Author(s): Erica Anstey, Katherine Shealy

The medical preparation of a traveler who is breastfeeding differs only slightly from that of other travelers and depends in part on whether the breastfeeding traveler and child will be separated or together during travel. Most travelers should be advised to continue breastfeeding their children throughout travel.

Before departure, travelers might benefit from compiling a list of local breastfeeding resources at their destination, to have on hand during travel. Clinicians and travelers can use the Find a Lactation Consultant Tool to find contact information for experts at their destination. Clinicians and travelers can use La Leche League International’s interactive map to find specific location and contact information for breastfeeding support group leaders and groups worldwide. Travelers who will need to store expressed milk while traveling can call ahead to their hotel or other place of lodging to request access to a refrigerator, if available.

Travel with a Breastfeeding Child

Breastfeeding provides unique benefits to children while traveling. Explain clearly to breastfeeding travelers the value of continuing to breastfeed during travel. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first 6 months of life. Exclusive breastfeeding means feeding only breast milk, no other food or drink, which potentially protects children from contaminants and pathogens in foods or liquids. Additionally, feeding only at the breast protects children from potential exposure to contaminants on bottles, containers, cups, and utensils.

During the first 6 months, breastfeeding children require no water supplementation, even in extreme heat environments. Breastfeeding protects children from eustachian tube collapse and pain during air travel, especially during ascent and descent, by allowing them to stabilize and gradually equalize internal and external air pressure.

Frequent, unrestricted breastfeeding opportunities ensure that the lactating traveler’s milk supply remains sufficient, and that the child’s nutrition and hydration are ideal. Travelers concerned about breastfeeding away from home might feel more comfortable breastfeeding the child in a fabric carrier or by using a nursing cover. In many countries, breastfeeding in public places is practiced more widely than in the United States. US federal legislation protects parents’ and children’s rights to breastfeed anywhere they are otherwise authorized to be while on federal property, including US Customs areas, embassies, and consulates overseas. The Consolidated Appropriations Act, 2021, SEC. 722 states, “Notwithstanding any other provision of law, a woman may breastfeed her child [PDF] at any location in a Federal building or on Federal property, if the woman and her child are otherwise authorized to be present at the location.”

Travel Without a Breastfeeding Child

Before departure, a breastfeeding person might decide to express and store a supply of milk to be fed to the child during the traveler’s absence. Building a supply takes time and patience, and is most successful when begun gradually, many weeks in advance of departure. Clinicians and others who provide lactation support should help travelers determine the best course for breastfeeding based on a variety of factors, including the amount of time available to prepare for the trip, the flexibility of time while traveling, options for expressing and storing milk while traveling, the duration of travel, and destination.

While away from the child, expressing milk can help the breastfeeding traveler maintain milk supply for when they return home. Expressing milk also can help avoid engorgement, which can increase the risk of developing a breast infection. Expressing milk by hand is a useful technique to learn prior to traveling because it does not require any equipment or a reliable power source. Hand expressing can be helpful when travelers need to express milk while in transit (e.g., on a bus, car, plane, train). Travelers intending to use breast pumps should plan to pack multiple breast pump kits if they anticipate being unable to clean individual pump parts after each use (see the section on breast pump safety later in this chapter). A nursing cover can provide some privacy when expressing milk.

Travelers who return to a nursing child can continue breastfeeding and, if necessary, supplement with previously expressed milk or infant formula until milk supply returns to its prior level. Often, after returning from travel, several days of feeding at the breast will help bring milk supply back to its prior level. Prolonged separation from the nursing child might, however, increase the difficulty and time it takes to transition back to breastfeeding. A lactation consultant can help address breastfeeding challenges after a traveler reunites with their child.

Medications, Vaccines & Other Exposures

In almost all situations, clinicians can and should select medications and vaccines for the nursing traveler that are compatible with breastfeeding. In most circumstances, it is inappropriate to counsel travelers to wean to be vaccinated, or to withhold vaccination due to breastfeeding status.

Breastfeeding and lactation do not affect maternal or child dosage guidelines for any medication or vaccine; children always require their own medications and vaccines, regardless of maternal dose. In the absence of documented risk to the breastfeeding child associated with a particular maternal medication, the known risks of stopping breastfeeding generally outweigh a theoretical risk for exposure via breastfeeding.

