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Breastfeeding While Sick: What's Safe & What Isn't
In most cases, you can and should continue breastfeeding when sick. Your body makes antibodies that pass to baby through breast milk, protecting them from your illness. Common cold, flu, COVID, mastitis, and mild GI bugs are all safe to breastfeed through. Medications that are generally safe: acetaminophen, ibuprofen, most antibiotics, pseudoephedrine (may reduce supply), and many antidepressants. Avoid: aspirin, codeine, some antihistamines (may reduce supply), and herbal supplements without checking. If baby is sick, breast milk provides hydration, antibodies, and comfort — continue feeding unless baby can't keep milk down.
Can I keep breastfeeding when I'm sick?
You wake up with a sore throat, fever, and body aches. Your first thought: "Can I still breastfeed?" The answer is almost always yes — and in most cases, you should continue.
Here's why: by the time you feel symptoms, your body has already started making antibodies. Those antibodies pass into your breast milk and protect your baby from getting sick — or make their illness milder if they do. Stopping breastfeeding removes this protection and exposes baby to formula risks (preparation, contamination, lower immunity).
What's safe to breastfeed through
Common cold / upper respiratory infection
Safe to continue. The cold virus doesn't pass through breast milk. Wash your hands frequently, wear a mask if you want extra protection, and keep feeding. Your antibodies will help baby fight off the virus.
Influenza (flu)
Safe to continue. Same as a cold — the flu virus doesn't transmit through milk. If you're very sick, you may need to pump and have someone else give bottles, but direct breastfeeding is fine if you can manage. Oseltamivir (Tamiflu) is compatible with breastfeeding.
COVID-19
Safe to continue. The CDC and AAP confirm that COVID doesn't pass through breast milk. Wear a mask while feeding, wash hands, and continue. Antibodies in your milk protect baby. If you're too sick to nurse, pump and have a caregiver feed the milk.
Mastitis
Safe and important to continue. Continuing to nurse or pump on the affected side is essential for clearing the infection. Stopping can lead to abscess. The milk is safe for baby — even with bacteria in the breast tissue, the milk itself is not contaminated. Antibiotics for mastitis (dicloxacillin, cephalexin) are compatible with breastfeeding.
Stomach bug (gastroenteritis)
Safe to continue. Most GI viruses don't pass through breast milk. Wash hands meticulously (before touching baby, after using the bathroom). Stay hydrated — you need extra fluids when vomiting or having diarrhea. If you're dehydrated, your supply may dip temporarily, but it recovers with fluids.
Urinary tract infection (UTI)
Safe to continue. UTI bacteria don't pass through milk. Most antibiotics for UTIs are breastfeeding-safe.
COVID, flu, or other vaccines
Safe and recommended. Getting vaccinated while breastfeeding passes antibodies to baby. Most vaccines are safe during lactation — including flu, COVID, Tdap, and MMR. Live vaccines (like nasal spray flu) are generally avoided, but the injectable flu shot is fine.
When to temporarily stop or pump instead
In rare cases, direct breastfeeding may not be possible, but you can usually pump and feed the milk:
- You're too weak or exhausted to nurse — pump and have a caregiver give bottles
- Open sore or lesion on the nipple from herpes — cover the lesion or pump from that side until it heals (herpes can transmit through skin contact, not milk)
- You're taking a medication that's not safe — pump and dump temporarily, or ask for an alternative medication
- You have active tuberculosis (TB) — don't nurse until you've been treated for 2 weeks and are no longer contagious (but you can pump and feed the milk)
- You're using recreational drugs — don't breastfeed; the substances pass to baby
- You've had alcohol — wait 2–3 hours per drink before nursing, or pump and dump if needed
Medication safety: what's generally OK
Always check with a pharmacist or use the LactMed database (NIH) before taking any medication. But these are generally considered compatible with breastfeeding:
| Medication | Use | Notes |
|---|---|---|
| Acetaminophen (Tylenol) | Pain, fever | Safe; preferred for pain if NSAIDs not tolerated |
| Ibuprofen (Advil, Motrin) | Pain, fever, inflammation | Safe; very little passes into milk; preferred for mastitis |
| Most antibiotics (penicillins, cephalosporins) | Bacterial infections | Safe; watch baby for diarrhea or thrush |
| Pseudoephedrine (Sudafed) | Congestion | May reduce milk supply; use cautiously, prefer saline spray |
| Oxymetazoline nasal spray (Afrin) | Congestion | Safe for short-term use (3 days max) |
| Guaifenesin (Mucinex) | Mucus | Probably safe; limited data |
| Zofran (ondansetron) | Nausea | Safe; very little passes into milk |
| Omeprazole (Prilosec) | Acid reflux | Safe |
| Most antidepressants (SSRIs) | Depression, anxiety | Most are safe; sertraline (Zoloft) and paroxetine (Paxil) have the most data |
| Insulin | Diabetes | Safe; doesn't pass into milk |
| Levothyroxine | Thyroid | Safe |
What to avoid
- Aspirin — associated with Reye's syndrome in babies; use acetaminophen or ibuprofen instead
