Is it safe to breastfeed with herpes

Herpes Simplex Virus (HSV) | Breastfeeding

Herpes simplex virus (HSV) in infants can be severe. Mothers with HSV can continue to breastfeed if no lesions are present on the breasts and if lesions elsewhere on the body are carefully and fully covered. Mothers with active lesions on the breast should temporarily stop breastfeeding from the affected breast and should not feed expressed breast milk from the affected breast.

Herpes simplex virus (HSV) is a lifelong virus that is categorized into two distinct herpesvirus species, herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). HSV-1 is typically transmitted by oral-oral contact to cause oral herpes but can also cause genital herpes through oral-genital contact.  HSV-2 is typically sexually transmitted and causes genital herpes but can also cause infections in the mouth. Importantly, both types of virus can cause herpes disease in newborns and infants and can appear anywhere on the body.

In newborn infants, HSV infections are often severe and result in high rates of mortality and morbidity.  Every precaution needs to be taken to prevent infants from being exposed to the herpes virus and appropriate hand hygiene should be done before holding the infant.

Is it safe for a mother to breastfeed if she has active herpetic lesions?

Maybe. Women with herpetic lesions may transmit HSV to their infants by direct or indirect contact with the lesions. Breastfeeding is acceptable if no lesions are present on the breasts and if active lesions elsewhere on the mother are carefully and fully covered. In cases where a mother has herpetic lesions on her breast, the mother should temporarily refrain from breastfeeding her infant from the affected breast or feeding her infant expressed breast milk from the affected breast. She should discard expressed breast milk from the affected side until the lesions have healed. A mother may breastfeed her infant or express milk from the unaffected breast but should ensure that the lesions on the affected breast are completely covered to avoid transmission. Mothers should also follow appropriate hand hygiene practices to avoid transmission of herpes to her infant.

Providers: Lesions on the breast could easily be mistaken for impetigo or eczema. Questionable lesions should be tested promptly for HSV so that if positive, acyclovir (safe to use while breastfeeding) can be administered quickly and breastfeeding can be discontinued until the lesion has healed.

Some mothers may need additional support to maintain their milk production and/or supplement with their expressed human milk (previously expressed milk or expressed milk from the unaffected breast) or formula while herpetic lesions on the breast are healing. Mothers should talk with their physicians to determine if their lesions have healed and they can resume breastfeeding or expressing milk from the affected breast.

Is it safe for a mother to give her infant hand expressed or pumped breast milk if she has active herpetic lesions on her breast?

No. Breast milk can be contaminated if it comes in contact with active herpetic lesions through touching the breast during hand expression or via the pump. Therefore, if a mother has herpetic lesions on her breast, she should discard expressed breast milk from the affected side until the lesions have healed. Expressing breast milk will be important for maintaining milk production while not directly breastfeeding from the affected breast. Mothers should be vigilant about practicing appropriate hand hygiene and cleaning the pump parts thoroughly. Mothers should talk with their healthcare provider to determine if their lesions have healed and they can resume breastfeeding or expressing milk from the affected breast.

It is safe to use expressed breast milk from the unaffected breast, as long as the mother ensures that the lesions on the affected breast are completely covered to avoid transmission. Appropriate hand hygiene and cleaning the pump parts thoroughly are still important.

For more information about managing breastfeeding with specific medical conditions, read Lawrence RA, Lawrence R. (2016) Breastfeeding: A guide for the medical profession, 8th Edition.

Herpes and Breastfeeding - Breastfeeding Support

The herpesvirus family includes herpes simplex virus and varicella-zoster virus. An infection with herpes simplex virus is commonly known as herpes and varicella-zoster virus causes chicken pox and shingles. Symptoms of a herpesvirus infection include outbreaks of little blisters or sores on the skin which could include the breasts or nipples. If you think you might have one of these infections, consult with your doctor to get a positive diagnosis as blisters on nipples can have other causes. This article looks at frequently asked questions if you are breastfeeding and have herpes simplex virus or varicella-zoster virus.

