Breastfeeding During Maternal Influenza: Evidence‑Based Recommendations

Core Recommendation

The American Academy of Pediatrics strongly recommends that mothers with active influenza continue breastfeeding, because the immunologic protection conferred to the infant outweighs any theoretical risk of viral transmission through close contact. [1][2]

Breastfeeding stimulates innate antiviral pathways in the infant, notably the production of type‑1 interferons, which help limit viral replication. 1
Exclusive breastfeeding for the first six months is associated with a lower incidence of febrile respiratory illnesses in infants, demonstrating a protective effect against influenza‑related morbidity. 1

If the mother or infant is too ill to breastfeed directly, expressed breast milk should be pumped and fed to the infant to preserve both nutritional and immunologic advantages. [1][2]

Baloxavir is not recommended for breastfeeding mothers because safety data on its presence in breast milk and potential effects on the infant are lacking. 1

Health care facilities should avoid separating mother and infant or discontinuing breastfeeding solely on the basis of a maternal influenza diagnosis, as this deprives the infant of protective antibodies without reducing transmission risk. [1][2]
A 2011 survey indicated that 58 % of U.S. hospitals restricted breastfeeding for mothers with influenza‑like illness during the 2009 H1N1 pandemic, a practice that contradicts current evidence‑based guidance. 1

Breastfeeding actively protects infants against influenza through multiple mechanisms, including activating innate antiviral defenses, delivering influenza-specific immunoglobulin A, and reducing respiratory illness episodes with fever in the first 6 months of life when breastfeeding is more exclusive 3, 4, 5, 6
The American Academy of Pediatrics recommends breastfeeding as it provides protective antibodies and there is no evidence of viral transmission through milk 3, 7, 4

The Centers for Disease Control and Prevention recommends hand hygiene before every feeding and wearing a surgical mask while breastfeeding to minimize droplet exposure when the mother has active influenza infection 8, 9
The World Health Organization suggests continuing direct breastfeeding unless the mother or infant is too ill, and pumping and feeding expressed breast milk if either cannot breastfeed directly due to illness severity 3, 7, 4

The American College of Obstetricians and Gynecologists recommends Oseltamivir (75 mg twice daily for 5 days) as the preferred antiviral for breastfeeding mothers, which does not contraindicate breastfeeding 5
Baloxavir is not recommended for breastfeeding mothers due to lack of safety data on presence in breast milk, according to the Pediatric Infectious Diseases Society 5