Breastfeeding is widely considered to be the best way to nourish your baby. When you’re sick and caring for a baby, it’s completely normal to worry about passing your illness along. Many moms feel a mix of guilt, concern, and exhaustion during these moments. The good news is that babies are already being protected by the antibodies your body is making, especially if you’re breastfeeding. Breast milk protects infants from the flu (influenza) and other common contagions by sharing some of the nursing parent’s antibodies. It’s also a way for you to bond with your newborn through literal physical connection. Still, some parents may wonder if it’s okay to continue breastfeeding if they’re sick or taking medication.
Is it safe to breastfeed when sick?
In most cases, it’s perfectly safe to continue breastfeeding while you’re sick, as long as you take some basic precautions to protect your baby from illness. Breastfeeding while sick may even provide some protection against pathogens to your baby. When you’re sick, your immune system is actively producing antibodies, and those antibodies can pass to your baby through breast milk. It doesn’t necessarily mean your baby won’t get sick, but it could mean they’ll have reduced symptoms and a shorter illness. If you’re too sick to nurse at the breast, you can pump or express breast milk and have someone else feed your infant. That way, your baby still gets the nutrition they need, and you don’t have any interruptions to your milk flow.
If you’re breastfeeding while sick, make sure to wash your hands with soap and warm water before touching your baby or touching any objects your baby is going to touch. Wash your hands after coughing or sneezing, and sanitize bottles and pumping equipment. Wearing a mask can also reduce the transmission of respiratory viruses.
Breastfeeding While Sick With a Cold, Flu, or COVID
The flu, the common cold, and other respiratory viruses usually cause mild to severe illness by infecting the nose, throat, and lungs. Those infections are mostly spread through respiratory droplets introduced into the air when coughing, sneezing, or talking, not through breast milk.
The flu is not transmitted through breast milk, and research on COVID-19 did not find it in breast milk either. Transmission of other respiratory illnesses through breast milk is low, and both the Centers for Disease Control (CDC) and World Health Organization (WHO) recommend breastfeeding parents continue to breastfeed when sick. Even if you have the flu, breast milk is still the best source of nutrition for your baby, and continuing to breastfeed will help you maintain your milk supply.
If you are vomiting or have a stomach bug, you should continue breastfeeding while dramatically increasing your fluid intake to stay hydrated. Food and water-borne illnesses, which cause diarrhea or gastric distress, aren’t passed through breast milk.
Infants are at higher risk of flu-related complications, especially kids younger than six months old who can’t receive the flu shot. To reduce the risk to newborns, parents and caregivers should receive annual flu vaccinations. If you or anyone in your home is sick, make sure to disinfect surfaces, clean clothing, towels, and bedding, wash pumps, storage containers, bottles, and feeding utensils before and after each use to reduce the risk of spreading the infection to your baby.
What medications are safe while breastfeeding?
If you find yourself in need of prescription medication, discuss breastfeeding with your provider. They can balance many considerations, including your need for the medication, the impact on milk production, the amount of the medication that passes into the milk, the infant’s oral absorption, the positive and negative effects on the infant, the infant’s age, and other factors.
Almost all medications taken by mouth, whether prescribed or over the counter, pass through the breast milk, but the amount is usually small and has a negligible impact on your newborn. There are, however, some exceptions.
Nursing parents should avoid using bismuth subsalicylate, also known as pink bismuth. It’s the main ingredient in Pepto-Bismol and other medications for digestive discomfort. It can pass salicylate to children through the breast milk, potentially leading to a worsening brain disease called Reye syndrome.
Painkillers
Nursing parents should avoid aspirin, but acetaminophen and ibuprofen are generally safe pain killers to take while nursing.
Antibiotics
Antibiotics like amoxicillin and penicillin are generally safe to take while nursing. Antibiotics may be passed through breast milk, but most healthcare providers agree that short-term use of antibiotics is safe while breastfeeding. Talk with your child’s pediatrician about whether it’s safe to continue breastfeeding.
Other antimicrobial agents, such as miconazole (Monistat), fluconazole, and clotrimazole, can be used, but you should apply the smallest possible amount.
Antihistamines
Medications like cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) are commonly taken to treat symptoms of seasonal allergies and are generally safe to take while breastfeeding.
Decongestants
Over-the-counter decongestants don’t generally pose any risk to your newborn, but some decongestants like Sudafed 24 Hour and Zyrtec-D 12 Hour may reduce milk supply.
Birth Control
Many types of birth control are compatible with breastfeeding, including the intrauterine contraceptives levonorgestrel and copper, implant etonogestrel, and Progestin-only contraceptive pills, also called minipills (norgestrel or norethindrone).
Mental Health
Medications for depression and anxiety, including sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and others, are all safe to use while breastfeeding.
Muscle Relaxers
The transmission and effects of muscle relaxants like cyclobenzaprine are largely unknown. Talk with your doctor before nursing while taking muscle relaxers.
When taking any medication, talk to your child’s pediatrician if you notice changes in your child’s sleep habits, eating habits, fussiness, rash, difficulty breathing, or other unexpected changes in behavior. They can help you pinpoint what, if anything, might be affecting your child.
If you have questions about a specific medication, the U.S. National Library of Medicine (NLM) at the National Institutes of Health (NIH) maintains LactMed, a database that documents the impact of different medications and chemicals on breastfeeding.
When Breastfeeding May Need Extra Guidance if You’re Sick
In most cases, you can continue to breastfeed as you normally would while sick or taking medications, but some situations warrant extra caution. The highest risk is among premature babies, newborns, and babies with kidney issues. Babies who are six months or older with no underlying health conditions are generally able to process any medications passed through breast milk with minimal risk. Talk to your baby’s pediatrician about any medications or supplements you’re taking to assess the potential risk to your baby.
Some medications are safe for your baby but may reduce your milk supply. Prolactin and oxytocin are two hormones involved in milk production; any medications that affect either hormone can affect milk production. You may also want to avoid cold medicines containing pseudoephedrine, birth control containing estrogen, and fertility medications like clomiphene, all of which have been associated with reduced milk production.
If you’re taking a medication that might be harmful to your baby, your doctor may recommend a temporary alternative until you’re finished breastfeeding. Depending on the medication, you might only need to change the timing of your dose so that you take your medication right after breastfeeding or pumping. That way, the smallest possible dose is passed into the breast milk.
If you need to stop breastfeeding for any reason, you may want to continue pumping to help maintain your milk supply. In the meantime, the team at Families First Pediatrics can help you find the right feeding alternative until you’re ready to resume breastfeeding.