Drugs & Chemicals

According to the AAP 2013 Clinical Report: The Transfer of Drugs and Therapeutics into Human Breast Milk, many parents are inappropriately advised to discontinue breastfeeding or to avoid taking essential medications because of fears of adverse effects on their breastfed infants. Only a few medications are contraindicated in people who are breastfeeding or are associated with adverse effects on their children.

The National Institutes for Health’s Drugs and Lactation Database (LactMed) is an online source for clinical information about drugs and chemicals to which breastfeeding travelers could be exposed. LactMed provides information about the levels of substances in breast milk and infant blood, potential effects on breastfeeding children and on lactation itself, and alternative drugs to consider.

Another resource, Hale’s Medications and Mothers’ Milk, is a regularly updated pharmaceutical reference guide that provides comprehensive, evidence-based information on the compatibility or effects of >1,300 drugs, diseases, vaccines, herbals, and syndromes on breastfeeding, and includes risk categories, pharmacologic properties, interactions with other drugs, and suitable alternatives. An online version is available by subscription and is printable.

MotherToBaby is a service of the nonprofit Organization of Teratology Information Specialists (OTIS) and provides evidence-based information on the safety of or risk from medications and other exposures during pregnancy and lactation. OTIS provides a free information and risk assessment service to mothers, health care providers, and the public via text, chat, phone, and email, in English and Spanish.

Malaria Chemoprophylaxis

Because chloroquine and mefloquine can be safely prescribed to infants, both are considered compatible with breastfeeding. Most experts consider short-term use of doxycycline compatible with breastfeeding. Primaquine can be used for breastfeeding people and for infants with normal glucose-6-phosphate dehydrogenase (G6PD) levels, but screen both for G6PD deficiency before prescribing this drug. Because data are not yet available on the safety of atovaquone-proguanil prophylaxis in infants weighing <11 lb (5 kg), the Centers for Disease Control and Prevention (CDC) does not recommend it to prevent malaria in people who are breastfeeding infants weighing <5 kg (see Sec. 5, Part 3, Ch. 16, Malaria, for more information).

The quantity of antimalarial drugs transferred to breast milk is not enough to provide protection against malaria for the infant. Breastfeeding infants need their own antimalarial drug. See more information about malaria and breastfeeding.

Travelers’ Diarrhea Treatment

Exclusive breastfeeding protects children against travelers’ diarrhea (TD). Breastfeeding is ideal rehydration therapy. Children suspected of having TD should breastfeed more frequently and should not be offered other fluids or foods that replace breastfeeding. Breastfeeding travelers with TD should continue breastfeeding if possible, and increase their own fluid intake. The organisms that cause TD do not pass into breast milk.

Breastfeeding travelers should carefully check the labels of over-the-counter antidiarrheal medications to avoid using bismuth subsalicylate compounds, which can lead to the transfer of salicylate to the child via breast milk. Fluoroquinolones and macrolides, commonly used to treat travelers’ diarrhea, are excreted in breast milk. Consult with the breastfed child’s primary health care provider before deciding to prescribe antibiotics for breastfeeding travelers. Most experts consider the short-term use of azithromycin compatible with breastfeeding. Use of oral rehydration salts is fully compatible with breastfeeding.

Vaccinations

Vaccinate breastfeeding travelers and children according to routine, recommended vaccine schedules. Most live and inactivated vaccines do not affect breastfeeding, breast milk, or the process of lactation. Only 2 vaccines, smallpox (vaccinia) and yellow fever, require special consideration. Preexposure smallpox vaccine is contraindicated in breastfeeding people because of the risk for contact transmission to the breastfed child.

Yellow Fever Vaccine

Breastfeeding is a precaution against administering yellow fever vaccine. Three cases of yellow fever vaccine–associated neurologic disease (encephalitis) have been reported in infants exclusively breastfed by people who received yellow fever vaccine. All 3 infants were aged <1 month at the time of exposure.

Until specific research data are available, avoid vaccinating breastfeeding travelers against yellow fever. When a breastfeeding person must travel to a yellow fever endemic area, however, vaccination should be recommended. Although no data are available, some experts advise that breastfeeding travelers who receive yellow fever vaccine should temporarily suspend breastfeeding, and pump and discard milk for ≥2 weeks after vaccination before resuming breastfeeding (see Sec. 5, Part 2, Ch. 26, Yellow Fever, for more information). Refer the traveler to a lactation support provider for information on how to maintain milk production and how to best feed the child while not breastfeeding; options include using previously expressed milk, pasteurized donor human milk, infant formula, or a combination of these.

