Can you breastfeed when you have the flu?

By nursing stage

Newborn stage

Early weeks

Early weeks. A newborn is the most vulnerable audience for anything you are carrying, so this is the stage where hand-washing before holding your baby and masking while feeding do the most work. Keep nursing while you do it.

Predictable feeds

Established nursing

Established nursing. If your provider starts an antiviral, this is where the numbers reassure: at 150 mg of oseltamivir daily, an infant takes in about 0.012 mg/kg through milk against a direct infant dose of 3 mg/kg a day.

Fewer sessions

Weaning

Weaning. Fewer feeds means fewer antibodies going across, so the hygiene measures carry more of the load. The 48-hour window for starting antivirals is unchanged no matter how much you are still nursing.

What does the evidence show for flu?

• CDC encourages women to continue to breastfeed even if they have the flu, and there are antibodies in breast milk that might help keep a baby from getting sick with it, alongside hand-washing before holding the baby and masking while feeding. 1
• Oseltamivir and its active metabolite are poorly excreted into breastmilk: at maternal doses of 150 mg daily an infant takes in about 0.012 mg/kg a day, which is 0.5% of the mother's weight-adjusted dose, against a direct infant dose of 3 mg/kg daily for infants over 2 weeks. 2
• Continuation of breastfeeding is recommended even while the mother is receiving antiviral therapy for influenza, and neuraminidase inhibitors should be started within 48 hours of the initial symptoms to catch the early phase of viral replication. 3
• Acetaminophen is found in low levels in breast milk and negative effects in newborns exposed through breast milk are rare, and it has not been shown to increase the chance of birth defects at recommended dosages. 4
• Fever means a temporary rise in body temperature over 101°F (38.3°C), and most healthcare providers consider acetaminophen the fever reducer of choice, used only as needed and at the lowest effective dose. 5

When should I call my provider about flu?

Influenza after delivery is not a mild illness to ride out. MotherToBaby notes the flu can bring serious complications including respiratory distress that requires hospitalization. Call your provider the same day if your breathing is labored, if chest pain or confusion appears, or if a fever, meaning a temporary rise in body temperature over 101°F (38.3°C), is not coming down. Call early rather than late, because antiviral medications work best taken early in the course of the illness, within 48 hours of the first symptoms, and being unable to keep fluids down while nursing is its own reason to be seen rather than to wait. None of these lists replace your own judgment: if this symptom worries you, that on its own is enough reason to check in with your healthcare provider.