Sick babies

Can I breastfeed if my baby is sick?

If a baby is sick but can breastfeed effectively, mothers should keep breastfeeding unless health-care providers give a specific reason not to. Breast milk is nearly always the best nutrition for the baby; it helps fight infection and speeds healing. Breastfeeding calms the baby and relieves pain. Mothers who stop breastfeeding and express when their babies are sick may not express well and may develop a low milk supply, mastitis, and other problems. The baby may be unwilling to return to the breast after a period of not breastfeeding. Mothers can help a sick baby breastfeed by using supportive breastfeeding holds. If the baby cannot breastfeed well, mothers can express for every feed to provide milk supplements. This will prevent the breasts from becoming overfull and maintain the milk supply. It is important to ensure that the baby takes in enough milk. Mothers can supplement with appropriate milk if required.

A) The sick baby

A sick baby may:

Some signs that a baby is sick include:

  • Spitting that:
    • Started before two weeks of age or after six months of age
    • Persists after 18 months of age
  • Frequent, yellow, or bloody vomiting
  • Frequent or bloody diarrhea
  • Fever
  • Being excessively sleepy
  • Having seizures or being very limp
  • Crying that is not normal
  • Difficulty swallowing
  • Refusing to eat
  • Weight loss
  • Painful peeing

B) Reasons to continue breastfeeding when a baby is sick

Some mothers are told that breastfeeding is harder or more stressful for the baby than bottle-feeding, but research does not support this (Marino 1995; Mizuno 2006).

Discuss your baby’s case with your health-care providers. In general, if the baby can breastfeed, you should keep breastfeeding unless there is a specific reason not to. That’s because:

These benefits are especially important for babies who are hospitalized or need surgery.

Furthermore,

  • Mothers who do not breastfeed when their babies are sick and who only express, may not express effectively and as a result may develop a variety of problems and their milk supply may decrease.
  • The baby having become used to other feeding tools such as bottles, may be unwilling to resume breastfeeding.

C) Tools to support breastfeeding when a baby is sick

Babies who are sick are less likely to be breastfed (Reinheimer 2019). Breastfeeding specialists can be very helpful in this situation. The following can help support breastfeeding. 

1) Breastfeed

If your baby is sick but breastfeeding effectively, continue to breastfeed. You can help your baby by using supportive breastfeeding holds such as the laid-back hold. 

2) Expressing

Mothers should express regularly if their babies:

  • Have a reduced appetite because of illness and do not want to take in their regular amounts of milk.
  • Are unable to take in enough milk by breastfeeding.
  • Are unable to breastfeed.

Expressing can help to:

3) Assessing milk amounts

Slow growing babies may

  • Have mothers with a low milk supply.
  • Have breastfeeding challenges.
  • Be sick. 

To help identify and treat the problem and to supplement the right amounts of milk, it may be important to know how much milk the mother is making and how much milk the baby is taking in by breastfeeding. The relevant tools include: 

  • Expressing instead of breastfeeding to measure the mother's milk supply. 
  • Expressing after feeds to show how much milk the baby is leaving in the breast.
  • Before-feed and after-feed weights to show how much milk the baby is taking from the breast.

4) Other tools

Some babies have feeding problems and need further specialized assessment and testing (Willette 2016). Knowing what is wrong with the baby can explain why breastfeeding may not be going well and provide solutions. 

D) Infections

If your child has an infection, breast milk is the best medicine. The infection in the baby quickly increases the number of white blood cells in your breast milk to help fight the infection (Hassiotou 2013).

For babies with stomach flu caused by a virus, breast milk helps heal the bowel and rehydrate the baby. Unless the baby is significantly dehydrated, there is no need to give other liquids if you have enough breast milk. Very dehydrated babies may require additional fluids given by mouth or through a needle into a vein (IV treatment).

E) Chronic conditions

Families with special-needs children or children with chronic conditions often face many challenges and caregivers may be severely stressed (Golfenshtein 2019). Breast milk can optimize the baby’s health and and prevent or minimize other problems (Penn 2016).

Examples of chronic conditions include:

  • Abnormal hearts (i.e. congenital [born with] heart problems)
  • Genetic syndromes such as Down syndrome
  • Cancer
  • Cleft palate
  • Type 1 diabetes (Miller 2017)

Once stabilized, these babies may be able to breastfeed exclusively, partially, or not at all. It depends on the nature of the condition. If not, mothers are encouraged to express milk for their baby’s milk supplement.

Babies born with congenital heart disease who receive only human milk are at a lower risk of developing necrotizing enterocolitis (NEC), a severe bowel condition, and gain weight better (Davis 2019). They may be able to breastfeed (Barbas 2004; Tandberg 2010). It is important to monitor their growth closely, supplement appropriately, and get the support of a qualified health-care provider (Elgersma 2020; Mangili 2018). Before-and-after weights can be helpful (Gregory 2018).

Similarly, babies with poor muscle tone, such as those with Down syndrome, can breastfeed but require close monitoring (Thomas 2016). 

Chemotherapy puts children at very high risk of infection and disrupts the bacteria in the gut (microbiome). Breastfeeding can reduce the risk of these. Children who are undergoing bone marrow transplantation have been shown to have fewer infections and fewer reactions to their new bone marrow when given breast milk (Davies 2018).

References

Barbas KH, Kelleher DK. Breastfeeding success among infants with congenital heart disease. Pediatr Nurs. 2004 Jul-Aug;30(4):285-9
 
Davies SM. Human Milk to Prevent and Heal Gastrointestinal Tract Injury in Children After Bone Marrow Transplantation. Breastfeed Med. 2018 Apr;13(S1):S18-S19
 
Davis JA, Spatz DL. Human Milk and Infants With Congenital Heart Disease: A Summary of Current Literature Supporting the Provision of Human Milk and Breastfeeding. Adv Neonatal Care. 2019 Jun;19(3):212-218

Elgersma KM, McKechnie AC, Gallagher T, et al. Feeding infants with complex congenital heart disease: a modified Delphi survey to examine potential research and practice gaps. Cardiol Young. 2020 Dec 11:1-12
 
Golfenshtein N, Hanlon AL, Deatrick JA, et al. The associations between infant development and parenting stress in infants with congenital heart disease at six and twelve months of age. J Pediatr Nurs. 2019 Dec 5;51:1-7
 
Gregory C. Use of test weights for breastfeeding infants with congenital heart disease in a cardiac transitional care unit: a best practice implementation project. JBI Database System Rev Implement Rep. 2018 Nov;16(11):2224-2245
 
Hassiotou F, Hepworth AR, Metzger P, et al. Maternal and infant infections stimulate a rapid leukocyte response in breastmilk. Clin Transl Immunology. 2013 Apr 12;2(4):e3
 
Haug S, St Peter S, Ramlogan S, et al. Impact of Breast Milk, Respiratory Insufficiency, and Gastroesophageal Reflux Disease on Enteral Feeding in Infants With Omphalocele. J Pediatr Gastroenterol Nutr. 2019 Jun;68(6):e94-e98
 
Mangili G, Garzoli E, Sadou Y. Feeding dysfunctions and failure to thrive in neonates with congenital heart diseases. Pediatr Med Chir. 2018 May 23;40(1)
 
Marino BL, O’Brien P, LoRe H. Oxygen saturations during breast and bottle feedings in infants with congenital heart disease. J Pediatr Nurs 1995;10:360–364
 
Miller D, Mamilly L, Fourtner S, et al. ABM Clinical Protocol # 27: Breastfeeding an Infant of Young Child with Insulin-Dependent Diabetes. Breastfeed Med. 2017 Mar;12:72-76

Mizuno K, Ueda A. Changes in sucking performance from nonnutritive sucking to nutritive sucking during breast- and bottle-feeding. Pediatr Res. 2006 May;59(5):728-31

Penn AH, Carver LJ, Herbert CA, et al. Breast Milk Protects Against Gastrointestinal Symptoms in Infants at High Risk for Autism During Early Development. J Pediatr Gastroenterol Nutr. 2016 Feb;62(2):317-27
 
Reinheimer SM, Schmidt MI, Duncan BB, et al. Factors Associated With Breastfeeding Among Women With Gestational Diabetes. J Hum Lact. 2019 May 9:890334419845871
 
Tandberg BS, Ystrom E, Vollrath ME, et al. Feeding infants with CHD with breast milk: Norwegian Mother and Child Cohort Study. Acta Paediatr. 2010 Mar;99(3):373-8
 
Thomas J, Marinelli KA. ABM Clinical Protocol #16: Breastfeeding the Hypotonic Infant, Revision 2016. Breastfeed Med. 2016 Jun 17
 
Willette S, Molinaro LH, Thompson DM, et al. Fiberoptic examination of swallowing in the breastfeeding infant. Laryngoscope. 2016 Jul;126(7):1681-6