Breastfeeding with Coronavirus
There are many questions and concerns about the coronavirus disease known as (COVID-19). Among them, mothers are asking if it is safe to breastfeed their babies if they have COVID-19.
We know breast milk provides protection against many illnesses. However, there are rare occasions where breastfeeding is not recommended. Understandably, new mothers may have questions around what the best thing to do is during the COVID-19 pandemic. We have some answers for common breastfeeding questions, advised by Melanie Newkirk, registered dietitian/nutritionist and clinical nutrition manager for Nutritional Services and Lactation at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, Julia Johnson, M.D., a neonatology doctor at Johns Hopkins Children’s Center and Anna Sick-Samuels, M.D., M.P.H., a pediatric infectious disease doctor at Johns Hopkins Children’s Center.
What should a woman who is breastfeeding know about coronavirus?Though breastfeeding is ultimately a personal decision, the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and the Academy of Breastfeeding Medicine (ABM) all support giving mother’s breast milk to their babies even if they are infected with COVID-19.
Do studies show that the virus is detected in breast milk from mothers infected with COVID-19?At the time this was written, existing reports have not detected the virus causing COVID-19 in breast milk. Similarly, other respiratory viruses have not been transmitted in breast milk. For example, the severe acute respiratory syndrome (SARS-CoV) virus that is a similar virus has not been detected in breast milk.
Should a mother continue to breastfeed if she starts to feel symptoms related to COVID-19?
The ABM suggests if a mother who is confirmed to have COVID-19 or has symptoms and is under investigation, she should isolate from others, including from her infant to reduce the risk for transmission. The ABM recommends a breastfeeding mother can either:
- provide an ongoing supply of breast milk by expressing milk using a breast pump
- allow mother/baby contact for breastfeeding sessions with precautions.
Should mothers with COVID-19 be separated from their infants while infected with the virus and give their babies expressed breast milk instead of feeding the baby at the breast?
Separation between a mother with COVID-19 and her infant is a decision that should be made by a health care team or specialist and is based on many factors including the mother’s and baby’s health. If the mother and baby are able to remain together, breastfeeding at the breast is encouraged. In this case, the CDC recommends the mother wear a mask and use good hand hygiene before and after breastfeeding.
What happens if a woman with COVID-19 gives birth?
Based on the CDC recommendations, if a mother with COVID-19 gives birth in the hospital, the baby may be temporarily separated from the mother to reduce risk of transmission of COVID-19 to the newborn. During this time of separation, providing the baby with expressed breast milk is recommended. Once the mother’s symptoms improve and she and the baby are ready to go home, she would follow the same guidelines as above, either using expressed milk or allowing mother/baby contact for breastfeeding (with the mother wearing a mask and practicing hand hygiene). The medical team would help guide the mother as to the best way to continue breastfeeding in the transition home.
What is the best thing for a mother to do if she has to isolate away from the baby?
If the mother and baby are temporarily separated, the mother is encouraged to express her breast milk, and someone else, such a nurse, will feed the child. Although the baby would not breastfeed at the breast, mothers must still wash their hands before and after pumping.
- The counter or table top surface used while pumping should be cleaned with disinfecting products.
- The outside of the pump should be cleaned following manufacturer’s instructions, both before and after pumping.
- The pump kit should be cleaned after every pumping session per manufacturer’s instructions — taken apart, rinsed, cleaned with dish soap and water in a basin used only for cleaning infant feeding items, and rinsed.
- The pump kit may be cleaned in a dishwasher if it is dishwasher-safe.
- Pump parts should be sanitized at least once a day following instructions using a steam bag, boiling for five minutes, or in a dishwasher with a sanitize setting.
- Pump parts should never be placed directly in the sink and should be cleaned as soon as possible after pumping.
- Pump parts should be placed on a clean dishtowel or paper towel and allowed to air dry thoroughly before storing.
- Thoroughly clean the wash basin and bottle brush (if used) with soap and water after each use, or clean in a dishwasher if dishwasher-safe, and air dry.
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Safety Tips for Breastfeeding with COVID-19
Mothers with COVID-19 or with symptoms of illness are encouraged to use the following precautions when breastfeeding their infant or expressing breast milk.
- Avoid people who are sick.
- Cover your nose and mouth when you cough or sneeze (using the crook of your elbow is a good technique) and throw away any tissue used immediately, and wash hands well.
- Wear a mask for any contact, while including breastfeeding baby at the breast.
- Wash hands well for at least 20 seconds or use an alcohol-based sanitizer that contains 60% to 95% alcohol before and after feedings (both feeding at the breast and expressing milk). Wash hands well when visibly soiled.
- Clean and disinfect countertop, outside of pump and pump kit as described above.
- If a mother has coughed or sneezed onto her uncovered chest or breast, cleanse the skin that may come into contact with the baby or pump.
- Clean and disinfect other surfaces that the child may touch.
This information is based on what we currently know about COVID-19 and the transmission of other respiratory viruses. For more information on breastfeeding with COVID-19, please visit the Centers for Disease Control and Prevention. For general tips on parenting infants and toddlers, including breastfeeding, visit HopkinsAllChildrens.org/parenting.
This article was updated on April 6, 2020.
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