When a nursing mother becomes ill, the question of continuing to breastfeed naturally arises. There are actually few diseases or treatments that require you to stop breastfeeding, but in all cases, it is essential to seek medical advice.

Maternal illnesses requiring discontinuation of breastfeeding are rare:

• breast cancer being treated;
• active and untreated tuberculosis;
• type 1 human lymphocyte leukemia (HTLV1);
• herpes on the breast;
• cytomegalovirus. The virus can pass into breast milk. It is usually safe for a full term baby, but infection can be severe in a premature baby. Breastfeeding will then be contraindicated, or it will be necessary to pasteurize breast milk before giving it to the baby.
• HIV positive, as there is a risk of transmission of HIV through breast milk, even during the latent phase of HIV infection. Also in countries where mothers have access to infant milk and water such as France, HIV-positive mothers are not recommended to breastfeed. 

In case of chronic pathology

In the event of chronic pathology such as diabetes or high blood pressure, it is possible to breastfeed your baby. The treatment will be adapted, if necessary. As for fever, it does not justify interrupting breastfeeding, but it is strongly recommended to consult in order to know the cause, and to treat it correctly.

Current scientific data excludes the passage of a contaminating virus into breast milk. However, there remains the question of the direct transmission of the virus from the mother to her baby, by the hands or by breathing. The French health authorities and professional groups but also international (WHO in particular) have issued recommendations in favor of continuing breastfeeding in the event of Covid-19 if the mother is asymptomatic or has minor symptoms. 

However, as long as it remains contagious, precautions should be taken when feeding:

• wearing a surgical mask and a gown changed at each feeding,
• washing hands thoroughly before and after feeding,
• nipple cleaning and disinfection.

The only drug treatment justified in a mother with an asymptomatic form or with mild symptoms of Covid-19 is paracetamol, compatible with breastfeeding.

If the mother was infected during the last trimester of her pregnancy and is cured at the time of childbirth, then breastfeeding is strongly recommended in order to benefit the baby, via breast milk, from the antibodies produced during the birth. infection.

The CRAT (Reference Center on Teratogenic Agents) 

Many drugs pass into breast milk. Some are harmless because they are destroyed and / or not absorbed by the infant’s digestive tract, but others can be harmful to the infant. In France, the CRAT (Reference Center on Teratogenic Agents) is the body responsible for studying and providing information on the teratogenic effects of treatments during pregnancy and breastfeeding.  

Self-medication and breastfeeding = not recommended

As during pregnancy, self-medication should be avoided during breastfeeding. As a precaution, it is recommended that breastfeeding mothers always seek advice from their doctor, midwife or pharmacist before taking any medication, even for specialties available without a prescription.

In the event of pain, various analgesics are compatible with breastfeeding. In first intention will be prescribed a non-opioid analgesic or NSAID (level 1), among these different molecules:

• le paracétamol
• ibuprofen
• ketoprofen
• flurbiprofen
• diclofenac
• celecoxib

Aspirin can be prescribed, but only as a single dose.

If the Step 1 analgesic is not sufficient to relieve the pain, a Step 2 analgesic may be prescribed. Tramadol is compatible with breast-feeding, provided the treatment is short (2 to 3 days) and the dosage as low as possible. Codeine can be used under the same conditions, except for the first two weeks after childbirth, during which it is prohibited.

Corticosteroids can be used in nursing women. 

A cold does not require stopping breastfeeding. On the contrary: by fighting against the disease, the mother will produce antibodies that she will transmit to her baby through her milk. The infant will thus benefit from the immune protection of his mother. At the same time, basic hygiene measures are necessary to limit the risk of transmission such as:

• hand washing before and after each feeding,
• and avoid kisses on her baby’s mouth.  

The nursing mother can relieve the symptoms (fever, headache) with paracetamol or ibuprofen. Be careful, however, with anti-cold treatments available without prescription: some are contraindicated during breastfeeding.

In the event of the flu, the mother can continue breastfeeding. Knowing that the risk of contagion is at its highest during the 24 hours preceding the appearance of the first clinical signs, when the mother begins to be sick, the baby has already been exposed to the virus. Continuing to breastfeed then allows her to give the baby the benefit, through her milk, of antibodies specifically directed against the virus.  

How to relieve the symptoms?

To relieve the symptoms, she may take paracetamol (for fever) and ibuprofen (for muscle pain). Oseltavimir (an antiviral administered orally in the curative and preventive treatment of influenza) can be considered during breast-feeding.  

At the same time, care should be taken to respect basic hygienic procedures (hand washing, use of hydroalcoholic gel, wearing a mask).  

Flu vaccine and breastfeeding

Note that it is possible to get a flu shot while breastfeeding. Seasonal influenza vaccines are devoid of infectivity, so breastfed babies are not at risk of infection.

Flu or mastitis?

Finally, some flu symptoms (fever, body aches, chills) are common with those of infectious mastitis, which requires antibiotic treatment so as not to develop into an abscess. In the event of flu-like symptoms associated with a painful area in the breast, it is important to consult without further delay. It is still possible to continue breastfeeding.

Some antibiotics are compatible with breastfeeding, others are not. This is why it is very important not to self-medicate with a previously prescribed treatment. 

In case of urinary tract infection, the following antibiotics are compatible with breast-feeding: Amoxicillin, Cefixime, Ciprofloxacin, Fosfomycin, Ofloxacin, Pivmecillinam, Trimethoprim. Certain urinary tract infections with resistant bacteria may require the establishment of an antibiotic treatment incompatible with breast-feeding. If she wishes to continue breastfeeding, the mother will be able to express her milk during the treatment in order to maintain her lactation during the treatment.

Homeopathy and breastfeeding

Homeopathy does not present any risk during breastfeeding. Just make sure there is no alcohol in the preparations. 

Herbal medicine and breastfeeding

Herbal medicine has been little studied during breastfeeding, so as a precaution, its use is not recommended.

Aromatherapy and breastfeeding

Aromatherapy is not without risk either, as essential oils can accumulate in milk due to their high fat solubility. During breastfeeding, the use of essential oils is therefore not recommended.