Zika Virus

CDC encourages people with Zika virus infection and those living in or traveling to areas with ongoing Zika virus transmission to breastfeed their children. Evidence suggests that the benefits of breastfeeding outweigh the risks of Zika virus transmission through breast milk.

Air Travel

Air travel should not be a barrier to breastfeeding or expressing breast milk. Being prepared and aware of available resources can help ease anxiety about traveling by air with breast milk, breast pump equipment, or a breastfeeding child.

Breast Pump Equipment & Breast Milk

Before departure, people who will be traveling by air and expect to have expressed milk with them during travel need to carefully plan how they will transport the expressed milk. Airport security regulations for passengers carrying expressed milk vary internationally and are subject to change.

In the United States, expressed milk and related infant and child feeding items are exempt from Transportation Security Administration (TSA) regulations limiting quantities of other liquids and gels. Travelers can carry with them expressed milk, ice packs, gel packs (frozen or unfrozen), pumps and pump kits, and other accessories required to transport expressed milk through airport security checkpoints and onboard flights, regardless of whether the breastfeeding child is also traveling. At the beginning of the screening process, travelers should inform the TSA officer that they are carrying breastfeeding equipment, and separate the expressed milk and related accessories from the liquids, gels, and aerosols that are limited to 3.4 oz (100 mL) each, as subject to TSA’s Liquids Rule.

Breast pumps are medical devices regulated by the US Food and Drug Administration (FDA), and most airlines allow passengers to carry breast pumps on board in addition to other permitted carry-on items. Travelers can check the airline’s policies related to breastfeeding and breastfeeding equipment prior to travel.

X-rays used in airport screenings have no effect on breastfeeding, expressed milk, or the process of lactation. FDA states that no adverse effects are known from eating food, drinking beverages, or using medicine screened by x-ray. Travelers also should inform the TSA officer if they do not want expressed milk to be opened or irradiated in scanners. TSA officers might conduct additional screening procedures (e.g., pat down, and screening of other carry-on property). Travelers should plan for extra time at the airport to get through the airport security checkpoints when traveling with expressed milk and related supplies. Travelers might find that providing TSA officers with the related TSA regulations for expressed milk can help facilitate the screening process.

Travelers carrying expressed milk in checked luggage should refer to cooler pack storage guidelines on the CDC website, Proper Storage and Preparation of Breast Milk. Expressed milk is considered a food for individual use, and is not considered a biohazard. International Air Transport Authority regulations for shipping category B biological substances (UN 3373) do not apply to expressed milk.

Lactation Spaces

By 2023, all small, medium, and large hub airports in the United States are required by the Friendly Airports for Mothers Improvement Act (www.congress.gov/bill/116th-congress/senate-bill/2638) to provide a clean, private, non-bathroom lactation space in each terminal for breastfeeding or expressing milk. Travelers can check the airport’s website to locate these spaces.

Packing & Shipping Breast Milk

Travelers shipping frozen milk should follow guidelines for shipping other frozen foods and liquids. Travelers planning to ship frozen milk might need to bring supplies (e.g., milk storage bags or resealable bags; paper lunch bags or newspaper for wrapping frozen milk; coolers; labels, packing tape, and shipping boxes; tongs or gloves for handling dry ice). Some shipping carriers provide temperature-controlled options that can be used for transporting expressed milk. Some employers will cover the cost of shipping expressed milk home for employees who are traveling for work. Travelers should make sure in advance that transporting expressed milk will meet customs regulations, because these can vary by country. Expressed milk does not need to be declared at US Customs upon return to the United States.

Breast Pump Safety

Travelers who plan to use an electric breast pump while traveling might need an electrical current adapter and converter, and should have a back-up option available, including information on hand expression techniques or a manual pump. Travelers using a breast pump should be sure to follow proper breast pump cleaning guidance to minimize potential contamination. See related guidance for cleaning infant feeding items (e.g., bottles and the nipples, rings, and caps that go with them).

Travelers should thoroughly wash hands with soap and water prior to pumping and handling expressed milk; if safe water is not immediately available, travelers can use an alcohol-based hand sanitizer containing ≥60% alcohol. If travelers are unable to clean pump parts between uses, they should bring extra sets of pump parts (e.g., connectors, flanges, membranes, valves) to use until they are able to thoroughly clean used parts. Travelers also could consider packing a cleaning kit for breast pump parts, including a cleaning brush, dish soap, and portable drying rack or mesh bag to hang items to air dry.