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
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