Breastfeeding Interruption and Resumption: A Risk-Based Clinical Decision Framework

Lactating women often need medication, contrast-enhanced or nuclear imaging, or treatment for infection, and each raises the question of whether breastfeeding can continue. Advice is frequently binary, and in some settings interruption may be recommended more readily than the evidence warrants. This narrative review proposes that breastfeeding interruption be managed as a clinical decision with three linked components: whether interruption is necessary, its minimum necessary duration and the criterion for resumption. We distinguish the hazard of an agent, the infant's actual exposure and the resulting clinical risk, and apply a common sequence of questions to maternal pharmacotherapy, contrast media, radiopharmaceuticals and selected maternal infections, using pharmacokinetic, dosimetric or transmission measures. The evidence base remains limited and heterogeneous: in a major lactation database, 54% of listed medications had no breastfeeding safety data, and no direct measurement of contrast-media absorption in breastfed infants was identified. The proposed framework grades management across five levels, from unrestricted breastfeeding to avoidance or definitive cessation; whether a restriction is temporary or definitive follows the applicable guidance, and resumption criteria are defined at the outset. This conceptual aid is not a validated decision rule, does not replace agent-, procedure-, radionuclide- or pathogen-specific guidance and requires prospective evaluation.