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Herpes simplex virus

There are two herpes simplex viruses; type 1 (HSV-1) and type 2 (HSV-2). An infection with herpes simplex 1 usually appears as an open sore (known as a cold sore) or small blisters (fever blisters) in the mouth area causing oral herpes but HSV-1 can also cause genital herpes. HSV-2 is almost exclusively transmitted through sexual contact, producing blisters on the skin and the moist lining of the genital or anal organs (genital herpes).¹  The small, painful, red-rimmed blisters containing viral material dry and form a scab after a few days (similar to chicken pox lesions). The blisters can appear anywhere on the body including the breast.

Can I breastfeed with herpes?

If a mother has herpes simplex virus, she can still breastfeed as long as the following precautions are observed:

#1 Prevent baby from touching the sores

As these viruses are spread by simply touching the sores, it is important that your baby doesn’t come into skin-to-skin contact with any of the herpes lesions. Sores should be completely covered so the baby cannot touch them.²

#2 Observe strict hygiene

Observing strict hygiene by washing hands thoroughly with soap before breastfeeding and sterilising breast pump parts after each use will help prevent spreading the infection.³

#3 Seek medical advice for babies under three weeks of age

Herpes can be very dangerous and life threatening for a newborn baby up to three weeks of age. A mother should speak to her healthcare provider for the latest recommendations and precautions if she has a very young baby and suspects she has herpes or has recurrent herpes.⁴

#4 Avoid kissing your baby if you have oral lesions

A mother with a cold sore on her lip can breastfeed but should be warned not to kiss her newborn and to wash her hands often and be very careful about hygiene precautions while the sore is active (Lawrence and Lawrence, 2016).

Can I breastfeed if herpes sores are on the breast or nipple?

If active herpes sores are on a breast or nipple, mothers are advised not to breastfeed from that breast until the lesions have dried.⁵⁶ Mohrbacher clarifies that breastfeeding can continue if it is possible to cover all the sores so the baby does not come into any contact with them otherwise breastfeeding could continue on the other breast if there are no lesions on that breast (Mohrbacher, 2020 p731). Treatment with antiviral medications may reduce the period of active herpes lesions (Lawrence and Lawrence, 2016).

The breast milk from a breast with an active herpes lesion will need to be expressed to maintain the mother’s milk supply and prevent engorgement or mastitis. If this milk can be expressed without it coming into any contact with a herpes sore (or any breast pump part or hand that has been in contact with a sore), the expressed milk can be given to the baby. However if the milk has been in contact with a sore it should be thrown away (Mohrbacher, 2020, p731).

Can I breastfeed a toddler who has oral herpes?

If a breastfed toddler has oral herpes there is a risk of transferring HSV-1 from the child’s mouth to the mother’s nipples by breastfeeding.⁷ However by the time the mother is aware that her little one has sores on their lips or in their mouth it is likely that she will have already been exposed to the virus because cold sores/herpes ulcers in the mouth are contagious for a day or two before the lesions appear.⁸⁹ Many people carry the herpes simplex virus without having any symptoms¹⁰ which will make it difficult for a mother to gauge her risk of getting the infection if she doesn’t have a history of herpes.

Jack Newman, a Canadian paediatrician and breastfeeding expert, says that a child with herpes ulcers in the mouth (herpes stomatitis) can carry on breastfeeding as the mother will have already been infected a few days before the sores appeared.¹¹ Newman adds that if the mother does develop sores on her nipple she can continue breastfeeding if she is able to, but if the sores make breastfeeding too painful, hand expressing breast milk for the toddler is likely to be more comfortable than pumping until the sores heal.  The mother should discuss her situation with her healthcare provider for the latest medical advice including whether antiviral medication is recommended (see below).

Is herpes passed on through breast milk?

The risk of catching herpes from breast milk is very low. Authors Wambach & Spencer state it is “doubtful” that HSV infection can be transmitted via human milk. Transmission during lactation is more likely to occur with direct contact with an active lesion or blister.¹²

The following paper also states the risk of viral transmission via breast milk is very low and that breastfeeding ought not be interrupted unless the sores are on the breasts:

Excerpt From

Recommendations for breastfeeding during maternal infections J Pediatr (Rio J), Lamounier et al, 2004

The risk of viral transmission via breast milk is very low. In nursing mothers with herpes, breastfeeding should not be interrupted, except when the herpetic vesicles are located on the breasts. Active lesions in other body parts should be covered, and the nursing mother’s hygiene should not be overlooked so that breastfeeding can be maintained.

