestfeed their infants?

Yes. Some transgender parents who have had breast/top surgery may wish to breastfeed or chestfeed their infants. Healthcare providers working with these families should be familiar with medical, emotional, and social aspects of gender transitions to provide optimal family-centered care and meet the nutritional needs of the infant. These families may need help with the following:

• Maximizing milk production
• Supplementing with pasteurized donor human milk or formula
• Medication to induce lactation or avoiding medications that inhibit lactation
• Suppressing lactation (for those choosing not to breastfeed or chestfeed)
• Finding appropriate lactation management support, peer support, and/or emotional support

Tips for helping mothers who have had breast surgery

Prenatal support:

• Talk with mothers who have had breast surgery about the type of surgery, placement of incisions, and underlying reasons for the surgery to understand the potential for reduced milk production.
• Examine mothers’ breasts to identify possible insufficient glandular tissue and provide anticipatory guidance for breastfeeding support.

Postpartum support:

• Closely monitor infants of mothers who have had breast surgery to be sure that the infant receives optimal nutrition for growth.
• When mothers present with insufficient milk production postpartum, inquire about prior breast surgery as part of your assessment.
• Refer to an International Board Certified Lactation Consultant (IBCLC) to teach mothers who have had breast surgery how to stimulate production and/or how to supplement with pasteurized donor human milk or formula.
• Ensure that mothers who have had breast surgery and encounter breastfeeding challenges receive appropriate emotional support.

Current evidence suggests that breast milk is not likely to spread the virus to babies.

COVID-19 vaccination is recommended for people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. In addition, everyone who is ages 18 and older, including those who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future, should get a booster shot. You should always wash your hands with soap and water for 20 seconds before breastfeeding or expressing breast milk,even if you don’t have COVID-19. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.

If you have COVID-19 and choose to breastfeed:

• Wash your hands before breastfeeding
• Wear a mask while breastfeeding and whenever you are within 6 feet of your baby.

If you have COVID-19 and choose to express breast milk:

• Use your own breast pump (one not shared with anyone else), if possible.
• Wear a mask as you express breast milk.
• Wash your hands with soap and water for at least 20 seconds before touching any pump or bottle parts, and before expressing breast milk.
• Follow recommendations for proper pump cleaning after each use. Clean all parts of the pump that come into contact with breast milk.
• Consider having a healthy caregiver feed the expressed breast milk to the baby. The caregiver should be fully vaccinated (at least two weeks after the 2nd dose of a 2-dose vaccine or two weeks after a 1-dose vaccine) and not be at increased risk for severe illness from COVID-19. If the caregiver is living in the same home or has been in close contact with you and is not yet fully vaccinated for COVID-19, they might have been exposed.
  • People who have come into close contact with someone with COVID-19 should be tested to check for infection:
    • Fully vaccinated people should be tested 5–7 days after their last exposure.
    • People who are not fully vaccinated should get tested immediately when they find out they are a close contact. If their test result is negative, they should get tested again 5–7 days after their last exposure or immediately if symptoms develop.
    • Self-tests are one of several options for testing for the virus that causes COVID-19 and may be more convenient than laboratory-based tests and point-of-care tests. Ask your healthcare provider or your local health department if you need help interpreting your test results.
• Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and during their own quarantine period after you complete isolation.

Mothers With Confirmed or Suspected Ebola Virus Disease (EVD) Should Not Breastfeed Their Infants.

Ebola Virus Disease, also known as Ebola virus or EVD, is a rare and deadly disease caused by an infection with a group of viruses within the genus Ebolavirus. Ebola virus is spread through direct contact with blood and other bodily fluids including urine, saliva, sweat, feces, vomit, breast milk, and semen, of a person who is sick with or has died from EVD.

Is it safe for mothers with Ebola virus to breastfeed their infants?

No. Ebola virus has been detected in samples of breast milk, but no data exist about when in the course of the disease the virus appears in breast milk or when it is cleared. Therefore, women with confirmed EVD and women who recently recovered from EVD should not breastfeed.

Learn more about the breastfeeding recommendations, safe handling of breast milk, and care of a newborn, also known as neonate, born to a mother who may have EVD, or has been exposed to EVD.

Is it safe for mothers who become pregnant after recovering from Ebola virus to breastfeed?

Yes. There is no known risk of transmission of Ebola virus via breastfeeding for infants born to women who become pregnant after recovering from EVD. Breastfeeding is safe and should be recommended for these women. Learn more about guidance for screening and caring for pregnant women with Ebola Virus Disease.

How should breast milk be safely handled in health care settings?

Standard precautions for preventing the transmission of bloodborne pathogens do not apply to human breast milk in most circumstances. However, there are no data about the risks from exposure to breast milk containing Ebola virus in health care settings. Thus, when a mother has confirmed Ebola virus, personal protective equipment guidance should be followed by anyone handling her breast milk. The expressed milk of a mother with confirmed Ebola virus is considered Category A infectious waste and must be disposed of in accordance with CDC guidance on waste management. If a mother is using a breast pump to express her milk, she should be provided with single-use disposable pump part kits.

Mothers with Hepatitis B or C infections can breastfeed their infants.

