What to know
Herpes simplex virus (HSV) infections in infants can be severe. Mothers with HSV can continue to breastfeed if there are no lesions on the breasts, and if lesions elsewhere on the body are carefully and fully covered.
About herpes simplex virus
HSV is a lifelong virus that is categorized into two herpesvirus species:
- HSV-1 is typically transmitted by oral-oral contact to cause oral herpes but can also cause genital herpes through oral-genital contact.
- HSV-2 is typically sexually transmitted and causes genital herpes but can also cause infections in the mouth.
Both virus types can cause herpes disease in newborns and infants and can appear anywhere on the body. In newborns, HSV infections are often severe and result in high rates of sickness and death. Every precaution must be taken to prevent infants from being exposed to the herpes virus. Women with HSV should follow appropriate hand hygiene before holding the infant.
Breastfeeding with active lesions
Women with herpes lesions may transmit HSV to their infants by direct or indirect contact with the lesions. For mothers with active lesions, breastfeeding is acceptable if:
- No lesions are present on the breasts, and,
- Active lesions elsewhere on the mother are carefully and fully covered.
Mothers with active lesions on the breast should temporarily stop breastfeeding from the affected breast. She should not feed expressed breast milk from the affected breast. She should discard expressed breast milk from the affected side until the lesions have healed.
A mother may breastfeed her infant from the unaffected breast but should ensure that the lesions on the affected breast are completely covered to avoid transmission. Mothers should also follow appropriate hand hygiene to avoid transmission of herpes to her infant.
While breast lesions are healing, some mothers may need additional support to maintain their milk production. Some mothers may feed their infant previously expressed milk or expressed milk from the unaffected breast. They could also supplement with infant formula.
Mothers should consult with their health care provider to determine if their lesions have healed. A health care provider can help determine if the mother can resume breastfeeding or feeding expressed milk from the affected breast.
Providers:
Feeding hand-expressed or pumped breast milk
It is not safe for a mother to give her infant hand-expressed or pumped breast milk from an affected breast if she has active herpes lesions on her breast. Breast milk can be contaminated if it comes in contact with active herpes lesions by touching the breast during hand expression or via the pump.
Expressing breast milk will be important for maintaining milk production while not breastfeeding from the affected breast. Mothers with herpes lesions should discard expressed breast milk from the affected breast until the lesions have healed. Mothers should be vigilant about practicing appropriate hand hygiene and cleaning the pump parts thoroughly. Mothers should talk with their health care provider to determine if their lesions have healed and if they can resume breastfeeding or feeding expressed milk from the affected breast.
Reminder
• Mothers with herpetic lesions should discard expressed breast milk from the affected breast until the lesions have healed.
• Mothers can safely feed their child expressed breast milk from the unaffected breast as long as the lesions on the affected breast are completely covered to avoid transmission.
• Appropriate hand hygiene and cleaning the pump parts thoroughly are still important.
Learn more:
- Herpes simplex virus—World Health Organization
- Red Book: Herpes Simplex—American Academy of Pediatrics
- Clinical Protocol #26: Persistent Pain with Breastfeeding—Academy of Breastfeeding Medicine
- Lawrence RA, Lawrence R. Breastfeeding: A guide for the medical profession. 8th ed. Elsevier; 2016.