- Codeine and tramadol — can cause excessive sleepiness and breathing problems in babies (especially in ultra-rapid metabolizers). Use acetaminophen or ibuprofen for pain
- Some antihistamines (diphenhydramine/Benadryl, chlorpheniramine) — may reduce milk supply and cause baby drowsiness. Use loratadine (Claritin) or cetirizine (Zyrtec) instead, which are less sedating
- Pseudoephedrine in large doses — can significantly reduce supply
- Herbal supplements — many are untested in breastfeeding. St. John's Wort, echinacea, and some "lactation teas" may have effects. Check with a pharmacist or IBCLC
- Chemotherapy and radiation — not compatible; discuss timing with your oncologist
- Alcohol — limit to occasional 1 drink, wait 2–3 hours before nursing
- Caffeine in excess — up to 300 mg/day (about 3 cups of coffee) is fine; more can make baby fussy
When baby is sick
If your baby is sick (cold, fever, stomach bug), breast milk is the best thing for them:
- Hydration: Breast milk is mostly water and prevents dehydration — especially important if baby has vomiting or diarrhea
- Antibodies: Your body makes antibodies to baby's illness and passes them through milk
- Comfort: Nursing is soothing for a sick baby
- Nutrition: Breast milk is easily digested when baby's stomach is upset
Tips for feeding a sick baby:
- Feed more frequently but for shorter sessions if baby is tired
- Try different positions if baby is congested (upright position helps)
- Use saline drops and a bulb syringe before feeds if baby is congested
- If baby refuses the breast, try expressed milk in a cup, syringe, or bottle
- Watch for dehydration: fewer than 6 wet diapers/day, dry mouth, sunken fontanelle, lethargy — call the pediatrician
Protecting baby when you're sick
- Wash hands frequently with soap and water for 20 seconds, especially before touching baby or pumping parts
- Wear a mask while feeding if you have a respiratory illness (COVID, flu, cold)
- Avoid coughing/sneezing directly on baby — turn away or cover your mouth
- Clean frequently touched surfaces — counters, pump parts, bottles
- Don't share cups, utensils, or towels with baby
- Keep feeding — your antibodies are baby's best protection
Maintaining supply when sick
Illness can temporarily reduce milk supply due to dehydration, stress, and missed feeds. To maintain supply:
- Drink extra fluids — water, electrolyte drinks, broth. Aim for clear or pale yellow urine
- Feed or pump on schedule — even if you're tired, don't skip sessions. Set an alarm if needed
- Rest as much as possible — let others take care of household chores
- Eat regularly — even small meals or snacks help
- Avoid decongestants that reduce supply (pseudoephedrine) — use saline spray instead
- If supply dips, it usually recovers within a few days of feeling better and resuming normal feeding
When to call a doctor
For you:
- Fever over 101°F (38.3°C) that lasts more than 24–48 hours
- Difficulty breathing, chest pain, or severe cough
- Signs of dehydration (dark urine, dizziness, dry mouth)
- Breast redness, warmth, or a tender lump (mastitis)
- Confusion or extreme lethargy
- Symptoms that worsen after 5–7 days
For baby:
- Fever over 100.4°F (38°C) in a baby under 3 months (emergency)
- Fewer than 6 wet diapers/day
- Refusing to feed or unable to keep milk down
- Lethargy, hard to wake, or weak cry
- Sunken fontanelle (soft spot) or dry mouth
- Breathing difficulty or blue lips
- Blood in stool or vomit
Find help near you
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Frequently asked questions
Can I breastfeed with a cold or flu?
Yes — continue breastfeeding. The virus doesn't pass through milk, and your antibodies protect baby. Wash hands and wear a mask while feeding. Most cold/flu medications are compatible with breastfeeding.
What medications are safe while breastfeeding?
Acetaminophen, ibuprofen, most antibiotics, Zofran, Prilosec, and most SSRIs are generally safe. Avoid aspirin, codeine, and high-dose pseudoephedrine (may reduce supply). Always check with a pharmacist or LactMed database.
Should I stop breastfeeding if I have COVID?
No — the CDC confirms COVID doesn't pass through breast milk. Wear a mask while feeding, wash hands, and continue. Your antibodies protect baby. If too sick to nurse, pump and have a caregiver feed the milk.
Can I breastfeed with mastitis?
Yes — continuing to nurse or pump on the affected side is essential for clearing the infection. The milk is safe for baby. Antibiotics for mastitis are compatible with breastfeeding.
What if baby is sick and refuses to nurse?
Try shorter, more frequent feeds, upright positions for congestion, or expressed milk in a cup/syringe. Watch for dehydration signs (fewer than 6 wet diapers, lethargy, dry mouth) and call the pediatrician if concerned.
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Not sure this applies to you?
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Sources & references
- Academy of Breastfeeding Medicine, Protocol #36: The Mastitis Spectrum (2022)
- CDC, Breastfeeding guidelines
- ILCA, International Lactation Consultant Association
- PubMed peer-reviewed literature on lactation and mastitis
Last reviewed: September 2026. Medical review pending IBCLC partnership.
Medical disclaimer: This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.