Hepatitis B

Hepatitis B is a liver infection caused by the hepatitis B virus (HBV), which is transmitted by blood, semen or other body fluid from an infected person. A woman with hepatitis B can infect her infant with the virus during childbirth. All pregnant women are given a blood test for hepatitis B as part of their prenatal care or when they arrive at the hospital to give birth. CDC recommends that babies get the first dose of the hepatitis B vaccine before leaving the hospital or within the first 24 hours. Babies are usually given the second dose of the vaccine 1-2 months after the first dose, and the third dose by the time they are 18 months old.

Is it safe for a mother infected with hepatitis B virus (HBV) to breastfeed her infant?

Yes. All infants born to HBV-infected mothers should receive hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccine within 12 hours of birth. The second dose of vaccine should be given at age 1–2 months, and the third dose at age 6 months. The infant should be tested after completion of the vaccine series, at age 9–12 months (generally at the next well-child visit), to determine if the vaccine worked and that the infant is not infected with HBV through exposure to the mother’s blood during the birth process. However, there is no need to delay breastfeeding until the infant is fully immunized. The risk of HBV mother-to-child transmission through breastfeeding is negligible if infants born to HBV-positive mothers receive the HBIG/HBV vaccine at birth.

Is it safe for the HBV-positive mother to breastfeed if her nipples are cracked and bleeding?

Data are insufficient to say yes or no. However, HBV is spread by infected blood. Therefore, if the HBV-positive mother’s nipples and/or surrounding areola are cracked and bleeding, she should stop nursing temporarily. To maintain her milk supply while not breastfeeding, she can express and discard her breast milk until her nipples are healed. Once her nipples are no longer cracked or bleeding, the HBV-positive mother may fully resume breastfeeding. Providers may need to refer mothers for lactation support to learn how to maintain milk production and how to supplement with pasteurized donor human milk or formula while temporarily not breastfeeding.

Hepatitis C

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV), which is transmitted by blood from an infected person. There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injecting drugs.

Is it safe for a mother infected with hepatitis C virus (HCV) to breastfeed her infant?

Yes. There is no documented evidence that breastfeeding spreads HCV. Therefore, having HCV-infection is not a contraindication to breastfeed.

Is it safe for the HCV-positive mother to breastfeed if her nipples are cracked and bleeding?

Data are insufficient to say yes or no. However, HCV is spread by infected blood. Therefore, if the HCV-positive mother’s nipples and/or surrounding areola are cracked and bleeding, she should stop nursing temporarily. To maintain her milk supply while not breastfeeding, she can express and discard her breast milk until her nipples are healed. Once her nipples are no longer cracked or bleeding, the HCV-positive mother may fully resume breastfeeding. Providers may need to refer mothers for lactation support to learn how to maintain milk production and how to supplement with donor human milk or formula while temporarily not breastfeeding.

Herpes simplex virus (HSV) in infants can be severe. Mothers with HSV can continue to breastfeed if no lesions are present on the breasts and if lesions elsewhere on the body are carefully and fully covered. Mothers with active lesions on the breast should temporarily stop breastfeeding from the affected breast and should not feed expressed breast milk from the affected breast.

Herpes simplex virus (HSV) is a lifelong virus that is categorized into two distinct herpesvirus species, herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). HSV-1 is typically transmitted by oral-oral contact to cause oral herpes but can also cause genital herpes through oral-genital contact. HSV-2 is typically sexually transmitted and causes genital herpes but can also cause infections in the mouth. Importantly, both types of virus can cause herpes disease in newborns and infants and can appear anywhere on the body.

In newborn infants, HSV infections are often severe and result in high rates of mortality and morbidity. Every precaution needs to be taken to prevent infants from being exposed to the herpes virus and appropriate hand hygiene should be done before holding the infant.

Is it safe for a mother to breastfeed if she has active herpetic lesions?

Maybe. Women with herpetic lesions may transmit HSV to their infants by direct or indirect contact with the lesions. Breastfeeding is acceptable if no lesions are present on the breasts and if active lesions elsewhere on the mother are carefully and fully covered. In cases where a mother has herpetic lesions on her breast, the mother should temporarily refrain from breastfeeding her infant from the affected breast or feeding her infant expressed breast milk from the affected breast. She should discard expressed breast milk from the affected side until the lesions have healed. A mother may breastfeed her infant or express milk from the unaffected breast but should ensure that the lesions on the affected breast are completely covered to avoid transmission. Mothers should also follow appropriate hand hygiene practices to avoid transmission of herpes to her infant.

Providers: Lesions on the breast could easily be mistaken for impetigo or eczema. Questionable lesions should be tested promptly for HSV so that if positive, acyclovir (safe to use while breastfeeding) can be administered quickly and breastfeeding can be discontinued until the lesion has healed.

Some mothers may need additional support to maintain their milk production and/or supplement with their expressed human milk (previously expressed milk or expressed milk from the unaffected breast) or formula while herpetic lesions on the breast are healing. Mothers should talk with their physicians to determine if their lesions have healed and they can resume breastfeeding or expressing milk from the affected breast.

Is it safe for a mother to give her infant hand expressed or pumped breast milk if she has active herpetic lesions on her breast?

No. Breast milk can be contaminated if it comes in contact with active herpetic lesions through touching the breast during hand expression or via the pump. Therefore, if a mother has herpetic lesions on her breast, she should discard expressed breast milk from the affected side until the lesions have healed. Expressing breast milk will be important for maintaining milk production while not directly breastfeeding from the affected breast. Mothers should be vigilant about practicing appropriate hand hygiene and cleaning the pump parts thoroughly. Mothers should talk with their healthcare provider to determine if their lesions have healed and they can resume breastfeeding or expressing milk from the affected breast.

