Wednesday, February 27, 2013

HSV-1 Transmission from Toddler to Mother

Yesterday I had a very unusual call from one of our moms. She said that the doctor had just diagnosed her 13 month old daughter with Herpes Simplex cold sores (HSV-1). She had asked him if it were possible to get sores on her nipples as a result of breastfeeding.  He replied, "Of course." When she asked what she would do then, he said "Wean very quickly,"  - even though she already has HSV-1. Something about that advice just didn't sound right to her, so she called me.

I did a quick search of the literature readily available and found quite a bit of information about HSV-1 transmission from mother to infant. Basically, if the mother of a newborn has an open herpes lesion on her breast she MUST avoid breastfeeding on that side because herpes is extremely dangerous for a newborn. However, there was very little available information about the transmission of herpes from baby to mother. I was able to find one instance where a 15 month old who was infected by his 5 year old sibling did, in fact, infect his mother. The mother in this situation did not previously have herpes simplex virus present in her system.

So I decided to check with some experts. I contacted Dr. Jack Newman, a Canadian pediatrician who is renowned for his work with breastfeeding mothers. I specifically asked him if the advice to wean was necessary or if the mother could perhaps nurse with a nipple shield. Here is his response:
Indeed, it is very unusual for a baby to get an “adult” type of cold sore on his lip.

Do you think a baby of 13 months of age would accept a nipple shield?  In any case, if the baby has a herpes simplex cold sore, then it’s way past the time to prevent transmission to the mother’s nipples.  That happened many days ago.  She should continue breastfeeding.  If she gets a feeling she is getting a herpes infection of the nipple(s), she should start acyclovir orally and continue breastfeeding.
I was truly grateful that he took the time to respond with such terrific advice. Needless to say I didn't suggest the nipple shield to the mother! In the meantime, I had also called my friend, Rebecca Saenz, MD, IBCLC, FABM - the only Breastfeeding Medicine physician specialist anywhere near us! Dr. Saenz was sweet enough to call me back and suggested that the mother ask the pediatrician for  Zovirax, a cream form of Acyclovar, for the baby's cold sores. She said the mother could also use the cream if she developed any lesions, but that there is absolutely no need for this mother to wean.

What a blessing it is to have such terrific resources at hand. I am extremely thankful for both Dr. Newman and Dr. Saenz and the wisdom they bring to the practice of lactation consulting!


  1. It's so sad that so many physicians just recommend the moms wean the babies. I think it's just the easiest possible remedy (they think this is what moms want) and therefore recommend it. I know with me personally I will tell the doc straight up, like one of the first things out of my mouth... "I'm not going to stop breastfeeding unless it's going to harm my baby if I don't. What other recommendations do you have?"

    Great post!

  2. I am so sad that Dr. Saenz is retiring from her practice! She was a lifesaver for me while nursing my second child. She was the only one to diagnose my problem as an internal yeast infection in my breasts and get me (and my little guy) on the medications to clear it up. A lactation consultant (not here in Huntsville) and my OB-GYN were both absolutely no help and acted as though I was crazy. Dr. Saenz diagnosed me immediately and reassured me that with some time, breastfeeding would once again become comfortable and enjoyable, and she was right!!!!

  3. its a nice post .
    It's so sad that so many physicians just recommend the moms wean the babies. I think it's just the easiest possible remedy (they think this is what moms want) and therefore recommend it.
    thanks for your post..
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  4. I have 2 year old with oral HSV 1 infection in mouth and breastfeeding. I have to wean that is what my doctor recommended me but I do not feel it is comfortable for me child to wean at this moment when he really needs me. I have also got oral HSV1 infection in mouth and it hurts but still coping breastfeeding. I see a red sore on one side of nipple. Please help! I ll see doctor tomorrow.

    1. You already have the HSV 1 virus in your body. Your toddler already has it. You are not going to pass it to him, nor will he pass it to you. Take a copy of this blog to your doctor referencing the advice from two well-respected physicians who are experts in breastfeeding medicine, and ask for oral acyclovar.

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