Herpes treatment and breastfeeding

Although there is not a cure for herpes, antiviral treatments (drugs and topical creams) focus on relieving symptoms and preventing the spread of HSV (Wambach and Spencer, 2020). Lawrence and Lawrence ¹³ state that oral or IV acyclovir (Zovirax) and valacyclovir (Valtrex) are compatible with breastfeeding. For the latest information on compatibility of antiviral drugs with breastfeeding refer to the resources listed in Medications and Breastfeeding, e.g. Hale’s Medications and Mothers’ Milk [paywall], Lactmed or  e-lactancia.

Varicella-zoster virus

Varicella-zoster virus also belongs to the herpesvirus family, it affects the central nervous system and an infection can cause chickenpox (varicella) and shingles (zoster).

Breastfeeding and chickenpox

Chickenpox is generally a mild contagious childhood illness.¹⁴ Most adults will have immunity to it as they will already have had it as a child or been immunised against it in some countries.

Can I breastfeed with chickenpox?

If a mother develops chickenpox for the first time while breastfeeding, she can continue to breastfeed because her baby will have already been exposed to the infection before the blisters came out, and immune factors in breast milk can help the baby’s recovery.¹⁵¹⁶¹⁷

Caution for the newborn baby

Note, if a mother develops chickenpox for the first time up to five days before or two days after her baby’s birth (Wambach and Spencer, 2020; e-lactancia, 2020), this could be very dangerous for her baby and she should seek urgent medical advice from her health professionals. ¹⁸ Breastfeeding can continue in this situation, but the baby will require treatment against the virus and the mother is advised to take special hygiene precautions, and avoid her baby being in contact with any skin lesions until they are fully crusted.¹⁹²⁰ Paediatrician Jack Newman explains:

Excerpt from

Dr. Jack Newman’s Guide to Breastfeeding (updated edition), Jack Newman and Teresa Pitman, 2014

Infected babies should be given zoster immune globulin (antibodies against the virus) immediately at birth and acyclovir or a similar drug to prevent the baby from getting very sick. The baby and mother should not be separated. The baby should be breastfed to get the immune factors present in the milk that will help protect his mucous membranes from invasion by the virus.

For more information about symptoms and treatments see Chickenpox and Breastfeeding, Breastfeeding Network, 2019.

Shingles and breastfeeding

If you have already had chickenpox, the virus can sometimes flare up again years later as shingles (herpes zoster virus). It causes a painful rash that develops into blisters usually affecting just one area of the body which may include the breast. It is possible to catch chickenpox from someone with shingles if you have not had it before—by skin-to-skin contact with the blisters.

Can I breastfeed with shingles?

Doctor Jack Newman explains that the baby of a mother with shingles will already have some immunity to chickenpox from his mother and breastfeeding can continue:

Excerpt from

Dr. Jack Newman’s Guide to Breastfeeding (updated edition), Jack Newman and Teresa Pitman, 2014

So, if the mother gets shingles, should she stop breastfeeding? Absolutely not. She is immune. She had chicken pox in the past and the baby got antibodies from her during pregnancy. These antibodies remain in the baby’s blood for about six months; plus, he will receive immunity through breastfeeding. If the mother is treated with acyclovir or a similar drug and painkillers, she does not have to interrupt breastfeeding.

Lesions on the breast?

The Academy of Breastfeeding Medicine advises against breastfeeding from a breast with shingles lesions until they have healed:

Excerpt from

ABM Clinical Protocol #26: Persistent Pain with Breastfeeding, Academy of Breastfeeding Medicine, 2016

Exposure to these [shingles] lesions can result in chicken pox (varicella zoster) in unimmunized infants. In most situations, it should be treated similarly to a Herpes simplex infection and women should not breastfeed or use expressed breast milk from an affected breast until the lesions have healed. Infants may be given Zoster immunoglobulin if appropriate.