It is safe to use expressed breast milk from the unaffected breast, as long as the mother ensures that the lesions on the affected breast are completely covered to avoid transmission. Appropriate hand hygiene and cleaning the pump parts thoroughly are still important.

For more information about managing breastfeeding with specific medical conditions, read Lawrence RA, Lawrence R. (2016) Breastfeeding: A guide for the medical profession, 8th Edition.

In the United States, to prevent HIV transmission, HIV-infected mothers should not breastfeed their infants.

HIV is a virus that attacks the body’s immune system and is spread through certain body fluids, including breast milk. Mother-to-child transmission can occur during pregnancy, birth, or breastfeeding. Treatment for HIV (antiretroviral therapy, or ART) reduces the risk of transmission from a mother to her infant.

Is it safe for a mother infected with HIV to breastfeed her infant?

No. The best way to prevent transmission of HIV to an infant through breast milk is to not breastfeed. In the United States, where mothers have access to clean water and affordable replacement feeding (infant formula), CDC and the American Academy of Pediatrics recommend that HIV-infected mothers completely avoid breastfeeding their infants, regardless of ART and maternal viral load. Healthcare providers should be aware that some mothers with HIV may experience social or cultural pressure to breastfeed. These mothers may need ongoing feeding guidance and/or emotional support.

In resource-limited settings, such as some parts of Africa, the World Health Organization (WHO) recommends that HIV-infected mothers breastfeed exclusively for the first 6 months of life and continue breastfeeding for at least 12 months, with the addition of complementary foods. These mothers should be given ART to reduce the risk of transmission through breastfeeding.

Breast milk provides protections against many respiratory diseases, including influenza (flu). A mother with suspected or confirmed flu should take all possible precautions to avoid spreading the virus to her infant while continuing to provide breast milk to her infant.

Influenza (also called flu) is an acute, contagious respiratory tract illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. Flu can cause mild to severe illness, and at times can lead to death. Pregnant women and young children, among others (e.g., adults 65 years of age and older, people with certain medical conditions) are at high risk of developing flu-related complications.

Can the flu be transmitted through breast milk?

No. Flu is not spread to infants through breast milk. The flu is spread mainly from person-to-person via respiratory droplets when people cough, sneeze, or talk, or possibly, when a person touches a surface or object that has the flu virus on it and then touches their own mouth or nose.

Should mothers continue breastfeeding if they have flu or come in contact with someone with flu?

Yes. A mother’s breast milk contains antibodies and other immunological factors that can help protect her infant from flu and is the recommended source of nutrition for the infant, even while the mother is ill. If a mother is too sick to feed her infant at the breast and another healthy caregiver is caring for the infant, the breastfeeding mother should be encouraged and supported to regularly express her milk so that the infant continues to receive her breast milk. Prior to expressing breast milk, mothers should wash their hands well with soap and water and, if using a pump, follow recommendations for proper cleaning. Because breast milk supply could decrease for some mothers while they are ill, mothers may need additional lactation support from a lactation provider to address milk supply concerns, reduce the possibility of developing a breast infection, and support the breastfeeding relationship during this time.

Can infants who have flu continue to breastfeed?

Yes. When an infant has flu, the mother should be encouraged to continue breastfeeding or feeding expressed breast milk to her infant. Infants who are ill need fluids to stay hydrated and breast milk is the best option. Expressed breast milk can also be given from a cup, syringe, or bottle if the infant is unable to breastfeed directly at the breast.

Are there special considerations for mothers with flu in peri- and postpartum healthcare settings?

Yes. Newborns infected with influenza viruses are at increased risk for severe complications, including death. CDC has specific recommendations that apply to mothers who have flu and their newborns in the hospital setting at the time of birth. Visit Guidance for the Prevention and Control of Influenza in the Peri- and Postpartum Settings for more information.

If direct breastfeeding is interrupted due to temporary separation of mother and child, the breastfeeding mother should be encouraged and supported to regularly express her milk so that the infant continues to receive her breast milk. A breastfeeding mother with flu may need access to a hospital-grade pump and additional lactation support while in the hospital and after discharge to maintain her milk supply and reduce the possibility of developing a breast infection. Prior to expressing breast milk, mothers should wash their hands well with soap and water and, if using a pump, follow recommendations for proper cleaning. If a mother is expressing breast milk, the expressed breast milk should be fed to the infant by a healthy caregiver who does not have flu, if possible.

How can a breastfeeding mother with flu protect her infant from getting sick?

A mother with flu should take precautions to avoid spreading flu to her infant (regardless of feeding method) because infants are at high-risk of serious flu-related complications. These precautions are especially important for infants younger than 6 months of age because they cannot be vaccinated against influenza viruses. Mothers with flu should thoroughly wash and dry their hands with soap and water before touching the infant or any item that the infant will touch (including during feeding) and anytime they sneeze or cough on their hands.

Breast milk remains the best source of nutrition for the infant, and provides protection from infections through antibodies and other immunological factors. If a mother is too sick to feed her infant at the breast, if possible, expressed breast milk should be fed to the infant by a healthy caregiver who does not have flu. Whenever a mother expresses her breast milk, she should wash her hands well with soap and water and, if using a pump, follow recommendations for proper cleaning.

