Over the years, far too many parents have been wrongly told they had to stop breastfeeding. The decision about continuing breastfeeding when the breastfeeding parent 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 breastfeeding parent, 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, minuscule amount of medication, as is almost always the case, to the breastfeeding parent’s milk make breastfeeding more hazardous than formula feeding? The answer is almost never. Breastfeeding with a tiny amount of drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping. See the information sheet “Breastfeeding and Medications”. The same consideration needs to be taken into account when the breastfeeding parent 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 breastfeeding parent to pump milk while the baby is not breastfeeding, but this is not always easy in practice and the breastfeeding parent may end up painfully engorged.

Illness in the Breastfeeding Parent

Very few illnesses require the breastfeeding parent to stop breastfeeding. This is particularly true for infections the breastfeeding parent might have, and infections are the most common type of illness for which breastfeeding parents are told they must stop. Viruses cause most infections, and most infections due to viruses are most infectious before the breastfeeding parent even begins to feel sick. By the time the breastfeeding parent has fever (or runny nose, or diarrhoea, or cough, or rash, or vomiting etc), the infection has probably already passed on to the baby. However, breastfeeding protects the baby against infection, and the breastfeeding parent 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 breastfeeding parents are pleasantly surprised that their babies do not get sick at all. Bacterial infections (such as “strep throat”) are also not of concern for the very same reasons.

Click here for an article written by Dr. Jack Newman further describing how breastfeeding protects infants from infections.

Click here for more information about breastfeeding and illness in the breastfeeding parent.

HIV (new recommendations)

The World Health Organization now recommends that all breastfeeding parents, regardless of their HIV status, practice exclusive breastfeeding – which means no other liquids or food are given – in the first six months. It is recommended that both HIV-positive breastfeeding parents and their infants take antiretroviral drugs throughout the period of breastfeeding and until the infant is 12 months old. This means that the child can benefit from breastfeeding with very little risk of becoming infected with HIV. With the provision of antiretroviral drugs, breastfeeding is made dramatically safer and the “balance of risks” between breastfeeding and replacement feeding is fundamentally changed. A major additional benefit of this recommendation is that the breastfeeding parent’s health is also protected for a greater proportion of HIV-infected women.

Antibodies in the Milk

Some breastfeeding parents 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 body against its own tissues. Some breastfeeding parents have been told that because antibodies get into the milk, they should not breastfeed, as it will cause illness in the baby. This is incredible nonsense. The breastfeeding parent 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.

Breast Problems

• Mastitis (breast infection) is not a reason to stop breastfeeding. In fact, the breast is likely to heal more rapidly if the breastfeeding parent continues breastfeeding on the affected side (see information sheet “Blocked Ducts and Mastitis”).
• Breast abscess 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, not only for this baby but all subsequent babies. 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. Nonetheless, these days breast abscess does not require surgery. Repeated needle aspiration, or placement of a catheter to drain the abscess plus surgery.  See the information sheet “Blocked Ducts and Mastitis” for more information about abscess and a better way to treat abscess.  See more information about sore breasts here.
• Surgery of any kind does not require interrupting 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 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 and not only for this baby, but also for every subsequent baby. 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. 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 when the breast is lactating, but can still be useful. Once again, how long must a breastfeeding parent 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, MRI, CT scan, needle biopsy, sore biopsy). Discuss the options with your doctor. Let him/her know breastfeeding is important to you.

New Pregnancy

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 own. For articles supporting lack of negative effect of breastfeeding on pregnancy, click here and here. Here are two studies that provide evidence that breastfeeding while pregnant does not increase the risk of miscarriage:

Ayrim A, Gunduz S Akcal B, Kafali H. Breastfeeding Throughout Pregnancy in Turkish Women. Breastfeeding Medicine 2014;9(3):157-160 https://goo.gl/DsbK2E

“Conclusions: Breastfeeding during pregnancy is not harmful, and health professionals should not advise weaning if overlapping occurs and should observe mother, infant, and fetus closely for negative effects, and if a negative effect occurs they should take precautions.”

Madarshahian F, Hassanabadi M. A Comparative Study of Breastfeeding During Pregnancy: Impact on Maternal and Newborn Outcomes. Journal of Nursing Research 2012; 20(1):74-79 https://goo.gl/zoKNvK

“Conclusions/Implications for Practice: Results suggest that breastfeeding during normal pregnancy does not increase chance of untoward maternal and newborn outcomes. Nurses and midwives should give expectant mothers appropriate evidence-based guidance and focus attention on promoting proper nutritional intake based on lactation status during pregnancy.”

Illness in the Baby

Breastfeeding rarely needs to be discontinued for infant illness. Through breastfeeding, the breastfeeding parent is able to comfort the sick child, and, by breastfeeding, the child is able to comfort the parent.

• 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. Incidentally, oral rehydration fluids were developed as a very inexpensive treatment for dehydration. Check the price of commercial oral rehydration fluids in affluent countries. About the price of a decent bottle of wine. Not bad for selling water.
• 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 and breastfeeding.
• 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 and bilirubin is an antioxidant. (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 breastfeeding to stop. 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 the information sheet “Breastfeeding and Jaundice” for more information.  Also our blog Breastfeeding, bilirubin and jaundice.

A sick baby does not need breastfeeding less, he needs it more!!

If the question you have is not discussed above, do not assume that you must stop breastfeeding. Do not stop. Get more information. Breastfeeding parents have been told they must stop breastfeeding for reasons too silly to discuss.

The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.

This information sheet may be copied and distributed without further permission on the condition that you credit International Breastfeeding Centre and it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!

©IBC, updated July 2009, June 2017

Questions or concerns?  Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.