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.
- Can the flu be transmitted through breast milk?
- Should mothers continue breastfeeding if they have flu or come in contact with someone with flu?
- Can infants who have flu continue to breastfeed?
- Are there special considerations for mothers with flu in peri- and postpartum healthcare settings?
- How can a breastfeeding mother with flu protect her infant from getting sick?
- How can caregivers prevent transmission of flu to infants?
- Is the flu vaccine safe for breastfeeding mothers and their infants?
- Are influenza antiviral prescription medications safe to use while mothers are breastfeeding or providing expressed breast milk to their infants?
Influenza (also called flu) is an acute respiratory tract illness caused by influenza viruses that infect the nose, throat, and lungs, causing a contagious respiratory illness. 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.
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.
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.
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.
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.
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.
- Immunization of pregnant and breastfeeding women pdf icon[PDF-732KB] 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.
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)external icon. For additional general information on flu antiviral medications for healthcare providers, please visit the Influenza (Flu) Antiviral Drugs website.
|Table 1. Safety of currently recommended prescription influenza antiviral medications while breastfeeding|
|Prescription antiviral medication||Type of Influenza||Data on safety while breastfeeding|
|Oseltamivir||Influenza A and B||Poorly excreted in breast milk; adverse effects unlikely|
|Zanamivir||Influenza A and B||Not available|
|Peramivir||Influenza A and B||Not available|
|Source: U.S. National Library of Medicine, Toxicology Data Network, LactMedexternal icon|
- Encourage mothers to get the flu vaccination for themselves, their children who are aged 6 months and older, other household members, and others caring for their infants.
- Help mothers maintain their milk supply while ill and if separated from their newborns in the health care setting.
- Remind mothers and caregivers that breast milk remains the best source of nutrition for the infant, and provides protection through antibodies and other immunological factors.
- Teach mothers and their family members proper hand washing and cough etiquette techniques.
- Educate parents on how they can prevent flu in themselves and young children.
- Responding to Influenza: A Toolkit for Prenatal Care Providers pdf icon[PDF-5.43MB] – CDC
- Flu Shot Information for Pregnant and Breastfeeding Women pdf icon[PDF-732KB] – CDC
- Guidance for the Prevention and Control of Influenza in the Peri- and Postpartum Settings – CDC
- Protect Against Flu: Caregivers of Infants and Young Children – CDC – CDC
- Children, the Flu, and the Flu Vaccine – CDC
- Healthy Habits to Help Prevent Flu – CDC
- Handwashing: Clean Hands Saves Lives – CDC
- How to Keep Your Breast Pump Kit Clean: The Essentials – CDC
- Rasmussen, SA, Kissin, DA, Yeung, LF, et al. (2011). Preparing for Influenza after 2009 H1N1: Special Considerations for Pregnant Women and Newborns.external icon American Journal of Obstetrics & Gynecology; 204(6 Suppl 1):S13-20.
- Tanaka, T, Nakajima, K, Murashima, A, et al. (2009). Safety of neuraminidase inhibitors against novel influenza A (H1N1) in pregnant and breastfeeding women.external icon CMAJ; 181(1-2): 55-58.
- Greer, LG, Leff, RD, Rogers, VL, et al. (2011). Pharmacokinetics of oseltamivir in breast milk and maternal plasma.external icon American Journal of Obstetrics & Gynecology; 204(524): e1-4.