How can caregivers prevent transmission of flu to infants?

• Immunization of pregnant and breastfeeding women reduces the risk of flu to themselves and to their infants. To protect infants, especially those younger than 6 months of age who cannot be vaccinated, parents, siblings, other household members aged 6 months and older, and other caregivers should also receive an annual flu vaccination (except in rare cases).
• Everyday preventive actions such as avoiding close contact with sick persons, covering one’s nose and mouth with a tissue when sneezing or coughing and throwing the tissue away immediately afterwards, practicing proper hand hygiene, and disinfecting surfaces can also help protect all infants from flu, whether they are breastfed or not.
• Breast milk is the best source of nutrition for infants and provides protection from infections through antibodies and other immunological factors. Infants who are breastfed are less vulnerable to infections, including severe respiratory illnesses, than infants who are not breastfed. When a mother has flu, her breast milk contains antibodies that can help protect her infant from flu and breast milk remains the recommended source of nutrition for the infant, even while the mother is ill.

Is the flu vaccine safe for breastfeeding mothers and their infants?

Yes. Flu vaccination is safe for breastfeeding women and their infants aged 6 months and older. In fact, women who get the flu vaccine while pregnant or breastfeeding develop antibodies against flu that they can share with their infants through their breast milk. Breastfeeding can provide some protection against flu for infants, including children younger than 6 months who cannot receive the flu vaccine. Annual flu vaccination is recommended for all persons aged 6 months and older (except in rare cases), and is particularly important for pregnant women. Additionally, to protect children younger than 6 months of age from flu, persons around the infant (e.g., caregivers and household members) should receive the flu vaccination.

Are influenza antiviral prescription medications safe to use while mothers are breastfeeding or providing expressed breast milk to their infants?

Yes. While data on the effect of currently recommended influenza antiviral medications during breastfeeding are limited, CDC recommends that postpartum (e.g., within 2 weeks after birth) women with suspected or confirmed flu be treated with antiviral medications since they are at high risk of flu complications. For women who are breastfeeding with suspected or confirmed flu, treatment with oral oseltamivir is currently preferred. Available data indicate that oseltamivir is poorly excreted in breast milk. See Table 1. For additional information on medications and lactation, please refer to the Drugs and Lactation Database (LactMed). For additional general information on flu antiviral medications for healthcare providers, please visit the Influenza (Flu) Antiviral Drugs website.

Most newborns with jaundice can continue breastfeeding. Decisions about supplementation of a jaundiced newborn should be made on a case-by-case basis.

Jaundice, a sign of elevated bilirubin levels, occurs in 60% of term and 80% of preterm newborns during the first week of life. Bilirubin, a product from the normal breakdown of red blood cells, is elevated in newborns for several reasons:

• Newborns have a higher rate of bilirubin production due to the shorter lifespan of red blood cells and higher red blood cell concentration compared to adults.
• Newborns have immature liver function, leading to slower metabolism of bilirubin.
• Newborns may have a delay in passage of meconium, leading to increased reabsorption of bilirubin in the intestines.
• In most newborns, jaundice is termed “physiologic jaundice” and is considered harmless.

What is the difference between breastfeeding jaundice and breast milk jaundice?

There are different types of jaundice and some require treatment while others do not.

Breastfeeding jaundice most often occurs in the first week of life when breastfeeding is being established. Newborns may not receive optimal milk intake, which leads to elevated bilirubin levels due to increased reabsorption of bilirubin in the intestines. Inadequate milk intake also delays the passage of meconium, which contains large amounts of bilirubin that is then transferred into the infant’s circulation. In most cases breastfeeding can, and should, continue. More feedings can reduce the risk of jaundice.

Breast milk jaundice most often occurs in the second or later weeks of life and can continue for several weeks. While the exact mechanism leading to breast milk jaundice is unknown, it is believed that substances in the mother’s milk inhibit the ability of the infant’s liver to process bilirubin. Phototherapy is a common treatment and other therapeutic options include temporary supplementation with donor human milk or infant formula, and rarely, temporary interruption of breastfeeding.

Should a mother continue breastfeeding if her child has jaundice?

Usually. Most newborns with jaundice can continue breastfeeding. More frequent breastfeeding can improve the mother’s milk supply and, in turn, improve caloric intake and hydration of the infant, thus reducing the elevated bilirubin. In rare cases, some infants may benefit from a temporary cessation (24-48 hours) of breastfeeding with replacement feeding to help aid in the diagnosis of breast milk jaundice. If temporary breastfeeding cessation is required, it is critical to help mothers maintain their milk production during this time. Further guidance is outlined in the Academy of Breastfeeding Medicine’s clinical protocols on supplementation and jaundice.

Should a jaundiced breastfed infant be supplemented?

Sometimes. Jaundice is one of the possible indications for supplementation in healthy, term infants as outlined in the Academy of Breastfeeding Medicine’s clinical protocols on supplementation and jaundice. Any decisions about supplementation of a jaundiced newborn should be made on a case-by-case basis.

Breastfeeding mothers undergoing treatment for Lyme disease can continue to breastfeed their infants.

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks.

Can Lyme disease be transmitted through breast milk?

There are no reports of Lyme disease being spread to infants through breast milk.

Is it safe for a mother to continue breastfeeding while treating Lyme disease with antibiotics?

