How to Breastfeed if You Are Sick

Getting sick when you are breastfeeding adds a layer of confusion to an already exhausting situation. Should you keep nursing? Will you make the baby sick? Are the medications you are reaching for safe to take? The short answers, in most cases: yes, no (probably the opposite — you will help protect them), and many but not all. Here is a practical guide to keeping breastfeeding going when you are dealing with a common illness, and when to call a clinician.

This article is general guidance, not medical advice. Always check with your pediatrician or lactation consultant for your specific situation.

Most common illnesses: keep nursing

For colds, flu, COVID, stomach bugs, mastitis, food poisoning, sinus infections, and most other typical viral or bacterial illnesses, current major guidance from the AAP, WHO, and CDC is to continue breastfeeding. The reasoning is biological: by the time you have symptoms, your baby has already been exposed. Continuing to nurse delivers the antibodies your body has begun producing in real time — which is one of the more remarkable things about breast milk. Pulling them off the breast does not protect them; it removes a layer of protection.

Wash your hands carefully before nursing. Consider wearing a mask while feeding if you have a respiratory illness. Avoid coughing or sneezing on the baby’s face. These small precautions reduce direct droplet exposure without interrupting feeding.

Hydrate aggressively

Illness depletes fluids and milk supply responds quickly to dehydration. A water bottle by the bed and another by the couch is the easiest infrastructure. Add electrolyte drinks if you have fever, vomiting, or diarrhea. A simple electrolyte powder mixed into water keeps you ahead of the dehydration curve.

If supply does dip during the worst day or two of an illness, it usually rebounds within a few days of recovery and good fluid intake. If it does not, that is a call to your IBCLC (lactation consultant) or pediatrician.

Most over-the-counter medications are compatible

The following are generally considered compatible with breastfeeding (verify with LactMed or InfantRisk for your specific scenario):

Pain and fever: Acetaminophen and ibuprofen. Avoid aspirin in nursing parents (Reye’s syndrome risk in infants). Cough/cold: Most expectorants are fine. First-generation antihistamines (Benadryl) can reduce supply with regular use; second-generation (Zyrtec, Claritin) are usually preferred. Pseudoephedrine is well-known to lower supply — avoid if at all possible. GI: Loperamide (Imodium) for diarrhea is fine; oral rehydration is more important. Antibiotics: Most common ones (penicillins, cephalosporins, erythromycin) are compatible.

For specific medications, the LactMed database (free, run by the NIH) is the gold standard. The InfantRisk Center hotline (806-352-2519) takes free phone calls from breastfeeding mothers and clinicians.

Set up a comfortable sick-day nursing station

The single best change is reducing how far you have to move when you are sick. Pick one location — a recliner, a couch, your bed — and stage everything you need within arm’s reach: a stack of burp cloths, water bottles, snacks, your phone charger, a pacifier, and a thermometer. A sturdy nursing pillow reduces the strain of holding the baby for long stretches when you have body aches.

If you have a partner or other helper, this is the day to ask for everything: bringing the baby to you, handling diaper changes, cooking the meals. You should be doing one job — nursing and resting.

Mastitis is its own situation

Mastitis (breast infection) feels alarming — fever, flu-like symptoms, a hot painful area on the breast — but it is treatable, and the worst thing you can do is stop nursing on the affected side. Continued draining of the breast is part of the treatment. Recent updated guidance from the Academy of Breastfeeding Medicine recommends gentle, normal nursing or pumping rather than aggressive emptying or massage, plus cold compresses for swelling and acetaminophen/ibuprofen for symptom relief.

Call your clinician within 24 hours if symptoms are not improving, if you have a fever above 101°F, or if you see a hard area that is not softening with normal feeding. Antibiotics may be needed.

Pumping if you cannot nurse directly

If you are too sick to bring the baby to the breast safely (a stomach bug where you cannot stop running to the bathroom, for example), pumping every 2-3 hours preserves supply and lets a partner or caregiver feed your baby with bottled milk. A reliable double electric breast pump is the standard tool. Manual pumps work as a backup.

Wash hands thoroughly before pumping and clean pump parts after each use. Standard hygiene is enough — you do not need to sterilize the milk itself.

Eat what you can, when you can

You will not feel like eating, but your milk supply needs calories. Soup, crackers, fruit, smoothies, anything you can keep down. Lactation cookies are not magic but they are calorically dense and easy to keep at the bedside.

Call a doctor if

You have fever above 101°F not resolving with medication. You see signs of severe dehydration. You cannot keep fluids down for 24+ hours. Symptoms are worsening rather than improving by day 3. You are taking a new prescription medication and have not yet checked it against LactMed. Mastitis symptoms are worsening or you see streaking, abscess, or significant swelling.

The honest takeaway

Most common illnesses are not a reason to stop breastfeeding. Your body is actively delivering protection through your milk in real time, and pulling the baby off the breast removes one of their best defenses. Hydrate, rest, accept help, check medications against trusted sources, and keep nursing. You and your baby will get through this.