The World Health Organization (WHO) estimates that about 2 billion people worldwide have been or are currently infected with hepatitis B virus (HBV), of which about 350 million are chronically infected. Mother-to-child transmission is one of the important routes of HBV infection, and about 50% of HBV infections originate from mother-to-child transmission, especially in some areas of Asia and Africa where hepatitis B is highly prevalent. China is also a region with a high prevalence of hepatitis B, with about 93 million people living with chronic HBV infection. The good news is that since 1992, when hepatitis B vaccination was incorporated into the national immunization program for infants and children, the rate of HBV infection in infants and children has decreased significantly. Many studies have confirmed that breastfeeding is widely recognized for its many health benefits for both infants and mothers. However, since Linnemann and Goldberg first demonstrated the presence of hepatitis B virus surface antigen (HBsAg) in breast milk in 1974, hepatitis B virus e antigen and hepatitis B virus DNA have been found in breast milk one after another. The presence of these viral infection indicators in breast milk has caused many mothers to abandon breastfeeding in favor of artificial feeding for fear of HBV transmission to their infants through breast milk. In fact, it has not been conclusively established whether breastfeeding increases the risk of vertical transmission. With the accumulation of research observations, the balance of academia is now quietly tilted in favor of breastfeeding. A growing body of research shows that breastfeeding or artificial formula is safe when combined with scheduled infant immunizations and hepatitis B immunoglobulin (HBIg) protection. There is no need for maternal concern that feeding practices will affect immunoprophylaxis or that breastfeeding will increase the risk of vertical transmission. In the days before hepatitis B vaccine and immunoglobulin (HBIg) were used, studies have found that although breastfeeding and artificial feeding both have more than 50% of vertical transmission, there is no substantial difference in the risk of vertical transmission between the two feeding methods. In other words, the risk of vertical transmission was not found to be higher with breastfeeding than with artificial feeding. The reason for this is still not very clear. Some studies have pointed out that lactoferrin in breast milk has antibacterial and antiviral activities; some studies have observed that lactoferrin and zinc- and iron-saturated lactoferrin significantly inhibit HBV-DNA replication in HBV-infected hepatocytes; others have suggested that small amounts of HBV-DNA in colostrum are inactivated in the infant’s gastrointestinal tract. All of these views explain, in different ways and to some extent, why breastfeeding does not increase the risk of vertical transmission of HBV. With a comprehensive interruption program of early maternal screening and neonatal immunoprophylaxis, the efficiency of HBV vertical transmission interruption from mother to child is 95%, therefore, the American Academy of Pediatrics recommends: retain breastfeeding on the basis of immunoprophylaxis. Immunoprophylaxis consists of two measures: vaccination of infants and children, and application of hepatitis B immunoglobulin (HBIg). Studies have shown that infants delivered by HBV-carrier mothers receive one dose of hepatitis B immunoglobulin (HBIg) immediately after birth, after which only routine hepatitis B vaccination is required to achieve the desired immunoprophylactic effect. Infants and children born to hepatitis B carrier mothers, after hepatitis B vaccination and immunoglobulin administration, obtained protective antibodies (HBsAb) of more than 90%, regardless of whether they were breastfed or fed with artificial formula, and there was no significant difference. Our 2010 guidelines for the prevention and treatment of chronic hepatitis B suggest that newborns of HBsAg-positive mothers should be given hepatitis B immunoglobulin (HBIg) as early as possible within 24 hours after birth, along with hepatitis B vaccination at different sites, and the second and third doses of hepatitis B vaccine at 1 and 6 months of age, respectively, to significantly improve the effectiveness of mother-to-child transmission interruption. The CDC suggests that HBV is not transmitted through breastfeeding, kissing, hugging, coughing, food or water, sharing utensils or cups, and casual contact. Breastfeeding does not increase the risk of HBV infection in infants born to HBV-positive mothers, even if the mothers are seropositive for HBsAg and HBeAg and have a high HBV-DNA load (highly infectious), after receiving hepatitis B vaccine combined with a single dose of hepatitis B immunoglobulin. However, the safety of breastfeeding has not been fully evaluated in HBV carrier mothers who are taking antiviral drugs during breastfeeding. Therefore, breastfeeding is not recommended for this group of mothers. In addition, HBV carrier mothers with pathological changes in the nipples (e.g., rupture, bleeding, etc.) should also be cautious about breastfeeding. In conclusion, all mothers with HBV (except HIV infection), regardless of their serum viral load, should breastfeed their newborns as long as there are no pathological changes in the nipples. There is no concern that breastfeeding practices increase the risk of vertical transmission and interfere with the effectiveness of immunoprophylaxis. Mothers who are treated with antiviral therapy drugs while breastfeeding should not breastfeed their infants.