Yes. Some antibiotics are safer than others while breastfeeding. Breastfeeding mothers diagnosed with Lyme disease should consult with their healthcare providers who can prescribe an antibiotic that is safe to use while breastfeeding.

Most antimalarial medications are safe to take while breastfeeding. Breastfeeding infants may need their own antimalarial drug.

Malaria is a mosquito-borne disease caused by a parasite. The vast majority of cases in the United States occur in travelers and immigrants returning from countries where malaria transmission occurs, including sub-Saharan Africa and South Asia.

Can malaria be transmitted to an infant through a mother’s breast milk?

No. However, a breastfeeding mother who plans to travel to a geographic region where malaria is prevalent is advised to take every precaution to reduce her risk of infection. Standard preventive approaches include mosquito avoidance measures, such as insect repellent, and prophylactic antimalarial medications. When using insect repellant, a breastfeeding mother should avoid applying insect repellents under their clothes or to the nipple area and should wash their hands before holding and breastfeeding her infant.

Are prophylaxis antimalarial medications safe to take while breastfeeding?

Most prophylaxis antimalarial medications are safe for nursing mothers. Prophylaxis antimalarial medications are taken before, during, and after travel to an area with malaria to prevent malaria transmission. Breastfeeding mothers traveling to malaria-endemic regions should adhere to the standard recommended dosage of prophylaxis antimalarial medications appropriate for the country they are visiting. The breastfeeding child also needs his or her own antimalarial drug.

If a mother is taking a prophylaxis antimalarial drug and breastfeeding, will her infant be protected from malaria through the transfer of medication in her breast milk?

No. The quantity of drug transferred in breast milk is not enough to provide protection against malaria for the infant. The breastfeeding infant needs his or her own prophylaxis antimalarial drug.

Is it safe for an infant to breastfeed while his or her mother is taking medication to treat malaria?

Yes, mothers who are taking antimalarial medications may continue to breastfeed, provided they are healthy enough to do so. However, some medications used to treat malaria are not safe for breastfeeding infants who weigh less than 5 kg (11 lb), and should be avoided in breastfeeding mothers. Providers need to be aware if a mother is breastfeeding in order to prescribe the appropriate medication. Mothers who are diagnosed with malaria should begin appropriate treatment as soon as possible.

Mothers with a MRSA infection can usually continue to breastfeed while receiving appropriate treatment compatible with breastfeeding.

Staphylococcus aureus (staph), is a type of bacteria found on people’s skin. Staph bacteria can be carried by individuals and not cause any symptoms, but can also cause serious infections that can lead to sepsis or death. Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to several antibiotics.

These bacterial pathogens can be associated with mastitis (a breast infection) and breast abscesses in breastfeeding mothers, and require prompt medical attention. In most cases, mothers with a staph or MRSA infection can continue to breastfeed their infant.

If a mother has a MRSA infection, can she continue to breastfeed?

Usually, yes. Continued breastfeeding is appropriate and recommended for most healthy infants. Breastfeeding promotes drainage and helps to resolve the infection, if it involves the breast. Staph bacteria, including MRSA, are not transmissible via human milk; however, these bacteria can be transferred through direct contact with infected tissue, such as an open lesion on the breast, or through expressed milk that has come in contact with infected tissue. Breastfeeding can continue on the affected breast (even if a drain is present in the case of an abscess) as long as the infant’s mouth does not come in contact with purulent drainage or open infected tissue. All open infectious tissue should be completely covered with clean, dry bandages while breastfeeding or expressing milk. Continued breastfeeding is also recommended for most healthy infants when their mother is colonized, but does not have a MRSA infection.

If it is not possible to avoid contact with infectious tissue while breastfeeding or expressing milk, the mother can express milk from the affected breast and discard it until she is no longer infectious on that side (undergone 24-48 hours of antibiotic therapy). Expressing milk is important for maintaining milk production while not directly breastfeeding from the affected breast. Mothers should be vigilant about practicing appropriate hand hygiene and cleaning breast pump parts thoroughly.

What is the best treatment for breastfeeding mothers diagnosed with MRSA?

There are several medications used to treat MRSA that are compatible with breastfeeding. For additional information on medications and lactation, please refer to the Drugs and Lactation Database (LactMed). If the mother requires abscess drainage, outpatient treatment using needle or catheter aspiration will allow the infant to remain with the mother and continue breastfeeding. Furthermore, breastfeeding promotes abscess drainage and helps resolve the infection. If a drain needs to be left in the abscess to allow for healing, the infant can continue to breastfeed or receive expressed milk from that breast as long as the infant’s mouth or the pump’s flange does not come in contact with the insertion of the drain.

Are there special precautions for a mother-infant dyad infected with MRSA if the infant is in the Neonatal Intensive Care Unit (NICU)?

Yes. Infants in the NICU, or who are premature or small-for-gestational-age, are more susceptible to morbidity and mortality due to MRSA. Infants in the NICU are at higher risk, so a facility might recommend special precautions, like using gowns and gloves when caring for infants whose mothers are carrying or are infected with MRSA, or placing mother and infant in their own room. If the MRSA infection is in the breast (e.g., mastitis) it might be prudent to minimize the infant’s exposure to infected tissue or contaminated milk. One approach might be to culture breast milk expressed by a mother with a MRSA infection to confirm the breast milk does not contain staph bacteria before feeding it to the infant. Alternatively, expressed milk could be discarded and if appropriate, pasteurized donor human milk could be provided to the infant until the mother’s milk is culture-negative for MRSA or until the signs of active infection have resolved. It is important for the mother to receive lactation support and continue to express her milk to maintain her milk supply during this time while she receives treatment.

