What are the recommendations for a new mother diagnosed with influenza regarding breastfeeding and contact with her newborn infant?

Recommendations for Mothers with Influenza Caring for Newborns

Mothers diagnosed with influenza should continue breastfeeding and rooming-in with their newborn while implementing specific infection control measures—hand hygiene before every feeding and wearing a surgical mask during all close contact. 1

Breastfeeding Recommendations

Breastfeeding should be continued and is actively encouraged when a mother has influenza, as there is no evidence of viral transmission through breast milk and breastfeeding provides critical protective antibodies to the infant. 1

Key protective mechanisms of breastfeeding during maternal influenza:

• Delivers influenza-specific immunoglobulin A that provides passive immunity to the newborn 1
• Activates innate antiviral defenses in the infant's immune system 1
• Reduces respiratory illness episodes with fever during the first 6 months of life 1

Infection control during breastfeeding:

• Perform hand hygiene before every feeding to prevent droplet and contact transmission 1
• Wear a surgical mask while breastfeeding to minimize respiratory droplet exposure 1
• If mother or infant is too ill for direct breastfeeding, pump and feed expressed breast milk 1

Contact and Rooming-In Practices

Physical separation between mother and newborn is NOT recommended based on current evidence. A 2013 study following 42 mother-infant pairs through three influenza seasons found zero cases of influenza transmission when mothers practiced hand hygiene, received antiviral treatment, and continued rooming-in and breastfeeding. 2

Recommended approach:

• Continue rooming-in unless either mother or infant is too severely ill 1, 2
• Maintain standard infection control precautions rather than separation 2
• Focus on hand hygiene and mask use as primary protective measures 1

Important caveat:

Despite clear evidence supporting continued contact, a 2011 survey revealed significant practice variation in U.S. hospitals—58% restricted breastfeeding and 90% maintained physical separation during the 2009 H1N1 pandemic. 3 This represents outdated practice that contradicts current evidence-based recommendations.

Maternal Antiviral Treatment

Mothers should receive oseltamivir 75 mg orally twice daily for 5 days, which is safe during breastfeeding and does not contraindicate nursing. 1, 4

• Oseltamivir is the preferred antiviral for breastfeeding mothers according to ACOG 1
• Baloxavir is NOT recommended due to lack of safety data on presence in breast milk 1
• Treatment protects both mother and infant by reducing viral shedding and symptom duration 2

Prevention for Future Pregnancies

All pregnant women should receive inactivated influenza vaccine during any trimester, which provides up to 72% risk reduction for laboratory-confirmed influenza hospitalization in infants during their first months of life. 5, 4

• Vaccination during pregnancy transfers protective antibodies transplacentally 5
• Postpartum vaccination is also recommended if not received during pregnancy 5
• Family members and close contacts should be vaccinated to create a protective cocoon around the newborn 6

Risk Context for Newborns

Newborns exposed to family members with influenza face significant risk, as 18 of 21 neonates with confirmed influenza in a 2024 study had documented exposure to symptomatic family members before hospitalization. 7 Only 1 mother in that cohort had received influenza vaccine during pregnancy, highlighting the critical importance of maternal vaccination. 7