by Anne Eglash MD, IBCLC, FABM

How can a breastfeeding mother with influenza protect her infant from the flu? It is widely known that we are having an aggressive worldwide influenza outbreak this year, with many deaths among young and old internationally.

Our last very serious influenza season was during the H1N1 outbreak, also known as the swine flu, in 2009-2010. At that time the U.S Center for Disease Control (CDC) published guidelines on the management of breastfeeding when the mother has influenza and is still in a healthcare setting, such as a hospital or birthing center. Healthcare settings were advised to separate symptomatic mothers from their infants until after she met the following criteria:

• The ill mother had received antiviral treatment for more than 48 hours
• The ill mother was without fever for more than 24 hours
• The ill mother was able to control her cough and respiratory secretions.

Ill breastfeeding women were encouraged to express their milk for their newborns. If the mother and infant could not be separated due to space limitations, the infant was to be kept greater than 6 feet from the ill mother, a healthy adult was to be present to care for the infant, and the mother was to use a mask and other personal protective equipment such as gloves when near or touching the infant.

Not without criticism, in February 2018 the CDC updated their guidelines on the management of breastfeeding mothers with influenza in healthcare settings. The CDC first emphasizes that breastmilk itself does not transmit influenza. Influenza is transmitted by respiratory secretions, such as from a runny nose and cough. Breastmilk prevents influenza in the infant, in addition to lessening the severity of the illness.

What do you think are true regarding updates to the CDC’s recommendations for management of the breastfeeding mother with influenza symptoms in healthcare settings? Choose 1 or more:

1. The updated guidelines have separated the recommendations for the ill breastfeeding mother at home vs the ill breastfeeding mother who is immediately postpartum in the hospital, and these recommendations are different.
2. The updated guidelines advise shared decision making between the healthcare team and the ill breastfeeding mother when determining whether to separate the mother and infant postpartum in the healthcare setting.
3. The updated guidelines emphasize the need to support breastfeeding women who are separated from their infants, in order to optimize maternal health and milk expression.
4. The updated guidelines suggest that the decision on when to cease separation of an ill breastfeeding mother and infant should be considered on a case by case basis, rather than the strict rules of the old guidelines.
5. If an ill breastfeeding mother is rooming in with her newborn baby at the hospital, the new guidelines suggest that mother wear a facemask and wash her hands well, rather than the ‘personal protective equipment’ recommendation in the old guideline.