Skip raw dairy in pregnancy and childhood, pediatricians advise

Clinical takeaway: Counsel pregnant and breastfeeding patients, and families with children, to choose only dairy labeled pasteurized. Although infectious H5N1 has been detected in unpasteurized milk, no human infections from drinking it have been identified.

Bacteria in unpasteurized milk products can sicken healthy people and can hit infants, young children, and pregnant patients especially hard, resulting in a range of issues including life-threatening illness and miscarriage. 

Pasteurization has long been the safeguard against these pathogens. But proponents of unpasteurized milk argue that heating strips out nutrients and good bacteria that can benefit health. A newer concern is avian influenza, which has spread through US dairy herds and been detected in unpasteurized milk. This policy statement from two academy committees reviews the evidence on pathogens and on nutrition. It confirms the risk of infection and finds any nutritional advantage outweighed by that risk. 

People younger than 20 accounted for 48% of the 675 illnesses linked to unpasteurized milk outbreaks from 2013 to 2018, including 14% in children younger than 5. The same outbreaks included 98 hospitalizations, 10 cases of hemolytic-uremic syndrome, two deaths, and two cases of Guillain-Barré syndrome. The statement says incidence of illness is largely unknown for the wider list of organisms detected in unpasteurized milk, which includes parasites and viruses. 

Outbreaks were traced most often to Campylobacter, at 49%, then to Salmonella at 17% and Shiga toxin-producing E coli at 15%. Listeria, behind a single outbreak with two illnesses, was linked to hospitalization in all cases, versus 42% for Shiga toxin-producing E coli and 16% for Salmonella. In FoodNet surveillance from 2008 to 2016, invasive listeriosis occurred at 3.73 per 100,000 pregnant patients a year, versus 0.28 per 100,000 in the general population outside pregnancy. 

A 2002 case series and review of 222 cases, which the statement cites, found spontaneous abortion or stillbirth in 20% of pregnancies and neonatal infection in 68% of the live-born infants. Contamination can still follow pasteurization, especially with Listeria, which is the basis for the recommendation to avoid soft cheeses in pregnancy. 

No human case from drinking unpasteurized milk has been identified, though infectious H5N1 virus was found in nearly one-quarter of unpasteurized milk samples from US states affected by the 2024 dairy cattle outbreak. Refrigerated unpasteurized milk can harbor the virus for up to five weeks, while pasteurization kills it. Dairy farm workers in direct contact with infected cows developed conjunctivitis, fever, and respiratory symptoms. The statement says patients with unpasteurized milk exposure followed by symptomatic influenza A, particularly with conjunctivitis, should be evaluated for H5N1 with the local health department. It adds that suspected and confirmed cases should receive antivirals. 

Pasteurization left fats, lactose, calcium, magnesium, and zinc comparable in the studies the statement cites, with a 2011 meta-analysis finding that only vitamin B2 declined among the vitamins milk supplies. One cited analysis found lower total antioxidant activity in heat-treated vs unpasteurized milk, although fatty acid concentrations were unchanged with pasteurization. The statement also reports loss of bioactive proteins such as lactoferrin and immunoglobulins, though it says they are not the primary purpose of drinking milk. 

Older adults and immunocompromised patients, transplant recipients included, share the highest risk with infants and pregnant patients, the statement says. Heating unpasteurized milk after purchase is not preferable, since methods vary and local contamination is a risk. The statement considers breastfeeding safe through most of these infections, including listeriosis and toxoplasmosis, except early brucellosis when breast milk should be discarded. 

Federal rules exempt cheese labeled unpasteurized and aged at least 60 days from the interstate shipping ban. That cheese still carries risk, as illustrated by a multistate E coli O157 outbreak from commercially sold aged Gouda that resulted in 38 illnesses and 15 hospitalizations. Another outbreak involved 171 cases of salmonellosis, 70% in children, linked to unpasteurized milk and aged cheese.

In surveys from 2016 and 2019, 4.4% of US adults reported drinking unpasteurized milk in the prior year, more often young adults and rural residents. As of May 2019, 27 states allowed its sale, with 52% of them permitting retail sale and the rest limiting sale to the farm. Among the single-state outbreaks in that period, 78% occurred in states that expressly allowed sale. 

The statement endorses a ban on the sale or distribution of unpasteurized milk and milk products nationwide, including fresh, soft, and soft-ripened cheeses. It encourages pediatricians to contact their state representatives in support. Meanwhile, it suggests working with local public health officials on restrictions such as warning labels, and on community education about the risks. 

"For infants, children and pregnant people, pasteurized dairy products are clearly the safest choice," said Mark R. Corkins, MD, of the University of Tennessee Health Science Center, who chairs the academy's Committee on Nutrition and co-authored the statement. 

Source: Ratner AJ, et al. (2026 Oct 5) Pediatrics. Consumption of Unpasteurized (Raw) Milk and Milk Products by Pregnant People and Children: Policy Statement