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Breastfeeding and the Flu: What Every Mother Needs to Know

Woman with tea and thermometer battling the flu.

The Centers for Disease Control (CDC) estimates that the flu results in between 9.3 and 49 million illnesses each year in the United States alone. Everyone tries to avoid getting the flu, and everyone wants to know how to cope with it if they do get it, but nursing mothers usually have additional concerns. So, if you’re a nursing mother, here are some quick facts about breastfeeding and the flu.

Cold, flu, or something else?

Symptoms of the flu virus frequently mimic symptoms of the common cold — a different virus. But, fever is a big clue. An oral temperature of about 38.0 (about 100.4°F) or more is common with the flu, but seldom occurs with a common cold. Special tests are needed to determine if you have the flu, or a common cold. However, the CDC has a table that compares several signs and symptoms of cold versus flu.

Having the flu and breastfeeding has yet another twist. You might ask yourself if you have mastitis. Over the years I’ve heard mothers complain of flu-like symptoms, especially the overall achiness and fever. So, if you have localized pain or redness in your breast along with those flu-like symptoms, consider mastitis as a possible problem. (Remember, mastitis can come on gradually, or very suddenly.)

Prevention

First, the best line of defense against the flu, and any viral illness, is good prevention. For as many decades as I can recall, public health authorities have named handwashing as a first and primary means of prevention for illness. Adults need to be especially committed to handwashing if they are in contact with infants under 6 months who cannot be vaccinated against the flu.

The CDC here in the US recommends washing with soap and water for 20 seconds, whereas the World Health Organization recommends washing for a full one minute. Cough into your elbow, rather than into your hands, to decrease the likelihood of spreading the virus to your baby or someone else.

Year to year, the formulation of the flu shot differs. It isn’t always a perfect match for the prevalent strain of the season, but getting the shot can reduce the severity of symptoms.

Is the flu shot safe for breastfeeding mothers? Of course, because the formulation of the flu shot differs each year, you should check the CDC’s web site before getting the shot. However, the seasonal flu vaccine has been administered for decades to millions of pregnant or breastfeeding women without any documented major complications.

The American Academy of Pediatrics recommends that for the 2019-20 season, children 6 months and older receive the flu shot or nasal vaccine, as appropriate by age. The CDC recommendation for the 2019-20 season is also the shot, or nasal vaccine when allowable or desired. The CDC emphasizes the importance of the injection for immunocompromised individuals, or those who are caregivers to the immunocompromised. And, asthmatics, pregnant women, or  individuals who have taken influenza antiviral medications within the last 48 hours, should receive the injection.

Breastfeeding with the flu: continue, or stop?

I’m often asked, “Can I still breastfeed while I have the flu?” The answer is yes! While you may be exhausted and feel awful, you can — and should — continue breastfeeding. There’s a high likelihood that if the lactating mother comes down with the flu, her baby has already been exposed. Separating the baby from his mother at this point  causes both physical and emotional consequences for both of them.

The flu does not pass through your milk. Your baby needs your antibodies. Your milk will help to build your child’s immune system. Last year, I encountered one mother who had a terrible case of flu, but she continued to nurse her 4-month old, who never got the flu at all. She attributed her baby’s well-being to her good handwashing practices and the antibodies she passed on to him.

In addition, issues with breastfeeding and the flu go beyond just nursing the baby. Thorough cleaning of pump parts is also important to reduce the risk of spreading the virus.

Treatment: what’s safe and effective for the flu while breastfeeding?

Tamiflu® and Relenza® are both effective in combating the flu, provided the dose is taken as soon as the signs and symptoms of flu begin. However, if you have had a fever for more than 48 hours, neither is likely to provide much — if any — benefit. Like all information published on this site, this post gives information, not medical advice. You should talk with your physician before deciding if and when to take any medication, including those related to flu. Below, is a table which I have adapted from the CDC; the CDC used information from LactMed for the data.

Prescription Antiviral Medication   Type of Influenza Data on Safety While Breastfeeding
Generic Name Trade Name
oseltamivir Tamiflu® Influenza A and B Poorly excreted in mother’s milk; adverse effects unlikely.
zanamivir Relenza® Influenza A and B Not available
peramivir Rapivab® Influenza A and B Not available
baloxavir marboxil Xofluza® Influenza A and B Not available

Be sure you have a virus before taking an antiviral prescription

Certainly, it will do no good to take a medication to treat the flu unless you have the flu! Antiviral medications can lessen flu symptoms. Studies show that these medications only help you recover from the flu one to two days faster. However, the CDC recommends that people in high risk categories, including pregnant women, should promptly seek medical attention.

What’s the bottom line about breastfeeding and the flu? Use simple techniques such as handwashing to avoid getting the flu. Consider the CDC’s recommendation to get a flu shot early in the flu season. If you develop symptoms, be sure that you have the flu, not something else. If you do have the flu virus, taking Tamiflu® is likely to provide benefit if taken in the first 48 hours, and according to the above-mentioned sources, is unlikely to pose much if any threat to your nursing baby. Most of all continue breastfeeding!

What have you done to protect yourself and your baby from the flu? Have you been ill with the flu while breastfeeding?

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2 Comments

  1. Jean Bonnyman, IBCLC

    Thanks for sharing this vital information to keep babies safe from influenza! One thing not mentioned was that (according to the CDC website) “people with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly their eyes.” So, while handwashing is important in general, it might not be enough for the flu. We should encourage mothers with the flu to wear a surgical mask to protect their infants from their saliva droplets until they are no longer contagious. This could be several days.

    • Marie Biancuzzo

      Jean, you are, of course, spot on! Thank you especially for pointing out the 6 feet away information–and using multiple means to reduce the likelihood of contagion.

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