Malaria is passed on through blood and needs to be injected.  It is
unlikely that the parasite, even if the baby got some blood from a
cracked nipple, would survive in the baby's stomach to be absorbed or
even that it could be absorbed.

The mother would likely be treated with chloroquine (as this is a
relapse it is a type of malaria which is *not* resistant).
Elimination of the liver parasite (from which the relapses occur)
would be eliminated using primaquine.  Neither of these drugs is
incompatible with breastfeeding.  However, primaquine may cause
hemolysis in people with G6PD deficiency, so if the mother or baby
have a high risk of being deficient (Asian or African origin), they
should be tested for this before treatment.  If the mother is G6PD
deficient, she may have to live with her relapses.  If the baby, but
not the mother, is deficient treatment of the mother with primaquine
should be delayed until the baby is weaned.  There is no rush, this is
an inconvenient infection, but, unlike falciparum malaria, is not
potentially fatal, and relapses usually occur only very occasionally.

Jack Newman, MD, FRCPC