Breast milk provides essential nutrients and immune components that protect infants from various illnesses. Many parents wonder about the possibility of transmitting infections through breast milk. Understanding which infections can or cannot be passed, and the necessary precautions, is important for informed feeding decisions. This discussion aims to clarify the complexities surrounding infection transmission and breastfeeding.
Infections That Can Be Transmitted
Some infections carry a risk of transmission through breast milk. Human Immunodeficiency Virus (HIV) is one such infection. For mothers with HIV, especially where safe infant formula is available, healthcare providers generally recommend avoiding breastfeeding to prevent transmission. However, for mothers on antiretroviral therapy (ART) with an undetectable viral load, the transmission risk is less than 1%, though not zero.
Human T-lymphotropic Virus Type 1 and 2 (HTLV-1/2) can also be transmitted through breast milk, which is considered its primary mode of mother-to-child transmission. Studies indicate that the risk of transmission increases with longer breastfeeding durations. Avoiding breastfeeding is generally recommended to prevent HTLV-1/2 transmission.
Herpes Simplex Virus (HSV) is typically transmitted through direct contact with active lesions, not through the milk itself. If a mother has active herpes lesions on her breast, it is not safe to feed from that breast or use expressed milk from it, as the milk can become contaminated. Breastfeeding from the unaffected breast is generally acceptable, provided active lesions on the affected breast are completely covered.
Syphilis can be passed to a baby during breastfeeding if sores are present on the breast. The bacteria can enter the baby through direct contact with active sores. If a mother has syphilis sores on her breast, she should pump or hand-express milk from that breast and discard it until the sores heal.
Varicella-zoster virus (VZV), which causes chickenpox, can pose a risk if the mother has active lesions, particularly on the breast. While generally transmitted via respiratory droplets or direct contact, an active infection on the breast might require temporary cessation of breastfeeding from that breast. Cytomegalovirus (CMV) can be present in breast milk and transmitted to infants. While CMV transmission rarely causes serious illness in full-term infants, it can concern premature infants, especially those with very low birth weight, who are more susceptible to severe outcomes.
Infections Not Transmitted
Many common infections do not typically transmit through breast milk, or the risk is low and often outweighed by breastfeeding’s protective benefits. Viruses causing the common cold and influenza are generally not passed through breast milk. Instead, breastfeeding transmits protective antibodies from the mother to the infant, offering immunity. Maintaining good hygiene, like frequent handwashing and wearing a mask with respiratory symptoms, prevents droplet transmission.
Most common bacterial infections, including strep throat, skin infections, or mastitis, do not pose a risk of transmission through breast milk. For mastitis, continuing to breastfeed from the affected breast can help resolve the infection and maintain milk supply. If a bacterial infection requires maternal antibiotic treatment, compatible regimens can often be chosen.
Hepatitis A is not transmitted through breast milk, even if detected in the milk. Breastfeeding benefits generally outweigh any potential risk, and mothers with Hepatitis A are encouraged to continue breastfeeding with proper hygiene. For Hepatitis B, while the virus can be found in breast milk, infant transmission risk is negligible if the baby receives Hepatitis B immune globulin (HBIG) and the first vaccine dose shortly after birth. This vaccination effectively protects the infant, making breastfeeding safe.
Hepatitis C transmission through breast milk is very low and generally not a contraindication to breastfeeding. While the virus can be found in breast milk, no strong evidence suggests it causes illness in breastfed infants. If nipples are cracked or bleeding, temporary cessation from the affected breast might be advised to prevent potential blood-borne transmission, as Hepatitis C is primarily spread through blood.
Regarding COVID-19, current evidence indicates that while the SARS-CoV-2 virus might be present in breast milk, no documented transmission causes illness in infants through this route. Breast milk from mothers who have had COVID-19 or been vaccinated contains protective antibodies, offering passive immunity. Mothers with COVID-19 are encouraged to continue breastfeeding with appropriate hygiene precautions.
Protecting Your Baby While Breastfeeding
Protecting the baby while breastfeeding with an infection involves several practical measures. Treating the mother’s infection is often the most effective way to safeguard the infant. Timely medical consultation ensures appropriate diagnosis and management.
Consistent hygiene practices minimize the spread of germs. Frequent handwashing, especially before and after handling the baby or breastfeeding, reduces the transfer of infectious agents. If a mother has respiratory symptoms, wearing a mask during close contact with the baby, including feeding, prevents droplet transmission.
In specific situations, temporary cessation of breastfeeding from one or both breasts might be advised. This could occur if active lesions on the breast could directly expose the infant to infection, or if the mother’s severe illness requires medications incompatible with breastfeeding. During such interruptions, pumping and discarding milk can help maintain the mother’s milk supply.
Personalized medical advice is always recommended. Healthcare providers, including pediatricians, obstetricians, and lactation consultants, offer tailored guidance based on the specific infection, its severity, and the individual circumstances of the mother and infant. Their expertise helps balance breastfeeding benefits against potential risks.
Making Informed Choices
Decisions about breastfeeding with an infection involve carefully weighing potential risks against breast milk’s considerable benefits. Breast milk offers unique nutritional advantages, supports the infant’s immune system, and fosters bonding. For many infections, the transmission risk through breast milk is low, and its protective factors often outweigh this minimal risk.
Individualized guidance from healthcare professionals is important. A pediatrician provides insight into the infant’s health and susceptibility, while an obstetrician advises on the mother’s condition and treatment. Consulting a lactation consultant also offers practical support for maintaining breastfeeding during challenging times.
Parents are encouraged to have open discussions with their medical team. This includes sharing details about the specific infection, treatment options, and personal breastfeeding goals. With accurate information and support, most mothers can safely navigate breastfeeding, even when managing an illness.