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Coronavirus and Breastfeeding

There continue to be questions related to breastfeeding and COVID-19 (Coronavirus Disease 2019). LLL USA has created a list of resources and common questions that you may find helpful. We will update here as new information becomes available. 

Last updated: May 14, 2020

Frequently Asked Questions

Can I breastfeed my baby if I’m sick with coronavirus?

Yes, you can breastfeed your baby if sick with COVID-19.

According to the World Health Organization, those with COVID-19 can breastfeed if they wish to do so. They continue by stating, “Close contact and early, exclusive breastfeeding helps a baby to thrive. A woman with COVID-19 should be supported to hold her newborn skin-to-skin, and share a room with her baby.”

Arthur I. Eidelman, MD, Editor-in-Chief of Breastfeeding Medicine, concurs that “there is no need or indication to categorically separate infants from COVID-19 suspect or positive mothers other than in circumstances wherein the mother’s medical condition precludes her caring for the infant. Feeding mothers’ own breast milk, either by nursing or by feeding of expressed milk, is OK and desired!”

Are there precautions that I should take while nursing my baby?

There are precautions that anyone who is sick should take while caring for a baby, no matter the feeding method. According to the World Health Organization, those who wish to breastfeed while sick should:

  • Wear a mask if available or cover their mouth with a make-shift mask if possible.
  • Wash hands before and after touching the baby;
  • Routinely clean and disinfect surfaces the infected person has touched.

From the CDC, “A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast.  If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.”

Public Health Agency of Canada states, “If you have suspected, probable or confirmed COVID-19, you must isolate yourself in your home as much as possible; this includes practicing physical distancing in your home, with the only exception being the baby. You should take all possible precautions to avoid spreading the virus to your baby, which includes:

  • Wash your hands often, especially before and after touching your baby or your other children.
  • Wear a face mask that covers your mouth and nose. Homemade fabric masks are not medical devices. There is no evidence they protect you from virus-sized particles.
  • Ensure the environment around you is clean and disinfected with approved hard-surface disinfectants.”

Are there benefits to breastfeeding while I’m sick with coronavirus? 

According to La Leche League International, breastfeeding is the best means of protecting a baby from getting sick or of reducing the severity of a baby’s illness if a baby does become ill.

From the WHO’s Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: “Breastfeeding protects against morbidity and death in the post-neonatal period and throughout infancy and childhood. The protective effect is particularly strong against infectious diseases that are prevented through both direct transfer of antibodies and other anti-infective factors and long-lasting transfer of immunological competence and memory.”

From the CDC: “Breast milk provides protection against many illnesses. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended.”

In addition, several scientists are currently looking into whether breastmilk may hold clues into fighting coronavirus.

Are there risks to stopping or pausing nursing while sick with coronavirus? 

Yes, there are risks to stopping or pausing nursing while sick with coronavirus.

They include:

  • Problems for the nursing parent associated with sudden weaning including higher risk for mastitis.
  • a child at greater risk from becoming ill. Nursing parents pass on antibodies in their milk to pathogens to which they are exposed. Children who are weaned do not benefit from these protective antibodies.
  • Difficulties going back to nursing at the breast after the illness has passed. Many babies struggle to transition back to the breast after an extended time without nursing.
  • Significant emotional trauma for the nursing child who receives both nutrition and comfort from nursing.

Dr. Stuebe Alison Stuebe, MD, President of the Academy of Breastfeeding Medicine, outlines “several risks of separating mothers and infants in the hospital, which disrupts breastfeeding and skin-to-skin contact during the critical hours and days following birth. For example, infants who lack skin-to-skin contact with their mothers tend to have higher heart rates and respiratory rates and lower glucose levels. The separation also stresses the mother, which could make it more difficult for her to fight off the viral infection. In addition, separation interferes with the provision of maternal milk to the infant, which is important for the development of the infant’s immune system. Separation also disrupts breastfeeding, which puts the infant at increased risk of severe respiratory infections, including pneumonia and COVID-19.”

Can my baby get coronavirus through my milk? 

There is no evidence to suggest that babies have become sick with COVID-19 through human milk.

The World Health Organization states: “The COVID-19 virus has not, to date, been detected in the breastmilk of any mother with confirmed/suspected COVID-19. It appears unlikely, therefore, that COVID-19 would be transmitted through breastfeeding or by giving breastmilk that has been expressed by a mother who is confirmed/suspected to have COVID-19. Researchers continue to test breastmilk from mothers with confirmed/ suspected COVID-19.” 

The World Health Organization continues: “Amniotic fluid from six mothers positive for COVID-19 and cord blood and throat swabs from their neonates who were delivered by caesarean section all tested negative for the COVID-19 virus by RT-PCR. Breastmilk samples from the mothers after the first lactation were also all negative for the COVID-19 virus.