Mothers with postpartum depression can usually continue to breastfeed. Healthcare providers should work with mothers to ensure they receive appropriate treatment, support, and medications that are safe to use while breastfeeding.

Is there an association between breastfeeding and postpartum depression?

There is insufficient evidence on whether breastfeeding is associated with postpartum depression. In particular, the direction of the relationship between breastfeeding and higher or lower rates of depression is unclear. According to a 2018 systematic review by the Agency for Healthcare Research and Quality (AHRQ), “Elucidating the relationship between breastfeeding and postpartum depression is challenging, because women with depression may have difficulty initiating and sustaining breastfeeding, and women who experience breastfeeding difficulties may develop depression” (p. 107).

Are antidepressant medications safe to take while breastfeeding?

Maybe. Although many medications do pass into breast milk, most have little or no effect on milk supply or on infant well-being. When discussing medications it is important for the healthcare provider to ask a mother about whether she is breastfeeding. Together they can decide which medications are right for her and safe to use while breastfeeding.

Can a mother experiencing postpartum depression continue to breastfeed?

Usually. While some mothers experience positive feelings from breastfeeding, others may not. Healthcare providers can work with mothers to address depression in a timely manner and to help them reach their breastfeeding goals. Healthcare providers can talk to mothers about treatment options for depression including medications and non-pharmacological options (e.g., individual or group therapy) and assist mothers in accessing professional breastfeeding support as needed.

An immunocompetent mother with shingles may be able to continue breastfeeding if she does not have skin lesions on her breast.

Shingles, also known as herpes zoster or zoster, is caused by the varicella zoster virus, the same virus that causes chickenpox (varicella). After a person recovers from chickenpox, the virus stays dormant (inactive) in the body and can reactivate years later, causing shingles. Anyone who has recovered from chickenpox may develop shingles, but the risk of shingles increases as you get older.

Shingles cannot be passed from one person to another and cannot be spread to an infant through breast milk. However, the varicella zoster virus can spread from a person who has active shingles and cause chickenpox in someone who has never had chickenpox or received the chickenpox vaccine. The virus is spread through direct contact with fluid from the rash blisters caused by shingles.

Should a mother with shingles continue to breastfeed?

Maybe. If a mother has active shingles infection, she can continue to breastfeed if she does not have skin lesions on her breast. If a lesion develops on or near the areola, where the infant’s mouth would touch the lesion while nursing, then the mother needs to express her milk on that side to maintain her milk supply and prevent mastitis. She can discard that milk until the infant can resume nursing directly at that breast. She may need access to a hospital-grade pump and additional lactation support to maintain her milk supply and reduce the possibility of developing a breast infection.

Before expressing breast milk, mothers should wash their hands well with soap and water and, if using a pump, follow recommendations for proper cleaning. Breastfeeding can continue on the unaffected breast during this time. All lesions should be covered with clean, dry bandages until they are healed to avoid direct contact with an infant. Mothers need to be vigilant about hand washing until all lesions are fully crusted over.

Immunocompromised mothers who develop an active shingles infection can seek consultation from a specialist on how or if to proceed with breastfeeding. If the infant comes into direct contact with the shingles lesions, consultation with a pediatric specialist is recommended and Varicella-Zoster Immune Globulin may be considered.

Should a mother on antivirals continue to breastfeed?

Yes. Women can take antiviral medications to treat shingles while breastfeeding.

If a mother is on antivirals, does her infant also need treatment?

Most infants who develop chickenpox can tolerate the infection. However some may experience complications. Mothers should consult their child’s health care provider, even for infections that seem mild.

Is the varicella (chickenpox) vaccine safe to administer to lactating mothers?

Yes. The varicella vaccine should be administered to nursing mothers who lack evidence of immunity. Two doses of the chickenpox vaccine is more than 90% effective at preventing chickenpox. Excretion of the vaccine strain in human milk or of transmission to infants has not been found.

Sexually transmitted infections (STIs) are also called sexually transmitted diseases, or STDs. STIs include chlamydia, gonorrhea, trichomoniasis, genital herpes, genital warts, HIV, and syphilis. Some STIs can pass from mother to baby during pregnancy and through breastfeeding.

How do STIs affect pregnant women?

STIs can cause many of the same health problems in pregnant women as in women who are not pregnant. But having an STI also can hurt the unborn baby's health.

Having an STI during pregnancy can cause:

• Premature labor (labor before 37 weeks of pregnancy). Early (preterm) birth is the number one cause of infant death and can lead to long-term developmental and health problems in children.
• Infection in the uterus (womb) after birth

Can I pass an STI to my baby?

Yes. Some STIs can be passed from a pregnant woman to the baby before and during the baby's birth.

• Some STIs, such as syphilis, cross the placenta and infect the baby in the womb.
• Other STIs, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can pass from the mother to the baby as the baby passes through the birth canal.
• HIV can cross the placenta during pregnancy and infect the baby during delivery.

What are the harmful effects of passing an STI to a baby?