Cover lesions

The Breastfeeding Network indicates if the lesions can be covered there is little risk of passing on the infection:

Excerpt from

Shingles and Breastfeeding, Breastfeeding Network, 2019

If the rash is only on your body and can be covered by clothing, there’s little risk of passing the infection on to others even before the lesions have dried.

Summary

If a mother has herpes simplex virus she can continue to breastfeed as long as any herpes lesions are covered so that her baby has no contact with the sores. If active lesions are on a breast/nipple, breastfeeding will need to be interrupted from that breast until the sores heal. Contact with herpes can be very dangerous for a baby under three weeks of age and a mother should contact her doctor for advice if she suspects she might have herpes in the early weeks after birth. Breastfeeding can continue if a mother has chicken pox for the first time while she is breastfeeding, but again this can be dangerous for a newborn baby in their first week of life, and a health professional should be consulted so that appropriate precautions can be taken. Shingles is compatible with breastfeeding, the recommendation being to cover all lesions so that baby has no direct contact with any active sores.

This article should not be considered a substitute for advice from your health professionals. Any medical concerns about yours and your baby’s welfare should be discussed with your doctor, paediatrician or health care provider.

Footnotes & References

1. Herpes Simplex Virus. World Health Organisation. 2020

2. Mohrbacher. Breastfeeding Answers A Guide for Helping Families. 2020. p822

3. Breastfeeding and Human Lactation 6e, Wambach and Spencer. 2021. p 164

4. Mohrbacher. Breastfeeding Answers A Guide for Helping Families. 2020. p731

5. ABM Clinical Protocol #26: Persistent Pain with Breastfeeding, Academy of Breastfeeding Medicine, 2016

6. Breastfeeding, A Guide for the Medical Profession, 8e, Lawrence and Lawrence, 2016

7. Sealander and Kerr.  Herpes simplex of the nipple: infant-to-mother transmission. Am Fam Physician. 1989

8. Cold sores. NHS. 2020

9. Newman. Breastfeeding and Maternal Illness Part 2. updated 2020 [accessed 10 November 2020]

10. Globally, an estimated two-thirds of the population under 50 are infected with herpes simplex virus type 1. WHO. 2015

11. Newman. Breastfeeding and Maternal Illness Part 2. updated 2020 [accessed 10 November 2020]

12. Breastfeeding and Human Lactation 6e, Wambach and Spencer. 2021. p 163

13. Breastfeeding, A Guide for the Medical Profession, 8e, Lawrence and Lawrence, 2016

14. Chickenpox, National Health Service (NHS), 2017

15. Breastfeeding and Human Lactation, Wambach and Spencer, 2021

16. Dr Jack Newman’s Guide to Breastfeeding, Jack Newman and Teresa Pitman, 2014

17. Varicella-Zoster Virus, e-lactancia, 2020

18. Chickenpox and Breastfeeding, Breastfeeding Network, 2019

19. Breastfeeding and Human Lactation, Wambach and Spencer, 2020

20. Varicella-Zoster Virus, e-lactancia, 2020

Feeding when sick | Medela

If you or your baby are unwell, you may wonder if it is safe to breastfeed. The great news is that breastfeeding when you're sick is most often good for both of you. Read more about this in our article.

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Did you know that a breastfed baby is usually much less prone to illness? Although it is impossible to avoid them completely, the protective properties of breast milk help babies get sick less often ¹ and recover faster than formula-fed babies.

Breast milk contains antibacterial and antiviral agents. ² The longer you breastfeed your baby, the lower the risk of colds and flu, ear and respiratory infections, nausea and diarrhea. ¹ Scientists are already exploring the use of breast milk to treat everything from conjunctivitis to cancer. ^3.4

Should a sick baby be breastfed? nine0021

Yes. Breastfeeding promotes recovery and also helps to calm the baby. Breast milk contains antibodies, white blood cells, stem cells, and protective enzymes that help fight infections and help your baby recover faster. ^1,5,6 In addition, the composition of breast milk (the balance of vitamins and nutrients) is constantly adjusted to the baby's body to help him recover as soon as possible. Thus, you will spend less time on sick leave and visit the doctor less often. nine0009 7

“Breastfeeding gives the baby everything she needs when she is sick. This is his medicine, food, drink and comfort. For a baby, this is the best thing in the world,” says Sarah Beeson, a health visitor from the UK.