The World Health Organization also states, “If you are too unwell to breastfeed your baby due to COVID-19 or other complications, you should be supported to safely provide your baby with breastmilk in a way possible, available, and acceptable to you.”

Is donor human milk safe right now?

There is no evidence to suggest that pasteurized donor milk from a human milk bank poses a risk of transferring COVID-19 to a baby who receives it. Human Milk Banking Association of North American (HMBANA), states that based on information about genetically similar viruses, it is believed that heat inactivates COVID-19. “Studies have documented complete heat inactivation of genetically similar viruses such as SARS and MERS, specifically heat treatment of 60°C for 30 minutes (Miriam & Taylor, 2006; Rabenau et al., 2005; van Doremalen, 2014). All donor milk dispensed by HMBANA member banks undergo heat treatment using the Holder pasteurization method of 62.5°C for 30 minutes.”

Do I have to separate from my baby if I’m sick with coronavirus? 

Both the World Health Organization and the CDC leave allowances for staying with your nursing baby while sick with COVID-19.

The WHO encourages close contact between mother and baby including in the immediate postpartum period. They state: “Mothers and infants should be enabled to remain together and practise skin-to-skin contact, kangaroo mother care and to remain together and to practise rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.”

Harvard Medical School’s article COVID-19: Separating Infected Mothers from Newborns concludes, “To summarize, the CDC does not categorically recommend separating infants from infected mothers, and currently, there are insufficient data to support routinely doing so. Because the decision is ultimately up to the mother and family, they should be carefully educated about the clear risks of separation as well as its potential benefits. One must weigh the risk of the newborn getting severe COVID-19 infection, which is rare but likely finite, with the risk of undermining the establishment of breastfeeding and the consequences of breastfeeding failure, which can be significant, particularly in low-income settings.”

I’m pregnant, and the hospital where I am delivering is separating babies from mothers who are sick or may be sick with coronavirus. Can I keep my baby with me? 

Dr. Alison Stuebe writes in the journal Breastfeeding Medicine, “At the time of writing, we have no evidence to show that early separation improves outcomes.”

The American Academy of Family Physicians states, “the AAFP recommends promotion of breastfeeding and parent-infant bonding, and avoidance of parent-infant separation whenever possible.”

The WHO encourages close contact between mother and baby including in the immediate postpartum period. They state: “Mothers and infants should be enabled to remain together and practise skin-to-skin contact, kangaroo mother care and to remain together and to practise rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.”

“The many benefits of mother/infant skin-to-skin contact are well understood for mother-infant bonding, increased likelihood of breastfeeding, stabilization of glucose levels, and maintaining infant body temperature and though transmission of SARS-CoV-2 after birth via contact with infectious respiratory secretions is a concern, the risk of transmission and the clinical severity of SARS-CoV-2 infection in infants are not clear.

The CDC makes provisions for keeping the baby with the nursing parent (“rooming in”) while in the hospital. “The determination of whether or not to separate a mother with known or suspected COVID-19 and her infant should be made on a case-by-case basis using shared decision-making between the mother and the clinical team. Considerations in this decision include:

  • The clinical condition of the mother and of the infant
  • SARS-CoV-2 testing results of mother (confirmed vs. suspected) and infant (a positive infant test would negate the need to separate)
  • Desire to feed at the breast
  • Facility capacity to accommodate separation or colocation
  • The ability to maintain separation upon discharge
  • Other risks and benefits of temporary separation of a mother with known or suspected COVID-19 and her infant”

The CDC continues “If a mother with known or suspected COVID-19 and her infant do room-in and the mother wishes to feed at the breast, she should put on a face mask and practice hand hygiene before each feeding.”

The hospital policies related to separating newborns from mothers who are sick or have been exposed to COVID-19 vary widely across the United States and even from hospital to hospital within a city. It is important to speak with your birthing place to understand your options as a patient.

Can my baby have my milk if we are separated in the hospital? 

Yes. Human Milk Banking Association of North America has created guidelines for the safe handling of milk in this case.

Also, those who become too ill to breastfeed should be supported in expressing or pumping so that the baby can still be given their milk.

 

You may also find the following links helpful: 

Coronavirus and Breastfeeding Printable PDF, LLL USA, published March 14, 2020

COVID-19 Milk Expression, Storage, and Handling Infographics, Carolina Breastfeeding Institute, April 24, 2020

Induced Lactation and Relactation, LLL USA

Relactation During Emergencies, LLL USA

Breastfeeding in an Emergency, LLL USA

Medications and Breastfeeding, LLL USA

Milk Donation and Milk Sharing, LLL USA

Skin to Skin Care, LLLI

Breastfeeding, Childbirth, and COVID-19, LLLI

Continuing to Nurse Your Baby Through Coronavirus (2019-nCoV; COVID-19) and Other Respiratory Infections, LLLI