The harmful effects to babies may include:

• Low birth weight (less than 5 pounds)
• Eye infection
• Pneumonia
• Infection in the baby's blood
• Brain damage
• Lack of coordination in body movements
• Blindness
• Deafness
• Acute hepatitis
• Meningitis
• Chronic liver disease, which can lead to scarring of the liver (cirrhosis)
• Stillbirth

I'm pregnant. What can I do to prevent problems from STIs?

You can prevent some of the health problems caused by STIs and pregnancy with regular prenatal care. Your doctor will test you for STIs early in your pregnancy and again closer to childbirth, if needed.

• STIs caused by bacteria, such as chlamydia and gonorrhea, can be cured with antibiotics. Some antibiotics are safe to take during pregnancy. Your doctor can prescribe antibiotics for chlamydia, gonorrhea, syphilis, and trichomoniasis during pregnancy.
• STIs caused by viruses, such as genital herpes and HIV, have no cure.
  • If you have herpes, antiviral medicine may help reduce symptoms. If you have symptoms of herpes or active genital herpes sores at the start of labor, you may need a cesarean section (C-section). This can help lower the risk of passing the infection to your baby.
  • If you have HIV, antiviral medicines can lower the risk of giving HIV to your baby to less than 1%. You also may need to have a C-section.

You also can take steps to lower your risk of getting an STI during pregnancy.

Can I breastfeed if I have an STI?

Maybe. Some STIs affect breastfeeding, and some don't. The following are some general guidelines, but talk to your doctor, nurse, or a lactation consultant about the risk of passing the STI to your baby while breastfeeding:

• If you have HIV, do not breastfeed. You can pass the virus to your baby. In countries like the United States where clean water is available, using a breastmilk substitute like formula is recommended.
• If you have chlamydia, gonorrhea, or HPV, you can breastfeed your baby.
• If you have trichomoniasis, you can take the antibiotic metronidazole if you are breastfeeding. You may need to wait 12 to 24 hours after taking the medicine to breastfeed.
• If you have syphilis or herpes, you can breastfeed as long as your baby or pumping equipment does not touch a sore. It is possible to spread syphilis or herpes to any part of your breast, including your nipple and areola. If you have sores on your breast, pump or hand-express your milk until the sores heal. Pumping will help keep up your milk supply and prevent your breast from getting overly full and painful. You can store your milk to give to your baby in a bottle for another feeding. But if parts of your breast pump also touch the sore(s) while pumping, you should throw the milk away.

Are STI treatments safe to use while breastfeeding?

If you are being treated for an STI, ask your doctor about the possible effects of the medicine on your breastfeeding baby. Most treatments for STIs are safe to take while breastfeeding.

A breastfeeding mother with toxoplasmosis can continue to breastfeed her infant, but should be cautious if her nipples are cracked or bleeding.

Toxoplasmosis is a disease caused by a single-celled parasite called Toxoplasma gondii. It is most commonly transmitted to humans through eating contaminated foods or through handling the feces of infected cats (or soil or water contaminated by the feces of infected cats).

More than 30 million people in the United States may be infected with the Toxoplasma parasite. Of those who are infected, very few have symptoms because a healthy person’s immune system usually keeps the parasite from causing illness. However, pregnant women and individuals who have compromised immune systems should be cautious; for them, a Toxoplasma infection could cause serious health problems.

Can Toxoplasma infection be transmitted through breast milk?

No. There are no studies documenting transmission of Toxoplasma gondii in humans through breast milk. However, a woman who is newly infected with Toxoplasma during pregnancy can pass the infection to her fetus. The woman may not have symptoms, but there can be severe consequences for her infant at birth or later in life, such as blindness, brain damage, or mental disability.

Is it safe for a mother to breastfeed her infant if she contracted a Toxoplasma infection during her pregnancy?

Usually. There are no studies documenting transmission of Toxoplasma gondii in humans through breast milk. When a mother is infected during pregnancy, Toxoplasma may be circulating in her blood. If a breastfeeding woman has cracked and bleeding nipples or her breasts are inflamed, she might have some blood in her breast milk. Although it has never been documented, it is possible that Toxoplasma gondii could be in that blood and infect the infant through her breast milk. However, the likelihood of human milk transmission is very small.

How can mothers protect themselves and their infants from toxoplasmosis?

There are several food safety measures and environmental precautions mothers can take to help prevent Toxoplasma infection. These include cooking meats to safe temperatures, washing and peeling fruits and vegetables, wearing gloves while gardening, changing the cat litter daily, and practicing proper handwashing techniques consistently.

Should a woman experiencing "traveler's diarrhea" breastfeed her child while she is ill?

Yes. In fact, a nursing mother with diarrhea believed to have been caused by food or water sources should be encouraged to increase the frequency of breastfeeding while significantly increasing her own fluid intake.

Exclusive breastfeeding protects infants against travelers’ diarrhea. Breastfeeding is ideal rehydration therapy. Children who are suspected of having travelers’ diarrhea should breastfeed more frequently. Children in this situation should not be offered other fluids or foods that replace breastfeeding.

