ibc statement on breastfeeding and H1N1

NBCI: Newman Breastfeeding Clinic and Institute:


Breastfeeding protects babies against infectious illnesses. Breastmilk provides many immune factors to the baby. Although everyone talks about antibodies, antibodies are only one group of immune factors, of which there are dozens in breastmilk. These immune factors interact in many ways to protect the baby. One important way is that breastfeeding provides the baby with “mucosal immunity”. That is, breastmilk provides antibodies, mucins, lactoferrin, lysozyme, oligosaccharides and many other immune factors that line the gut and upper respiratory surface and prevent microbes (viruses, bacteria, fungi etc) from entering the baby’s body and making him sick1 2. In other words, breastfeeding, in effect, is isolation of the baby without isolating the baby.


How would the mother’s getting the H1N1 vaccine (mist or injectable) affect the baby?


It is not known if the vaccine would provide extra immunity to the baby, but there is no reason to believe it wouldn’t. If you get the vaccine, you should be confident that it will not harm your baby. If anything it might provide him with some extra protection but this has not been proved.


Should the mother who develops symptoms of H1N1 be separated from her baby? No!


The Center for Disease Control in Atlanta has stated that if a mother develops symptoms of H1N1 influenza, she should pump her milk and the milk be given to the baby by someone else, so the baby can be separated from the mother.


This is a puzzling statement. A mother who develops symptoms of H1N1 influenza was already infectious a day or more before she developed any symptoms, so the baby has almost surely been exposed to the virus already. Separating him from his mother can do no good and can do harm. First of all, a baby separated from his mother is under stress as is his mother, especially when the situation is overlaid with the stress of illness3. Secondly, expressing milk and giving it to the baby in a bottle results in some of the important immune factors decreasing in concentration in the milk.


The mother and baby should stay together, in bed together if the mother is feeling unwell and breastfeeding should continue. If the baby gets sick, it is best for the baby to continue breastfeeding.


The antiviral medications such as oseltamivir (Tamiflu) used to treat H1N1 can be taken by breastfeeding mothers without interrupting breastfeeding. The baby needs continued breastfeeding to decrease his risk of developing the illness. (Tanaka T, Nakajima K, Murashima A, Garcia-Bournissen F, Koren G, Ito S. Safety of neuraminidase inhibitors against novel influenza A (H1N1) in pregnant and breastfeeding women. CMAJ 2009; 181(1-2)


1 Hanson L, Korotkova M, Haversen L, et al. Breast-feeding, a complex support system for the offspring. Pediatrics International 2002;44;347–352

2 Per Brandtzaeg. Mucosal immunity: integration between mother and the breast-fed infant. Vaccine 2003:21;3382–3388

3 Christensson et al. Separation distress call in the human neonate in the absence of maternal body contact. Acta Paediatr 1995;84:468-73.

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