What to know
Breast milk helps protect infants from many respiratory diseases, including influenza (flu). Mothers with suspected or confirmed flu should take all possible precautions to avoid spreading the virus to their infants while continuing to provide them with breast milk.
About influenza
Influenza (also called flu) is an acute, contagious respiratory tract illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. Flu can cause mild to severe illness and, at times, can lead to death. People at high risk of developing flu-related complications include:
- Pregnant women.
- Young children.
- Adults 65 years and older.
- People with certain medical conditions.
Breastfeeding and flu transmission
Flu is not transmitted through breast milk
The flu is spread mainly from person-to-person via respiratory droplets when people cough, sneeze, or talk. These droplets can also possibly spread when a person touches a surface or object that has the flu virus and then touches their own mouth or nose. Flu is not transmitted through breast milk.
Mothers with flu can keep breastfeeding
Breast milk remains the best nutrition for infants
A mother with the flu may be too sick to feed her infant at the breast. In that case, the breastfeeding mother should be encouraged and supported to regularly express her milk so that the infant continues to receive her breast milk. Before expressing breast milk, mothers should wash their hands well with soap and water. If mothers use a pump, they should follow recommendations for proper cleaning.
Breast milk supply could decrease for some mothers while they are ill. A lactation support provider can address milk supply concerns, advise how to reduce the possibility of developing a breast infection, and support the breastfeeding relationship between mother and child.
Infants with the flu can continue to breastfeed
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 cannot breastfeed directly at the breast.
Health care settings
Before and after childbirth
Newborns infected with influenza viruses are at increased risk for severe complications, including death. CDC has specific recommendations for mothers with flu and their newborns in the hospital setting at birth.
Health care staff support
Direct breastfeeding may be interrupted due to temporary separation of mother and child. In that case, 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. She may also need lactation support after discharge to maintain her milk supply and reduce the possibility of developing a breast infection.
Before expressing breast milk, mothers should wash their hands well with soap and water. If they use a pump, they should 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.
Protecting infants from flu
Mothers with flu
A mother with flu should take precautions to avoid spreading it to her infant, regardless of her feeding method. Infants are at high risk of serious flu-related complications. Precautions are especially important for infants younger than 6 months because they cannot be vaccinated against influenza viruses.
Mothers with flu should thoroughly wash their hands with soap and water and dry their hands:
- Before touching the infant.
- Before touching any item that the infant will touch, including during feeding.
- Anytime they sneeze or cough on their hands.
Masks also can help reduce the spread of respiratory viruses. A breastfeeding mother who is sick can wear a mask to protect others.
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
Caregivers
Immunizations are safe for pregnant and breastfeeding women. Infants younger than 6 months cannot be vaccinated. To protect infants, all caregivers and household members 6 months and older should receive an annual flu vaccination, except in rare cases.
The following everyday preventive actions can also help protect infants from flu, whether they are breastfed or not.
- Avoid close contact with sick persons.
- Cover your nose and mouth with a tissue when sneezing or coughing and throw the tissue away immediately afterwards.
- Wear a mask to help reduce the spread of respiratory viruses and protect others.
- Practice proper hand hygiene.
- Disinfect surfaces.
- Take steps for cleaner air. This can mean bringing in fresh outside air, purifying indoor air, or gathering outdoors.
Flu vaccination and antiviral prescription medication
Flu vaccine safety
Flu vaccination is safe for breastfeeding women and their infants 6 months and older. Women who get the flu vaccine while pregnant or breastfeeding develop antibodies that are shared with infants through breast milk. Therefore, breastfeeding provides some flu protection for infants.
Annual flu vaccination is recommended for all persons 6 months and older, except in rare cases. Flu vaccines are particularly important for pregnant women. Additionally, to protect children younger than 6 months from flu, caregivers and household members should receive the flu vaccination.
Influenza antiviral prescription medication safety
Data on the effect of currently recommended influenza antiviral medications during breastfeeding are limited. However, CDC recommends that postpartum women with suspected or confirmed flu be treated with antiviral medications since they are at high risk of flu complications. Postpartum women are those who gave birth within the last two weeks.
For women who are breastfeeding with suspected or confirmed flu, the preferred antiviral medication is oral oseltamivir. Available data indicate that oseltamivir is not easily passed to the infant in breast milk. See Table 1.
| 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, LactMed | ||
For additional information:
What health care providers can do
To help protect breastfeeding mothers and their infants from flu, health care providers can:
- Encourage mothers to get the flu vaccination for themselves, their children 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. Breast milk provides 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.
Learn more
CDC resources
Responding to Influenza: A Toolkit for Prenatal Care Providers
Flu Shot Information for Pregnant and Breastfeeding Women
Guidance for the Prevention and Control of Influenza in the Peri- and Postpartum Settings
Protect Against Flu: Caregivers of Infants and Young Children
Healthy Habits to Help Prevent Flu
Handwashing: Clean Hands Saves Lives
How to Keep Your Breast Pump Kit Clean: The Essentials
Publications
Preparing for Influenza after 2009 H1N1: Special Considerations for Pregnant Women and Newborns.
Pharmacokinetics of oseltamivir in breast milk and maternal plasma.