Breastfeeding mothers with travelers’ diarrhea should continue breastfeeding and increase their own fluid intake. The organisms that cause travelers’ diarrhea do not pass through breast milk. Use of oral rehydration salts by breastfeeding mothers and their children is fully compatible with breastfeeding. Breastfeeding mothers should carefully check the labels of over-the-counter antidiarrheal medications to avoid using bismuth subsalicylate compounds, which can lead to the transfer of salicylate to the child via breast milk. Fluoroquinolones and macrolides, which are commonly used to treat travelers’ diarrhea, are excreted in breast milk. The decision about the use of antibiotics such as fluoroquinolones and macrolides in nursing mothers should be made in consultation with the child’s primary health care provider. Most experts consider the use of short-term azithromycin compatible with breastfeeding.

Can a woman who becomes infected with West Nile Virus safely nurse her infant?

Yes. Scientists have found no evidence that a mother’s West Nile Virus infection harms her breastfeeding infant. Therefore, CDC recommends that women with West Nile Virus illness continue breastfeeding because the benefits of breast milk are thought to outweigh the theoretical risk of harm to the infant.

In the few documented cases of West Nile Virus transmission through breastfeeding (1 case in the year 2002; 3 cases in the year 2003), none resulted in recognizable illness in the infant.

In special cases, women may be advised not to breastfeed. These instances include when a woman is taking certain medications or drugs, when she has been diagnosed with a specific illness, or when other specific conditions apply.

Medications/Other Drugs and Breastfeeding

Certain medications are known to be dangerous to infants and can be passed to your infant in your breast milk. Women taking the following medicines should speak with their health care providers before considering breastfeeding:

• Antiretroviral medications (for HIV/AIDS treatment)
• Birth-control medications containing estrogen, until breastfeeding has been well established
• Cancer chemotherapy agents
• Illegal drugs
• Certain medications prescribed to treat migraines, such as ergot alkaloids
• Mood stabilizers, such as lithium and lamotrigine
• Sleep-aid medicines

In addition, women who are undergoing radiation therapy should not breastfeed, although some therapies may require only a brief interruption of breastfeeding.

The above list of medications and other drugs is only a guideline. Before breastfeeding, you should speak with your health care provider about all medications that you are taking. These include prescribed medications, over-the-counter medicines, vitamins, and herbal therapies.

Medications that are safe during pregnancy may also be safe for you to continue while you are breastfeeding, although you should check with your health care provider to make sure they are safe before you breastfeed.

Contact your infant's health care provider if you see any signs of a reaction to your breast milk in your infant, such as diarrhea, excessive crying, or sleepiness.

Health Conditions and Breastfeeding

Women with certain illnesses and infections may be advised not to breastfeed because of the danger of passing the illness or infection to the breastfed infant.

If you have any of the following conditions, breastfeeding your infant is NOT advised. For more information, speak with your health care provider:

• Infection with HIV
• Infection with human T-cell lymphotropic virus type I or type II
• Untreated, active tuberculosis

If you are sick with the flu, including the H1N1 flu (also called the swine flu), you should not stop feeding your infant expressed milk. You should avoid being near your infant, however, so that you do not infect him or her. To avoid infecting your infant, someone who is not sick should give your infant your expressed milk.

If you have Zika virus or live in areas where Zika virus is found, the CDC recommends you continue to breastfeed your infant. Although Zika virus has been detected in breast milk, there are no reports of transmission of the virus through breastfeeding, and the benefits of breastfeeding are thought to outweigh the risks. NICHD is partnering with other NIH Institutes and the Brazilian research organization Fundação Oswaldo Cruz (Fiocruz) to study Zika virus transmission in 10,000 pregnant women and their infants. If possible, breast milk will be collected from the mothers.

Domestic and International Guidelines on HIV/AIDS and Breastfeeding

In the United States, the American Academy of Pediatrics and the CDC recommend against breastfeeding if you are HIV positive; the same advice applies in other developed countries. Without any specific interventions to reduce transmission, infants breastfed by HIV-positive mothers have an increased chance of acquiring HIV through the breast milk. This rate increases if infants are breastfed longer and for mothers with newly-acquired HIV.

Only HIV-positive mothers living in developing countries should consider breastfeeding their babies, especially if a safe and reliable source of infant formula is unavailable. This is because breast milk may protect against malnutrition and diarrhea, which are major causes of infant mortality in some areas of the developing world. If an HIV-positive woman decides to breastfeed her baby, research indicates that the risk of transmitting HIV to her baby is reduced if she exclusively breastfeeds (does not use a combination of formula and breast milk) and if she and her infant take antiretroviral drugs.

Other Considerations for Breastfeeding

In some additional situations, or if women or infants have certain health conditions, women may be advised not to breastfeed or may have difficulty breastfeeding.

• Women with certain chronic illnesses may be advised not to breastfeed, or will be advised to take steps to ensure their own health while breastfeeding. For example, women who have diabetes should monitor their blood sugar levels regularly, may need to reduce their insulin, and may need a snack containing carbohydrates before or during breastfeeding. Also, women who are underweight, including those with thyroid conditions or certain bowel diseases, may need to increase their calories to maintain their own health during breastfeeding.
• Women who have had breast surgery in the past may face some difficulties with breastfeeding.
• Women who actively use drugs or do not control their alcohol intake, or who have a history of these situations, also may be advised not to breastfeed.
• Infants who have galactosemia—a rare metabolic disorder in which the body cannot digest the sugar galactose—should not be breastfed. Galactosemia is detected by newborn screening, allowing proper treatment and diet to begin immediately. If not detected, the galactose builds up and becomes toxic for the infant, leading to liver problems, intellectual and developmental disabilities, and shock.