Breastfeeding with Influenza: Recommendation
Yes, mothers with influenza should absolutely continue breastfeeding while implementing specific infection control measures—breastfeeding is strongly recommended and actively protects infants against influenza through multiple immune mechanisms. 1
Core Recommendation and Rationale
Breastfeeding should be encouraged even when the mother or infant has active influenza illness. 1 The protective benefits of breastfeeding substantially outweigh any theoretical transmission risks, as:
- Breastfeeding activates innate antiviral mechanisms in infants, specifically type 1 interferons 1, 2
- Human milk delivers influenza-specific immunoglobulin A antibodies that provide passive immunity 2, 3
- Greater exclusivity of breastfeeding in the first 6 months reduces respiratory illness episodes with fever in infants 1, 2
- There is no evidence of influenza viral transmission through breast milk 2
Required Infection Control Measures During Active Maternal Influenza
Mothers must implement strict precautions to prevent droplet transmission while continuing to breastfeed directly: 2, 3
- Perform hand hygiene before every feeding to prevent contact transmission 2, 3
- Wear a surgical mask during all breastfeeding and close contact to minimize respiratory droplet exposure 2, 3
- These measures are recommended by both the CDC and WHO 2
When Direct Breastfeeding Cannot Occur
If the mother or infant is too ill to breastfeed directly, pump and feed expressed breast milk. 1, 2 This maintains nutritional and immunologic benefits while accommodating illness severity. 1
Antiviral Treatment Compatibility
Oseltamivir (75 mg orally twice daily for 5 days) is the preferred antiviral for breastfeeding mothers and does not contraindicate nursing. 2, 3 The FDA drug label confirms:
- Oseltamivir and its active metabolite are present in human milk at low levels considered unlikely to lead to toxicity in breastfed infants 4
- Postmarketing experience has not reported serious adverse effects from oseltamivir exposure via breast milk 4
- The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for oseltamivir 4
Baloxavir is NOT recommended for breastfeeding mothers due to lack of safety data on presence in breast milk, effects on the breastfed infant, or effects on milk production. 1, 2
Common Pitfalls to Avoid
Do not unnecessarily separate mother and infant or discontinue breastfeeding based on maternal influenza diagnosis alone. 1 A 2011 survey revealed that 58% of US hospitals restricted breastfeeding by mothers with influenza-like illness during the 2009 H1N1 pandemic 5, which contradicts evidence-based guidelines and deprives infants of critical protective antibodies. 1, 2
The infant has already been exposed to influenza through close contact before diagnosis in most cases, so stopping breastfeeding at the time of diagnosis only removes the protective immunologic benefits without reducing transmission risk. 6
Additional Context on Protective Mechanisms
Breastfeeding provides adaptive immunity that is particularly relevant during viral pandemics—the immunological composition of breast milk adjusts to the infant's needs and provides timely immune defenses through immune regulation, modulation, and acceleration. 7 This dynamic protection is especially valuable when facing challenging organisms like influenza viruses. 7