Surprisingly, when a child becomes ill, the composition of breast milk changes. When you come into contact with pathogens of bacterial and viral infections, your body begins to produce antibodies to fight them, which are then passed through milk to your baby. nine0009 8 When your baby is sick, your milk also spikes in immune-boosting cells (white blood cells). ⁵

In addition, breast milk is very easy to digest, making it ideal for babies with indigestion.

“At 12 months my daughter contracted norovirus and could only breastfeed,” recalls Maya, a mother of two in Spain. produce more milk. It was amazing. After 48 hours, I was able to meet the daily requirement for milk. It saved my baby from a drip." nine0003

It should be taken into account that sometimes during an illness it is necessary to change the habitual breastfeeding regimen. For example, with a cold, a baby may want to eat more often, but little by little, both to calm down and because of nasal congestion, which makes it difficult to apply to the chest for a long time. If your baby has a stuffy nose, an upright breastfeeding position may be more comfortable, so don't be afraid to try different breastfeeding positions.

What should I do if my baby is seriously unwell and cannot breastfeed? nine0021

Occasionally, if a child feels unwell, they may not have an appetite or the strength to feed. If your baby is not eating well, seek advice from your healthcare provider, nurse practitioner, or lactation consultant to help prevent dehydration.

You may be asked to express milk to feed your baby with a bottle, a Soft Cup*, or other suitable method that requires minimal effort from the baby. Pumping on a regular breastfeeding schedule will also help keep your milk supply stable. nine0003

You can express milk with one of our convenient breast pumps, such as the modern electronic Swing Flex** or the Harmony** manual breast pump. Rest assured, freshly expressed breast milk is just as good as breast milk, so your baby will get all the protection and support it needs.

If you have concerns about your baby's health or how much milk they are drinking, see your doctor as soon as possible.

Can I continue to breastfeed if I become ill myself? nine0021

You may not want to do this if you feel unwell, but in most cases it is best to continue breastfeeding. If you have a cold, runny nose, diarrhoea, vomiting, or mastitis, continue breastfeeding as normal with your doctor's approval. The baby is unlikely to become infected through breast milk. What's more, the antibodies in your milk will help reduce your baby's risk of contracting the same ¹³ virus.

“Breastfeeding when sick is not only safe most of the time, but also beneficial. Your baby is the least at risk of catching your upset stomach or cold, as he is already in close contact with you and receives a daily dose of protective antibodies from milk, ”says Sarah Beeson. nine0003

If there is a risk of contracting a viral infection by airborne droplets, it is advisable to temporarily switch to expressing breast milk and bottle feeding.

In order not to lose the amount of milk produced when the body is still weakened by the disease, it is best to use the Swing Maxi Flex ** double breast pump, which helps to stimulate lactation, increase the amount of milk (by 18% on average) and increase its fat content (+1% ) ¹⁴ .

However, breastfeeding and pumping when sick can be very tiring. You need to take care of yourself so that you can take care of the baby. Try to drink more fluids, eat when you can, and get plenty of rest. Crawl under the covers for a few days and ask family or friends to help care for your baby if possible, so you can put all your energy into recovery. nine0003

“Don't worry about your milk supply, it will last. Most importantly, do not stop breastfeeding abruptly so that mastitis does not develop, ”adds Sarah.

Proper hygiene is very important to reduce the risk of spreading the disease. Wash your hands with soap and water before and after breastfeeding and pumping, preparing and eating food, using the toilet and changing diapers. Use a tissue when coughing and sneezing, or cover your mouth with the crook of your elbow (not your palm) if you don't have a tissue handy. Be sure to wash or sanitize your hands after coughing, sneezing, and blowing your nose. nine0003

Can I take medication while breastfeeding?

