Breastmilk has been shown to protect against a variety of diseases and is immensely beneficial to both mother and baby. Therefore, it is important to maximize the amount of breastmilk baby receives to help provide the best neurodevelopmental outcomes. The guidance for needing to "pump and dump" in certain situations is outdated. Mothers are still inappropriately advised to stop breastfeeding due to infection risk or stop medication use for fear of exposure in breastmilk. We will review absolute contraindications to breastfeeding in regard to types of infections and clarify several situations where mothers are still able to feed their infants with careful counseling.
Author's Note: A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person.
Contraindications to breastfeeding include:
- Mothers with HIV who are not on antiretroviral therapy and/or do not have suppression of their viral load during pregnancy, delivery and postpartum
- Mothers with human T-cell lymphotropic virus (HTLV) type I and type II
- Mothers using illicit drugs such as opioids, phencyclidine or cocaine*
- *Mothers taking methadone or buprenorphine maintenance therapy should be encouraged to still breastfeed.
- Mothers with suspected or confirmed Ebola virus
Temporary contraindications to breastfeeding AND providing expressed breast milk:
- Mothers with untreated brucellosis
- Mothers with active herpes simplex virus breast lesions
- Mothers with mpox viral infection until resolution of lesions
- Mothers undergoing diagnostic imaging with radiopharmaceuticals*
- *In the case of iodinated contrast or gadolinium, mother can still breastfeed afterwards without cessation.
Temporary contraindications to breastfeeding BUT expressed breast milk can still be given:
- Mothers with untreated, active tuberculosis
- Mothers with active varicella (chickenpox) infection that developed 5 days prior to delivery to 2 days following delivery
It is important to note that mothers can still breastfeed if they have mastitis, or inflammation and/or infection of the breast tissue. Continuing, breastfeeding is actually recommended since mastitis develops from lack of milk emptying from the breast, causing blockage.
In regard to medication usage, most commonly used medications are relatively safe during breastfeeding. Contraindicated medications include amiodarone (may affect infant thyroid function), anticancer medications (bone marrow suppression), codeine and tramadol (due to ultra-rapid metabolism and potential to cause breathing problems in the infant). Many mothers experience anxiety and post-partum depression but worry that treatment will affect their ability to breastfeed. Sertaline is the first-line treatment for mothers who are breastfeeding, but other antidepressants have also been found to be safe. Mothers should talk with their providers about treatment options that still allows breastfeeding goals to be met.
Caffeine: Good news here for sleep-deprived parents. Although caffeine does pass through breast milk, it does not affect the infant at low to moderate amounts (about 2-3 cups of coffee). Effects such as jitteriness, irritability, fussiness and poor sleep have been reported in infants when mothers consume 10 or more cups of coffee per day. Learn more.
Alcohol: A moderate amount of alcohol use (1 glass of wine or beer per day) is unlikely to affect a breastfeeding infant, especially if the mother waits about 2 hours before nursing again. The amount of alcohol in breastmilk has transient passage similar to alcohol levels in maternal blood. Beer has been shown to decrease breastmilk intake by 20-23% and decrease the length of time that mothers breastfeed their infants. Learn more.
There is a comprehensive Drugs and Lactation Database (LactMed) available through the National Institute of Health (NIH) that provides updated information on the effect of medications and herbal supplements on lactation and the breastfeeding infant. E-Lactancia is another resource in both English and Spanish that provides information about medication compatibility with breastfeeding.
Please remember, this is not an exhaustive list and mothers should always discuss with their own doctor as well as their baby’s pediatrician about breastfeeding concerns with infections and medication exposures.
About the Authors
Hailey Nelson, MD, FAAP, IBCLC is a complex care pediatrician at Valley Children’s Charlie Mitchell Children’s Center. Dr. Nelson enjoys working with children of all ages and abilities and is especially passionate about providing the best possible care to medically fragile children and their families. As the ambassador for Safe Kids Central California, she is a vocal advocate for children’s wellness and regularly appears in news media discussing pediatric healthcare. She is also a licensed breastfeeding consultant, certified by the International Board of Lactation Consultants to support nursing mothers and their babies.
Dr. Sarah Benke earned her medical degree from Touro University and is a pediatric resident with Valley Children’s Pediatric Residency Program. She is passionate about domestic violence, child abuse awareness, adverse childhood experiences, sports medicine and student mentoring. Her research experience includes studies on the changes in brain structure and behavior from radiation and chemotherapy, fetal care and placental development. Dr. Benke also has a background in drug safety side effect reporting.
Resources:
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. 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. 4. Academy of Breastfeeding Medicine. (2016). Protocol #26: Persistent Pain with Breastfeeding. Breastfeeding Medicine, 11(2):1-8.
5. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/
6. Hotham N, Hotham E. Drugs in breastfeeding. Aust Prescr. 2015 Oct;38(5):156-9. doi: 10.18773/austprescr.2015.056. Epub 2015 Oct 1. Erratum in: Aust Prescr. 2016 Feb;39(1):27. PMID: 26648652; PMCID: PMC4657301.