 

Additional Resources

Frequently Asked Questions: Breastfeeding and COVID-19 for Health Care Workers, World Health Organization, April 28, 2020

COVID-19 Milk Expression, Storage, and Handling Infographics, Carolina Breastfeeding Institute, April 24, 2020

AAFP Statement on Breastfeeding and COVID-19, American Academy of Family Physicians, April 14, 2020

Should Infants Be Separated from Mothers with COVID-19? First, Do No Harm, Alison StuebeBreastfeeding Medicine, published April 9, 2020

COVID-19: Considerations for Inpatient Obstetric Healthcare Settings, CDC, revised April 4, 2020

“The many benefits of mother/infant skin-to-skin contact are well understood for mother-infant bonding, increased likelihood of breastfeeding, stabilization of glucose levels, and maintaining infant body temperature and though transmission of SARS-CoV-2 after birth via contact with infectious respiratory secretions is a concern, the risk of transmission and the clinical severity of SARS-CoV-2 infection in infants are not clear.

The determination of whether or not to separate a mother with known or suspected COVID-19 and her infant should be made on a case-by-case basis using shared decision-making between the mother and the clinical team. Considerations in this decision include:

  • The clinical condition of the mother and of the infant
  • SARS-CoV-2 testing results of mother (confirmed vs. suspected) and infant (a positive infant test would negate the need to separate)
  • Desire to feed at the breast
  • Facility capacity to accommodate separation or colocation
  • The ability to maintain separation upon discharge
  • Other risks and benefits of temporary separation of a mother with known or suspected COVID-19 and her infant

If separation is not undertaken, other measures to reduce the risk of transmission from mother to infant could include the following, again, utilizing shared decision-making:

  • Using engineering controls like physical barriers (e.g., a curtain between the mother and newborn) and keeping the newborn ≥6 feet away from the mother.
  • Mothers who choose to feed at the breast should put on a face mask and practice hand hygiene before each feeding.
  • If the mother is not breastfeeding and no other healthy adult is present in the room to care for the newborn, a mother with known or suspected COVID-19 should put on a face mask and practice hand hygiene1 before each feeding or other close contact with her newborn.
  • The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on Transmission-Based Precautions in a healthcare facility.”

Milk Handling for COVID-19 Positive or Suspected Mothers in the Hospital Setting, Human Milk Banking Association of North America, published April 14, 2020

Pregnancy, childbirth and caring for newborns: advice for mothers (COVID-19), Public Health Agency of Canada, published April 4, 2020

“If you have suspected, probable or confirmed COVID-19, you must isolate yourself in your home as much as possible; this includes practicing physical distancing in your home, with the only exception being the baby. You should take all possible precautions to avoid spreading the virus to your baby, which includes:

  • Wash your hands often, especially before and after touching your baby or your other children.
  • Wear a face mask that covers your mouth and nose. Homemade fabric masks are not medical devices. There is no evidence they protect you from virus-sized particles.
  • Ensure the environment around you is clean and disinfected with approved hard-surface disinfectants.”

COVID-19: Separating Infected Mothers from Newborns: Weighing the Risks and Benefits, Harvard Medical School, published March 31, 2020

“Breastfeeding is the safest, most reliable method of infant feeding in an emergency. There have been widespread reports of shortages of retail supplies of infant formula due to hoarding… Thus, providers are already recommending that women who are supplementing with formula transition to exclusive breastfeeding. Because of the scarcity of formula in many locales and concern for infant health, there have been efforts to re-establish lactation in mothers who have stopped breastfeeding.”

The paper concludes, “To summarize, the CDC does not categorically recommend separating infants from infected mothers, and currently, there are insufficient data to support routinely doing so. Because the decision is ultimately up to the mother and family, they should be carefully educated about the clear risks of separation as well as its potential benefits. One must weigh the risk of the newborn getting severe COVID-19 infection, which is rare but likely finite, with the risk of undermining the establishment of breastfeeding and the consequences of breastfeeding failure, which can be significant, particularly in low-income settings. Failure to establish breastfeeding could put the newborn at risk of food insecurity and other infections. If an infected mother is not planning to breastfeed, then separation may make more sense if other factors allow, and separation seems more important if a newborn has underlying health conditions.”

Infant and Young Child Feeding in Emergencies, including COVID-19, U.S. Breastfeeding Committee, published March 27, 2020

Questions & Answers on COVID-19, pregnancy, childbirth, and breastfeeding, World Health Organization, published March 18, 2020

From WHO:

Can women with COVID-19 breastfeed?

Yes. Women with COVID-19 can breastfeed if they wish to do so. They should:

  • Practice respiratory hygiene during feeding, wearing a mask where available;
  • Wash hands before and after touching the baby;
  • Routinely clean and disinfect surfaces they have touched.
I have COVID-19 and am too unwell to breastfeed my baby directly. What can I do?

