contraindications

Last reviewed 01/2018

Breast feeding is contraindicated in the following:

  • infants with particular metabolic disorders e.g. - classic galactosaemia
  • in mothers
    • HIV-positive mothers 
      • although contraindicated in the developed world, in the developing world breastfeeding may outweigh the risk of the acquiring HIV infection from human milk
    • positive for human T-cell lymphotrophic virus type I or II or untreated brucellosis – breastfeeding and providing expressed milk is contraindicated
    • with active (infectious) untreated tuberculosis
      • expressed milk can be used since these infectious organisms do not pass through the milk
      • can start breastfeeding when the mother is treated for a minimum of 2 weeks and is documented that she is no longer infectious
    • with active herpes simplex lesions on her breast –
      • can breastfeed and use expressed breast milk from the other breast if free from lesions.
    • maternal substance abuse e.g. - PCP (phencyclidine), cocaine, and cannabis can be detected in human milk and thus are contraindicated (1)
    • maternal drugs e.g. - anticancer drugs (antimetabolites); diagnostic or therapeutic radioactive substances
    • who develop varicella 5 days before through 2 days after delivery
      • avoiding breastfeeding until mother is no longer infectious (5 days from onset of rash)
      • expressed milk can be used for feeding (2,3)

The benefits of breastfeeding outweigh the risks in the following conditions:

  • in  Hepatitis B surface antigen positive mothers
  • mothers infected with Hepatitis C virus
  • mother is carrier of cytomegalovirus (except for possibly very low birth weight babies)
  • maternal smoking – advice to stop smoking and not smoke in the home
  • mother consumes alcoholic beverages
    • consumption should be minimized and limited to  occasional small amount (no more than 0.5 g alcohol per kg body weight, which for a 60 kg mother is approximately 2 oz liquor, 8 oz wine, or 2 beers.)
    • avoid breastfeeding for 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk
  • baby born with jaundice and hyperbilirubinaemia - in rare cases of hyperbilirubinaemia breastfeeding may need to be interrupted temporarily (3).

Note that multiple births may be perceived as a barrier to breast feeding - breast feeding is difficult with twins and may be almost impossible with triplets. However a review article on this subject notes that (1):

  • human milk is the best available source of nutrition for singletons and multiples alike
  • mothers are capable of producing enough milk for more than one infant. In order that multiples should obtain maximum benefit from this natural resource, mothers need much support and guidance
    • may include nutritional and other advice during pregnancy and lactation and intensive support during the early stages of establishment of breast-feeding
    • many mothers may also require assistance during the frequent trials and tribulations which are part of the potentially profound experience of breast-feeding multiples
    • however, when breast-feeding is not possible, health care workers need to carefully avoid judgmental approaches that may induce feelings of guilt

A mother unable to breast feed can still offer breast milk by instead, expressing her milk and giving it her baby

Reference:

Related pages:

carcinoma (breast, lactating)

prematurity

human immunodeficiency virus

cleft lip and palate

galactosaemia

breast feeding multiples