Breastfeeding and Illness
Over the years, far too many women have been wrongly told
they had to stop breastfeeding. The decision about continuing
breastfeeding when the mother takes a drug, for example, is far more
involved than whether the baby will get any in the milk. It also
involves taking into consideration the risks of not breastfeeding, for
the mother, the baby and the family, as well as society. And there are
plenty of risks in not breastfeeding, so the question essentially boils
down to: Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping. The same consideration needs to be taken into account when the mother or the baby is sick.
Remember that stopping breastfeeding for a week or even days may result
in permanent weaning as the baby may then not take the breast again. On
the other hand, it should be taken into consideration that some babies
may refuse to take the bottle completely, so that the advice to stop is
not only wrong, but often impractical as well. On top of that it is easy
to advise the mother to pump her milk while the baby is not
breastfeeding, but this is not always easy in practice and the mother
may end up painfully engorged.
Illness in the Mother
Very few maternal illnesses require the mother to stop breastfeeding.
This is particularly true for infections the mother might have, and
infections are the most common type of illness for which mothers are
told they must stop. Viruses cause most infections, and most infections
due to viruses are most infectious before the mother even has an idea
she is sick. By the time the mother has fever (or runny nose, or
diarrhoea, or cough, or rash, or vomiting etc), she has probably already
passed on the infection to the baby. However, breastfeeding protects
the baby against infection, and the mother should continue
breastfeeding, in order to protect the baby. If the baby does
get sick, which is possible, he is likely to get less sick than if
breastfeeding had stopped. But often mothers are pleasantly surprised
that their babies do not get sick at all. The baby was protected by the
mother’s continuing breastfeeding. Bacterial infections (such as “strep
throat”) are also not of concern for the very same reasons.
See previous Information Sheet, Breastfeeding and Medications with regard to continuing breastfeeding while taking medication.
The only exception to the above is HIV infection in the mother. Until we
have further information, it is generally felt that the mother who is
HIV positive not breastfeed, at least in the situation where the risks
of artificial feeding are considered acceptable. There are, however,
situations, even in Canada, where the risks of not breastfeeding are
elevated enough that breastfeeding should not be automatically ruled
out. The final word is not yet in. Indeed, recently information came out
that exclusive breastfeeding protected the baby from
acquiring HIV better than formula feeding and that the highest risk is
associated with mixed feeding (breastfeeding + artificial feeding). This
work needs to be confirmed.
Antibodies in the Milk
Some mothers have what are called “autoimmune diseases”, such as
idiopathic thrombocytopenic purpura, autoimmune thyroid disease,
autoimmune hemolytic anemia and many others. These illnesses are
characterized by antibodies being produced by the mother against her own
tissues. Some mothers have been told that because antibodies get into
the milk, the mother should not breastfeed, as she will cause illness in
her baby. This is incredible nonsense. The mother should breastfeed.
The antibodies that make up the vast majority of the antibodies in the
milk are of the type called secretory IgA. Autoimmune diseases are not
caused by secretory IgA. Even if they were, the baby does not absorb
secretory IgA. There is no issue. Continue breastfeeding.
Mastitis (breast infection) is not a reason to stop
breastfeeding. In fact, the breast is likely to heal more rapidly if the
mother continues breastfeeding on the affected side. (See Information
Sheet Blocked Ducts and Mastitis)
Breast abscess is not a reason to stop breastfeeding, even on the
affected side. Although surgery on a lactating breast is more
difficult, the surgery and the postpartum course do not necessarily
become easier if the mother stops breastfeeding, as milk continues to be
formed for weeks after stopping breastfeeding. Indeed, engorgement
after surgery only makes things worse. Make sure the surgeon does not do
an incision that follows the line of the areola (the line between the
dark part of the breast and the lighter part). Such an incision may
decrease the milk supply considerably. An incision that resembles the
spoke on a bicycle wheel (the nipple being the centre of the wheel)
would be less damaging to milk-making tissue. These days breast abscess
does not always require surgery. Repeated needle aspiration, or
placement of a catheter to drain the abscess plus antibiotics often
allows avoidance of surgery.
Any surgery does not require stopping breastfeeding. Is the
surgery truly necessary now, while you are breastfeeding? Are you sure
that other treatment approaches are not possible? Does that lump have to
be taken out now, not a year from now? Could a needle biopsy be
enough? If you do need the surgery now, make sure again the incision is
not made around the areola. You can continue breastfeeding after the
surgery is over, immediately, as soon as you are awake and up to it.
If, for some reason, you do have to stop on the affected side, do not
stop on the other. Some surgeons do not know that you can dry up on one
side only. You do not have to stop breastfeeding because you are
having general anaesthesia. You can breastfeed as soon as you are awake
and up to it.
Mammograms are more difficult to read if the mother is
breastfeeding, but can still be useful. Once again, how long must a
mother wait for her breast no longer to be considered lactating?
Evaluation of a lump that requires more than history and physical
examination can be done by other means besides a mammogram (for example,
ultrasound, needle biopsy). Discuss the options with your doctor. Let
him/her know breastfeeding is important to you.
There is no reason that you cannot continue breastfeeding if you become
pregnant. There is no evidence that breastfeeding while pregnant does
any harm to you, or the baby in your womb or to the one who is nursing.
If you wish to stop, do so slowly, though; because pregnancy is
associated with a decreased milk supply and the baby may stop on his
Illness in the Baby
Breastfeeding rarely needs to be discontinued for infant illness.
Through breastfeeding, the mother is able to comfort the sick child,
and, by breastfeeding, the child is able to comfort the mother.
A sick baby does not need breastfeeding less, he needs it more!!
Diarrhoea and vomiting. Intestinal infections are rare in
exclusively breastfed babies. (Though loose bowel movements are very
common and normal in exclusively breastfed babies.) The best treatment
for this condition is to continue breastfeeding. The baby will get
better more quickly while breastfeeding. The baby will do well with
breastfeeding alone in the vast majority of situations and will not
require additional fluids such as so called oral electrolyte solutions
except in extraordinary cases.
Respiratory illness. There is a medical myth that milk should not
be given to children with respiratory infections. Whether or not this
is true for milk, it is definitely not true for breastmilk.
Jaundice. Exclusively breastfed babies are commonly jaundiced,
even to 3 months of age, though usually, the yellow colour of the skin
is barely noticeable. Rather than being a problem, this is normal.
(There are causes of jaundice that are not normal, but these do not,
except in very rare cases, require stopping breastfeeding.) If
breastfeeding is going well, jaundice does not require the mother to
stop breastfeeding. If the breastfeeding is not going well, fixing the
breastfeeding will fix the problem, whereas stopping breastfeeding even
for a short time may completely undo the breastfeeding. Stopping
breastfeeding is not an answer, not a solution, not a good idea. (See
Information Sheet Breastfeeding and Jaundice)
If the question you have is not discussed above, do not assume
that you must stop breastfeeding. Do not stop. Get more information.
Mothers have been told they must stop breastfeeding for reasons too
silly to discuss.
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Breastfeeding and Illness (You Should Continue Breastfeeding (2)) 2009©
Written and Revised by Jack Newman, MD, FRCPC, 2009©
Revised by Edith Kernerman, IBCLC, 2009©