Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants

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While human milk provides the most complete form of nutrition for infants, including premature and sick newborns, there are rare exceptions when human milk or breastfeeding is not recommended.

Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants

Physicians should make case-by-case assessments to determine whether a woman’s environmental exposure, her own medical condition, or the medical condition of the infant warrants her to interrupt, stop, or never start breastfeeding.

Mothers with HIV who have questions about breastfeeding should receive patient-centered, evidence-based counseling on infant feeding options. Learn more.

  • Infant is diagnosed with classic galactosemiaexternal icon, a rare genetic metabolic disorder1
  • Mother has HIV, is not on antiretroviral therapy (ART), and/or does not have a suppressed viral load during pregnancy (at a minimum throughout the third trimester), delivery, and postpartum.
  • Mother is infected with human T-cell lymphotropic virus type I or type II (HTLV – 1/2)1
  • Mother is using an illicit drug, such as opioids, PCP (phencyclidine) or cocaine4 (For mothers who discontinue illicit opioids or other substances and are on stable methadone or buprenorphine maintenance therapy, breastfeeding should be encouraged.)
  • Mother has suspected or confirmed Ebola virus disease

Mothers may be able to resume breastfeeding after consulting with a physician to determine when their breast milk is safe for their infant. These mothers should be provided with lactation support to learn how to maintain milk production and feed their infants with pasteurized donor human milk, previously expressed breast milk (if appropriate), or formula, while temporarily not breastfeeding.

  • Mother is infected with untreated brucellosis1
  • Mother is taking certain medications1,2
  • The mother is undergoing diagnostic imaging [PDF-778KB] with radiopharmaceuticals2
  • Mother has an active herpes simplex virus (HSV) infection with lesions present on the breast3 (Note: Mothers can breastfeed directly from the unaffected breast if lesions on the affected breast are covered completely to avoid transmission)
  • Mother has mpox virus infection (Note: breastfeeding should be delayed until criteria for discontinuing isolation have been met (i.e., all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed)5.

Mothers may be able to resume breastfeeding after consulting with a physician to determine when their breast milk is safe for their infant. These mothers should be provided with lactation support to learn how to maintain milk production and feed their infants with pasteurized donor human milk, previously expressed breast milk (if appropriate), or formula, while temporarily not breastfeeding.

Airborne and contact precautions may require temporary separation of the mother and infant, during which time expressed breast milk should be given to the infant by another care provider. Mothers should be able to resume breastfeeding after consulting with a physician to determine when there is no longer a risk of spreading infection. These mothers should be provided with lactation support to learn how to maintain milk production while not breastfeeding and/or while expressing their milk.

  • Mother has untreated, active tuberculosis4
    (Note: The mother may resume breastfeeding once she has been treated appropriately for 2 weeks and is documented to be no longer contagious)
  • Mother has active varicella (chicken pox) infection that developed within the 5 days prior to delivery to the 2 days following delivery4

Airborne and contact precautions may require temporary separation of the mother and infant, during which time expressed breast milk should be given to the infant by another care provider. Mothers should be able to resume breastfeeding after consulting with a physician to determine when there is no longer a risk of spreading infection. These mothers should be provided with lactation support to learn how to maintain milk production while not breastfeeding and/or while expressing their milk.

Few medications are contraindicated while breastfeeding. Although many medications do pass into breast milk, most have no known adverse effect on milk supply or on infant well-being. However, healthcare providers should always weigh the risks and benefits when prescribing medications to breastfeeding mothers.

Learn more about safe prescription medication use while breastfeeding.

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

Sources
  1. Meek JY, Noble L; Section on Breastfeeding. (2022). American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics, 150 (1): e2022057988. 10.1542/peds.2022-057988.
  2. American Academy of Pediatrics Committee on Drugs. (2013). The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics. Pediatrics, 132(3):e796-e809.
  3. Academy of Breastfeeding Medicine. (2016). Protocol #26: Persistent Pain with Breastfeeding. Breastfeeding Medicine, 11(2):1-8.
  4. Meek JY, Noble L; Technical Report: Breastfeeding and the Use of Human Milk. Pediatrics July 2022; 150 (1): e2022057989. 10.1542/peds.2022-057989
  5. Clinical Considerations for Mpox in People Who Are Pregnant or Breastfeeding – CDC.
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