In agreement with the attending physician and compliance with the dosage, certain medications are allowed. ^9.10

.

“When talking to a doctor or pharmacist for any reason, always state that you are breastfeeding,” she continues. nine0003

What about long-term treatment?

If you are on long-term treatment for diabetes, asthma, depression, or other chronic conditions, the benefits of breastfeeding may outweigh the risks. “Breastfeeding is often possible for almost any disease, with the exception of some very rare conditions,” Sarah says, “you will be very familiar with the drugs you are taking, and during pregnancy you can discuss them with your doctor or other specialist. There is guidance on the safe use of various medicines that all healthcare professionals use.” In any case, you should consult with your doctor. nine0003

“I was on high doses of epilepsy medication, but I was still able to breastfeed,” recalls Nicola, a mother from the UK. “I saw a neurologist to ensure my son was safe and to minimize the risk of a seizure. Seizures can happen due to lack of sleep, and I fed day and night, but I took good care of myself, and my husband supported me. It was a positive experience."

What if I have to go to the hospital?

If you need to be hospitalized or urgently hospitalized, there are different ways to continue feeding your baby healthy breast milk so that you can return to normal breastfeeding after you are discharged. nine0003

“Express and freeze breast milk so that the caregiver can feed the baby. Practice at home ahead of time and be sure to let your doctors know that you are a breastfeeding mother, both before entering the hospital and while in it, ”recommends Sarah.

“If the baby is very small, you may be allowed to take him with you. Find out if the hospital has a supervising doctor or lactation consultant to contact. This specialist will support you, especially if you are in a general ward. If hospitalization is urgent, warn the doctors that you have a baby so that they take this into account. nine0003

Surgery under local or general anesthesia does not necessarily mean that breastfeeding will have to be stopped, or milk will need to be pumped and discarded. By the time you recover from surgery and can hold your baby, the amount of anesthetic in your breast milk will be minimal, so breastfeeding will be safe in most cases. ¹⁰ However, it is always best to consult your doctor or attending physician beforehand. nine0003

To ensure that the situation of treatment or departure does not affect the baby's diet, it is advisable to create a breast milk bank. This should be done daily by expressing one extra serving and freezing it in the handy, durable Medela Breast Milk Storage Bags. Even stored for several months and then thawed, your carefully prepared milk will still be incomparably healthier than formula.

For hygienic and easy pumping, use a breast pump with 2-Phase Expression technology for a fast, full flow of milk. For example, the ultra-comfortable Swing Flex** breastpump that adapts to the shape of your breasts and allows you to pump milk in a comfortable position, even lying back on the pillows ¹⁵ .

Don't forget to sterilize your breast pump with the Quick Clean microwave bags. Medela milk storage bags do not need to be handled as they are aseptically packaged and ready to use immediately.

Are there times when breastfeeding is not allowed?

In some cases, for the safety of the baby, breastfeeding should be stopped for a while, and instead, milk should be expressed and discarded to maintain milk production until the end of treatment. This includes radiotherapy and chemotherapy for cancer, herpes sores on the chest, and infections such as tuberculosis, measles, or blood poisoning that can be transmitted through breast milk. nine0009 11.12 Consult with a qualified professional about your condition to decide whether breastfeeding can continue in such cases.

For quality lactation support during this period, you can use the dual electronic breast pump with innovative Flex technology or rent a Symphony Clinical Breast Pump** if possible. A list of cities where you can rent a breast pump can be found on the "Rent a Medela Clinical Breast Pump" page. nine0003

Literature

1 Victora CG et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet . 2016;387(10017):475-490. - Victor S.J. et al., "Breastfeeding in the 21st century: epidemiology, mechanisms and long-term effects". Lancet 2016;387(10017):475-490.

2 Lönnerdal B. Bioactive proteins in breast milk. J Pediatric Child Health. nine0120 2013;49 Suppl 1:1-7. - Lönnerdahl B., "Biologically active proteins of breast milk". F Pediatrician Child Health. 2013;49 Suppl 1:1-7.