La Leche League International encourages all families to recognize the importance of breastfeeding in providing immunological protection to the breastfed child. Most often, babies who are being nursed remain healthy even when their parents or other family members fall ill with an infectious illness, because they benefit from the antibodies provided in the lactating parent’s milk. Lactating parents who are infected or immunized with an appropriate vaccine during the antenatal period will produce sufficient quantities of specific secretory IgA antibodies in their milk to protect their nursing infants against infection from the influenza virus. Following good hygiene practices will also help reduce transfer of the virus.
The Centers for Disease Control (CDC) recently re-released an older report suggesting that breastfeeding should be temporarily discontinued and the lactating parent and baby separated when the parent exhibits flu symptoms. Members of La Leche League International’s Health Advisory Council have responded to concerns about the current applicability of the guidance offered. It is important to recognize that the report, originally developed during the 2009 H1N1 pandemic and updated in 2011, was based on concerns for newborns in labor, delivery, recovery, and postpartum hospital settings when their mothers have or are suspected of having influenza.
[CDC revised its guidance regarding breastfeeding mothers who exhibit symptoms of influenza, February 2018.]
Beyond the newborn stage, nursing babies or toddlers and nursing parents are generally living together in the same environment; they are exposed to the same germs. As the CDC explains, the “incubation period for influenza is 1-4 days (average: 2 days),” and “healthy adults may be able to infect others beginning 1 day before symptoms develop” (Centers for Disease Control and Prevention). Once the lactating parent has been exposed, so have the baby and the rest of the family. In addition, not every respiratory infection, even accompanied by fever, is the flu; winter is the season of many viral upper respiratory infections. Even colds may be accompanied by a fever at times.
Separating the baby from the lactating parent may have serious consequences. Being refused the breast can be emotionally traumatic for nursing babies and toddlers and may not prevent the baby or toddler from developing the illness. The stress of separation may actually increase the risk of illness in the infant or toddler. In addition, it is important not to interrupt the immunological protection that nursing provides or to risk early weaning.
In normal circumstances, there is no need to interrupt direct breastfeeding. Instead, parents who believe they may have the flu are encouraged to follow good hygiene practices, such as thoroughly washing their hands and wearing a protective mask to prevent spread of the virus. In unusual circumstances, when an interruption of nursing is deemed medically necessary, pumping or hand expression is encouraged. In such cases, the expressed milk, which contains antibodies specifically produced against the influenza virus, may be fed to the baby to help prevent the infection in the baby or to help reduce the severity and duration of the infection.
The LLLI Health Advisory Council suggests families discuss the pros and cons of influenza vaccines with their health care practitioners. Public health services in families’ own countries may have recommendations about influenza vaccination for those who may be interested. The World Health Organization’s (WHO) Global Influenzae Programme provides guidance to member states regarding influenza as it develops around the world. In the US, the CDC recommends vaccination for anyone who is lactating or pregnant, based on several studies conducted over a period of years, which have demonstrated that influenza immunization of mothers, either while pregnant or postpartum, protects both mothers and young infants up to about six months of age from acquiring influenza infections (e.g., Eick, et al., 2010; Schlaudecker, et al., 2013; Steinhoff, et al., 2010; Zaman, et al., 2008). Schlaudecker and her colleagues found that neutralizing IgA antibodies formed in human milk after influenza immunization of the mother. The American Academy of Pediatrics (AAP) also offers information regarding influenza vaccination for children. The UK offers information about influenza vaccination on its website (see Gov.UK). Please see a local health care provider for additional information.
American Academy of Pediatrics (AAP). (2017). Recommendations for prevention and control of influenza in children, 2017-2018. Accessed 21. January 2018 from http://pediatrics.aappublications.org/content/140/4/e20172550
Centers for Disease Control and Prevention (CDC). (2009-2016). Clinical signs and symptoms of influenza. Downloaded 20. January 2018 from https://www.cdc.gov/flu/professionals/acip/clinical.htm
Centers for Disease Control and Prevention (CDC). 2011-2018. Influenza. Downloaded 20. January 2018, revised 12 February 2018, https://www.cdc.gov/breastfeeding/disease/influenza.htm
Eick, A. A., Uyeki, T. M., Klimov, A., Hall, H., Reid, R., Santosham, M., O’Brien, K. L. (2011). Maternal influenza vaccination and effect on influenza virus infection in young infants. Archives of Pediatrics & Adolescent Medicine 165(2), 104-111. DOI: 10.1001/archpediatrics.2010.192.
Gov.UK. (2017). Seasonal influenza: Guidance, data, and analysis. Accessed 21. January 2018 from https://www.gov.uk/government/collections/seasonal-influenza-guidance-data-and-analysis
Schlaudecker, E. P., Steinhoff, M. C., Omer, S. B., McNeal, M. M., Roy, E., Arifeen, S. E., . . ., Zaman, K. (2013). IgA and Neutralizing Antibodies to Influenza A virus in human milk: A randomized trial of antenatal influenza immunization. PLOS ONE 8(8) e70867. DOI: 10.1371/journal.pone.0070867
Steinhoff, M. C., Omer, S. B., Roy, E., Arifeen, S. E., Raqib, R., Altaye, M., . . ., Zaman, K. (2010). Influenza immunization in pregnancy—Antibody responses in mothers and infants. The New England Journal of Medicine 362(17), 1644-1646.
World Health Organization (WHO. (2017). Influenza. Accessed 21. January 2018 from http://www.who.int/influenza/en/
Zaman, K., Roy, E., Arifeen, S. E., Rahman, M., Raqib, R., Wilson, E., . . ., Steinhoff, M. C. (2008). Effectiveness of maternal influenza immunization in mothers and infants. The New England Journal of Medicine 359(15), 1555-1564. DOI: 10.1056/NEJMoa0708630.