Contraindications to Breastfeeding

What to know

Breastfeeding is the best source of nutrition for most infants. It can also reduce the risk for certain health conditions for both infants and mothers.

Physicians should make case-by-case assessments to determine if a woman should interrupt, stop, or never start breastfeeding due to an environmental exposure, medical condition, or infant's medical condition.

Reasons not to breastfeed

Mothers should not breastfeed or feed expressed breast milk to their infants if:

• Their infant is diagnosed with classic galactosemia, a rare genetic metabolic disorder.1

• They have HIV and:
  • Are not on HIV treatment (antiretroviral therapy or ART), or
  • Are on ART but have not achieved sustained viral suppression during pregnancy (at a minimum throughout the third trimester) or at the time of delivery. Women on ART should also not breastfeed if they are unable to maintain sustained viral suppression after giving birth.

If a mother with a detectable viral load chooses to breastfeed, the provider should remain engaged, offer guidance on antiretroviral (ARV) HIV prevention drugs and HIV testing for the infant, and assist the parent to rapidly regain and maintain viral suppression. Consult with an expert or the National Perinatal HIV/AIDS hotline (1-888-448-8764).

• They are infected with human T-cell lymphotropic virus type I or type II (HTLV – 1/2).1

• They are using an illicit drug, such as opioids, PCP (phencyclidine) or cocaine.2 For mothers who discontinue illicit opioids or other substances and are on stable methadone or buprenorphine maintenance therapy, breastfeeding should be encouraged.

• They have suspected or confirmed Ebola virus disease.

Reasons to temporarily stop breastfeeding

Mothers should temporarily not breastfeed or feed expressed breast milk to their infants if:

• They are infected with untreated brucellosis.1

• They are taking certain medications.12
• They are undergoing diagnostic imaging with radiopharmaceuticals (drugs that emit radiation).2

• They have an active herpes simplex virus (HSV) infection with lesions (sores) present on the breast.3 (Note: Mothers can breastfeed directly from the unaffected breast if lesions on the affected breast are covered completely).
• They have mpox virus infection (Note: breastfeeding should be delayed until criteria for discontinuing isolation have been met, including all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed.

Mothers should temporarily not breastfeed, but can feed expressed breast milk if:

• They have untreated, active tuberculosis.
  • Note: The mother may resume breastfeeding once she has been treated appropriately for 2 weeks. In addition, a doctor must document that she is no longer contagious.
    

• They have an active varicella (chicken pox) infection that developed between 5 days before delivery and 2 days following delivery.

Taking medications while breastfeeding

There are few medications that you cannot take while breastfeeding. Although many medications pass into breast milk, most have no known adverse effect on milk supply or infant well-being. However, healthcare providers should always weigh the risks and benefits when prescribing medications to women who are breastfeeding.

Learn more about safe prescription medication use while breastfeeding.

Review the most up-to-date information available on medications and lactation on LactMed®.

Learn more

• American Academy of Pediatrics. Red Book Online, 2021.
• Infant Feeding for Individuals with HIV in the United States—HHS Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission