Mothers can continue to breastfeed infants as usual, even if they have chickenpox (varicella) infection. It is recommended to cover the vesicles (blisters) on the breast to reduce the risk of spreading the virus to babies. However, mothers who develop chickenpox infection five days before or two days after the delivery should seek immediate medical care for treatment and take measures to protect the newborn from contracting the infection (1).
Read this MomJunction post to know more about the symptoms, causes, diagnosis, treatment, and prevention of chickenpox when breastfeeding.
Is It Safe To Breastfeed When Having Chickenpox?
Breastfeeding is contraindicated if the mother develops chickenpox less than five days before or two days after the childbirth. In such cases, infants should be kept away from the mother, since they can develop a severe infection, and breast milk should be expressed for feeding.
Mothers can produce protective antibodies, and babies could get this through the placenta if the mother develops infection more than five days before childbirth. If chickenpox occurs after the third day of childbirth, then the breast milk can provide antibodies to the infant. These immune factors from human milk can give passive immunity to the baby. Mothers can breastfeed, and isolation is not required during this time.
If you develop chickenpox while breastfeeding, seek advice from your healthcare provider to determine the safety of nursing during these days. Your doctor may refer you to a lactation consultant to help you make better nursing decisions during this viral condition. You may have to express breast milk and feed the baby if recommended by your lactation consultant.
Precautions For Breastfeeding During Chickenpox
The following precautions can be taken by infected mothers while breastfeeding (2).
- Wash hands: Wash your hands properly with soap and water before touching the baby. It should also be done before preparing food for the baby or before contacting the baby’s toys, clothes, diapers, etc. You may use an alcohol-based sanitizer when soap and water are not accessible.
- Cover the lesions: Direct contact with the rash can cause infection. You should use a cloth to cover rashes on your hands, chest, or anywhere in the body that can come in contact with the baby.
- Wear a mask: Transmission through saliva and mucus droplets can be prevented by wearing a mask while breastfeeding.
You need to be extra careful to prevent the baby’s contact with rash or fluid coming from broken vesicles.
Symptoms Of Chickenpox
After being exposed to the varicella zoster virus (VZV), it may take ten days to three weeks to develop chickenpox symptoms. After this incubation period, the disease starts with symptoms of fever and tiredness. A few nursing mothers might have a headache and a loss of appetite.
Skin rashes and watery vesicles start to appear after fever. These can be anywhere on the body and are usually associated with severe itch. The blisters burst in a few days and form a crust. Broken vesicles may take a few days to heal, and typically the viral infection lasts for two weeks (3).
The mothers who have the primary infection could have severe symptoms compared to those who have a history of previous varicella infection.
Causes Of Chickenpox
Chickenpox is a highly contagious viral disease caused by the varicella zoster virus. The chickenpox virus can spread through (4):
- Direct contact: The infectious agent can be spread if the person has direct contact with rashes.
- Air droplets: If the person inhales the respiratory droplets from an infected person, while they cough or sneeze, then it could result in viral transmission.
Usually, pregnant women and nursing mothers may contract varicella from infected family members, especially from infected children. You should take precautions to avoid the varicella virus if one of your family members has an active infection.
Diagnosis Of Chickenpox
Your doctor may diagnose chickenpox infection with clinical history and observing the type of rashes. Usually, there is no requirement of additional tests for the medical diagnosis of chickenpox. Rarely, blood tests are ordered during chickenpox infection.
If there is a complication, lesion outbreak, or if the rashes appear similar to other skin diseases, then your doctor may order a laboratory analysis to identify the varicella zoster virus. Polymerase chain reaction (PCR) test is usually used to confirm the presence of varicella zoster virus in the skin lesions (5). Additional tests may be conducted to look for any complications or the presence of other diseases.
Treatment Of Chickenpox In Breastfeeding Mothers
Your doctor may prescribe paracetamol for fever and advise you to take enough rest and fluids. Antihistamines are prescribed if you have severe itching. Ibuprofen and other non-steroidal anti-inflammatory drugs are not recommended for the treatment.
If you consult a doctor within 24 hours after the onset of skin rashes, then they may prescribe an antiviral drug called acyclovir. This could help in reducing the severity and duration of the infectious disease. Acyclovir is safe while breastfeeding. However, there is no significant effect of acyclovir 24 hours after the onset of rashes (1).
Do note that an infected mother may transmit a severe infection to the newborn from five days before and two days after the delivery. If the chickenpox happens after childbirth, the mother should be isolated until the crusts are formed (contagious phase), while the infant receives treatment with varicella zoster immunoglobulin (VZIG) or standard immunoglobulin. The baby is also placed under observation for 21 days.
Acyclovir therapy is given if the babies have neonatal varicella infection shortly after birth (6).
Self-care Measures To Ease Breastfeeding With Chickenpox
It is essential for breastfeeding mothers to take care of themselves during chickenpox infection. Stay hydrated and eat healthy so that you can provide optimum nutrition to your little one through breastfeeding.
Use creams, lotions, or medications prescribed by the doctor to reduce the itch. The following homecare methods can help you minimize itch and related discomfort (7).
- Apply calamine lotion on the rashes
- Take a cold bath with oatmeal (uncooked) or baking soda in water
- Try to avoid scratching the rashes and keep nails trimmed
These methods could help you reduce itching and secondary bacterial infections from scratching. However, you should seek the doctor’s advice before using any home remedy, especially if you are a new mother with unhealed C-section stitches.
Chickenpox (Varicella) Vaccine When Breastfeeding
Although it is a live attenuated vaccine, the Centers for Disease Control and Prevention does not contraindicate the chickenpox vaccine for breastfeeding mothers. It means that the varicella vaccine is not known to affect safe breastfeeding while the mother has the infection (8).
Mothers who have no immunity to chickenpox may receive two doses of chickenpox vaccine during the postpartum period. The first dose is given before discharge from the hospital after childbirth, and the next dose is scheduled after four to eight weeks (9).
There is no evidence of varicella virus in the breast milk of mothers who receive chickenpox vaccine in the postpartum period (10). Therefore, there is no recommendation to delay the varicella vaccine during postpartum while breastfeeding or to discontinue nursing post-vaccination (11).
Speak to your doctor about having a chickenpox vaccination during postpartum. Immunization can decrease your chances of having chickenpox.
2. Joel A. Lamounier, et al.; Recommendations for breastfeeding during maternal infections
3. Signs and Symptoms; chickenpox (varicella); The Centers for Disease Control and Prevention
4. Chickenpox (varicella); The Centers for Disease Control and Prevention
5. Interpreting Laboratory Tests; chickenpox (varicella); The Centers for Disease Control and Prevention
6. Chickenpox and pregnancy; The Royal College of Obstetricians and Gynaecologists (RCOG)
7. Prevention and Treatment; chickenpox (varicella); The Centers for Disease Control and Prevention
8. Vaccinations; Vaccination Safety for Breastfeeding Mothers; The Centers for Disease Control and Prevention
9. Varicella Vaccine Recommendations; Vaccines & Preventable Diseases; The Centers for Disease Control and Prevention
10. Anne D. Walling; Is Varicella Vaccination Safe During Lactation?; The American Academy of Family Physicians
11. Shingles; breastfeeding; The Centers for Disease Control and Prevention