If you are too unwell to breastfeed your baby due to COVID-19 or other complications, you should be supported to safely provide your baby with breastmilk in a way possible, available, and acceptable to you. This could include:

  • Expressing milk;
  • Relactation;
  • Donor human milk.”

Infant Feeding During the COVID-19 Outbreak, UNICEF UK Baby Friendly Hospital Initiative, published March 17, 2020

Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected, Sections 12-13, World Health Organization, published March 13, 2020

Important points from WHO:

  • “Amniotic fluid from six mothers positive for COVID-19 and cord blood and throat swabs from their neonates who were delivered by caesarean section all tested negative for the COVID-19 virus by RT-PCR. Breastmilk samples from the mothers after the first lactation were also all negative for the COVID-19 virus.
  • Breastfeeding protects against morbidity and death in the post-neonatal period and throughout infancy and childhood. The protective effect is particularly strong against infectious diseases that are prevented through both direct transfer of antibodies and other anti-infective factors and long-lasting transfer of immunological competence and memory.” 
  • Those who are experiencing symptoms of COVID-19 should wear a medical mask when near the child including while feeding. They should also wash or disinfect their hands before and after contact with the child.As with all confirmed or suspected COVID-19 cases, symptomatic mothers who are breastfeeding or practising skin-to-skin contact or kangaroo mother care should practise respiratory hygiene, including during feeding (for example, use of a medical mask when near a child if the mother has respiratory symptoms), perform hand hygiene before and after contact with the child, and routinely clean and disinfect surfaces with which the symptomatic mother has been in contact.”
  • “Breastfeeding counselling, basic psychosocial support, and practical feeding support should be provided to all pregnant women and mothers with infants and young children, whether they or their infants and young children have suspected or confirmed COVID-19. All mothers should receive practical support to enable them to initiate and establish breastfeeding and manage common breastfeeding difficulties, including IPC measures. This support should be provided by appropriately trained health care professionals and community-based lay and peer breastfeeding counsellors.”
  • “In situations when severe illness in a mother with COVID-19 or other complications prevents her from caring for her infant or prevents her from continuing direct breastfeeding, mothers should be encouraged and supported to express milk, and safely provide breastmilk to the infant, while applying appropriate IPC measures.”
  • “In the event that the mother is too unwell to breastfeed or express breastmilk, explore the viability of relactation, wet nursing, donor human milk, or appropriate breastmilk substitutes, informed by cultural context, acceptability to the mother, and service availability.”
  • “Mothers and infants should be enabled to remain together and practise skin-to-skin contact, kangaroo mother care and to remain together and to practise rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.”

 

Academy of Breastfeeding Medicine Statement on Coronavirus 2019 (COVID-16), Academy of Breastfeeding Medicine, published March 10, 2020

For at-home care for person with COVID-19:

  • “A mother with confirmed COVID-19 or who is a symptomatic person-under-investigation (PUI) for COVID-19 should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast.”
  • If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well care for and feed the expressed breast milk to the infant.
  • “Persons with confirmed COVID-19 infection should remain separate (home isolation precautions) from other family members and friends or neighbors including the infant, except for breastfeeding.”
  • “The mother should practice careful handwashing and use of a mask as noted above for at least 5-7 days until cough and respiratory secretions are dramatically improved.”

 

Milk Banking and COVID-19, Human Milk Banking Association of North American (HMBANA), published March 6, 2020

  • Based on information about genetically similar viruses, it is believed that heat inactivates COVID-19. “Studies have documented complete heat inactivation of genetically similar viruses such as SARS and MERS, specifically heat treatment of 60°C for 30 minutes (Miriam & Taylor, 2006; Rabenau et al., 2005; van Doremalen, 2014). All donor milk dispensed by HMBANA member banks undergo heat treatment using the Holder pasteurization method of 62.5°C for 30 minutes.”
  • In limited studies including women with SARS, the virus has not been detected in breastmilk, however, it is not known whether mothers with COVID-19 can transmit the virus via breastmilk.”
  • In a recent, but small study in China, a group of six mothers testing positive for COVID-19 were studied after giving birth. No evidence of the virus was found in their samples of breastmilkcord blood, amniotic fluid or throat swabs of their newborns (Chen et al., 2020).”

 

COVID-19, National Perinatal Association, published March 2020

Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy, Centers for Disease Control and Prevention, published March 6, 2020

Frequently Asked Questions and Answers: Coronavirus Disease-2019 (COVID-19) and Children, Centers for Disease Control and Prevention, published March 6, 2020

Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19, Centers for Disease Control and Prevention, published February 19, 2020

A study published in The Lancet on February 12, 2020 states, “[B]reastmilk samples from six patients were tested for SARS-CoV-2 [COVID-19], and all samples tested negative for the virus.”

 

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