Version July 2025
| Do not breastfeed and do not feed expressed breast milk | |
| Infant has classic galactosemia (ie, not Duarte variant) | These conditions generally preclude breastfeeding. Refer to footnotes for details about exceptions. |
Mother has HIV infection and:
| |
| Mother is infected with HTLV I or II | |
| Mother is using illicit drugs (eg, phencyclidine or cocaine)Δ | |
| Mother has suspected or confirmed Ebola virus disease | |
| Temporarily do not breastfeed and do not feed expressed breast milk | |
| Mother has untreated brucellosis | Mothers may be able to resume breastfeeding after consulting with a clinician to determine when their breast milk is safe for their infant. These mothers should be provided with lactation support to learn how to maintain milk production and feed their infants with pasteurized donor human milk or formula while temporarily not breastfeeding. |
| Mother is taking certain medicationsפ | |
| Mother has an active HSV infection, with lesions present on the breast¥ | |
| Mother has monkeypox virus infection | |
| Temporarily do not breastfeed but may feed expressed breast milk | |
| Mother has untreated active tuberculosis‡ | Airborne and contact precautions may require temporary separation of the mother and infant, during which time, expressed breast milk should be given to the infant by another care provider. Mothers should be able to resume breastfeeding after consulting with a clinician to determine when there is no longer a risk of spreading infection. These mothers should be provided with lactation support to learn how to maintain milk production while not breastfeeding and/or while expressing their milk. |
| Mother has active varicella that developed between 5 days prior to delivery and 2 days following delivery | |
ART: antiretroviral therapy; HIV: human immunodeficiency virus; HSV: herpes simplex virus; HTLV: human T-lymphotropic virus.
* This recommendation is for women in the United States and other resource-abundant settings. Breastfeeding by HIV-infected women may be appropriate in resource-limited settings if breast milk replacement is not feasible, affordable, or safe[1].
¶ At a minimum, viral suppression should be sustained throughout the third trimester and at delivery and continue postpartum. Sustained viral suppression with undetectable viral load achieved with ART decreases the risk of HIV transmission through breastfeeding to less than 1% but does not completely eliminate the risk[2]. If a mother with a detectable viral load chooses to breastfeed, the provider should remain engaged, ensure professional lactation assistance is provided to avoid nipple damage and any associated bleeding, offer guidance on antiretroviral prophylaxis and HIV testing for the infant, and assist the parent to rapidly regain and maintain virologic suppression.
Δ Narcotic-dependent women who are in a supervised methadone program or buprenorphine program with negative screening for HIV and other illicit drugs may breastfeed[1].
◊ Most, but not all, therapeutic drugs are compatible with breastfeeding[1]. Medications should be reviewed on a case-by-case basis for potential contraindications. The LactMed database, produced by the National Library of Medicine, is a free authoritative reference for lactation compatibility for prescription and over-the-counter drugs. This resource provides data on drug levels in human milk and infant serum, potential adverse effects on breastfeeding infants and lactation, and recommendations for alternative drugs.
§ Breastfeeding should be suspended during and after administration of certain radiopharmaceutical drugs. The recommended suspension of breastfeeding varies depending on the radioactive compound. Compounds used for tumor and cardiac imaging usually require prolonged cessation of breastfeeding[3].
¥ Mothers breastfeed directly from the unaffected breast if lesions on the affected breast are covered completely and with good handwashing to avoid transmission.
‡ The mother may resume breastfeeding once she has been treated appropriately for 2 weeks and is documented to be no longer contagious[1].Adapted from: Contraindications to breastfeeding. Centers for Disease Control and Prevention. https://www.cdc.gov/breastfeeding-special-circumstances/hcp/contraindications/ (Accessed on August 1, 2024).
