Red flags — call us immediately or go to the Emergency Department if:
- Your baby is very hard or impossible to wake after a feed (sedation)
- Your baby's breathing is slow, irregular, or stops (respiratory depression)
- Your baby's lips or fingertips look blue or dusky (hypoxia)
- Your baby has come into skin contact with a patch — call 112 now
- Your baby is very irritable, trembling, or has a high-pitched cry (NAS)
- You have recently increased your patch dose and your baby seems more drowsy than before
- A rash that does NOT fade when you press a clear glass on it — sepsis sign
- Fever in a baby under 3 months (any temperature ≥ 38.0 °C)
- A fit/seizure, or your child becomes floppy or unresponsive — general red flag
What fentanyl and buprenorphine patches are
Fentanyl patches (such as Durogesic) are sticky patches worn on the skin for chronic severe pain — often cancer pain or severe non-cancer pain. They release a steady dose of fentanyl through the skin into the bloodstream over 72 hours. Buprenorphine patches (such as Norspan, Transtec) are used for moderate-to-severe pain. Buprenorphine is also used in tablet or film form (Subutex, Suboxone) for treating opioid use disorder. These are different uses of the same medicine.
Fentanyl patches — low-dose patches often compatible
At low doses (typically the 12 or 25 mcg/h patch), fentanyl passes into breast milk in small amounts. LactMed notes that low-dose patches result in low milk levels. With careful monitoring, low-dose fentanyl patches may be compatible with breastfeeding in older, healthy infants. Higher-dose patches (50 mcg/h or above) result in much higher blood and milk levels and require specialist input before breastfeeding. If you are unsure of your dose, check the number printed on your patch.
Buprenorphine — generally supported for breastfeeding
Buprenorphine at low-to-moderate doses is well-supported for breastfeeding, especially when used for opioid use disorder (OUD) treatment. Breastfeeding on buprenorphine actually helps reduce neonatal withdrawal symptoms and is recommended by guidelines from ABM (Academy of Breastfeeding Medicine) and the WHO. The amount that reaches your baby through your milk is small because buprenorphine is poorly absorbed from the baby's gut. If you are being treated for OUD, continuing buprenorphine and breastfeeding is generally encouraged by your treatment team.
Patch safety — keep patches away from your baby
This is critical: both fentanyl and buprenorphine patches can cause fatal opioid poisoning in a child if they come into skin contact with the patch. Keep all patches — used and unused — out of reach of your baby. Dispose of used patches by folding them sticky-side together and placing them in a sealed container (not in a nappy bin). Do not allow your baby to touch, chew, or come into contact with any patch. If a patch falls off on or near your baby, call 112 immediately.
Watch your baby closely
After every breastfeed, check your baby. They should wake normally, breathe at a regular rate, and feed well. Signs that they are getting too much of the medicine include: very hard to wake, slow or irregular breathing, limpness, or blue lips. If you see any of these, call 112 immediately. This is a medical emergency.
If anything changes
Keep all patches strictly away from your baby — direct contact can be fatal. After every breastfeed, check your baby is easy to wake and breathing normally. If your baby seems very drowsy, limp, or has slow breathing — call 112 immediately.
Emergency? Call 112. Do not wait for a reply from us.
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Message us on WhatsAppReviewed and signed off by Dr Didier Decamps on 5 September 2026. This is general information and does not replace an individual assessment by a qualified clinician.
Written with AI assistance. Reviewed, corrected and signed by Dr Didier Decamps, paediatrician.
Last reviewed: 5 September 2026