Table 1 Suggested guidelines for breastfeeding during COVID-19 pandemic with supporting evidence
From: Breastfeeding during the COVID-19 pandemic – a literature review for clinical practice
Category | Suggested guideline | Rationale/remarks |
|---|---|---|
All infants | Avoiding separation of mother-infant dyads, including infection control precautions. | Separation of a mother and her infant may have potential detrimental effects on feeding and bonding [18, 38, 40, 43,44,45]. |
Infant from healthy or non-symptomatic mother | Initiate and continue breastfeeding. | Breastfeeding is the optimal source of nutrition and protection for infants [46, 47]. |
Infant of mother with suspected COVID-19 (potentially exposed and/or symptomatic, but well enough to breastfeed) | Continue breastfeeding while applying infection control protocols with specific attention to droplet protection. | Mechanisms of breastmilk protect the infant [40, 43,44,45]. Respiratory viruses are not transmitted in breastmilk [1, 5, 38]. Direct transfer of antibodies into breastmilk [43]. Anti-infective factors transfer to breastmilk [43]. Immunological competence and memory in breastmilk [43]. |
Continue breastfeeding. | The virus is not transmitted via breastmilk [1, 5, 15, 38, 43, 44]. | |
All laboratory confirmed cases are isolated and cared for in a health care facility. Isolate mother-infant dyad together. | ||
Wear a mask during feeding. | To avoid coughing or sneezing on the baby while feeding at the breast [38, 43, 44, 47, 48]. | |
Infant of mother who test positive for COVID-19 (mother well enough to breastfeed) | Continue breastfeeding. | No virus detected in amniotic fluid [5, 15]. No virus detected in cord blood [5, 15]. No virus detected in neonatal throat swabs [5, 15]. No virus detected in breastmilk after first breastfeeding [5, 15]. |
Positive mother with mild symptoms | Isolate mother-infant dyad at home. | Avoid person-to-person transmission of the virus [35]. |
Wear a mask during feeding. | To avoid coughing or sneezing on the infant while feeding at the breast [38, 43, 44, 47, 48]. | |
Positive mother with severe symptoms (can breastfeed) | Hospitalize mother-infant dyad. | All laboratory confirmed cases are isolated and cared for in a health care facility [35, 40]. |
Isolate mother-infant dyad together in hospital. | ||
Conduct a risk/benefits discussion between neonatologists and families to individualise infant care in the case of infants requiring neonatal care. | Admission to the neonatal unit may be required in infants that are born to COVID-19 positive mothers and/or have symptoms. This may require close observation and may lead to separation, however, not necessarily to discontinuation of breastfeeding [38]. | |
Temporary separation may be needed in case of mothers who need medical care in hospital -continue to express milk [40, 47]. | ||
Infant of mother who test positive for COVID-19 (mother too ill to breastfeed) | Express milk and feed with clean cup or spoon. | Prevent accidental transmission of pathogens via surface areas [35, 44]. |
*Practical note: Mother can decant milk from her container into a clean container held by a healthy person to prevent transmission via the containers surface. | ||
Wear a mask during expressing. | Prevent accidental transmission of pathogens via air [35, 44, 47]. | |
Ask a healthy person to feed the baby expressed milk. | Prevent accidental transmission of pathogens via person-to-person contact or air [38, 47]. | |
In case of separation, ensure appropriately trained mental health and psychosocial support for parents. | The prevalence of common mental disorders in the antenatal and postpartum period is high [43]. | |
Expressing breastmilk: | Assumption: COVID-19 is not found in breastmilk, therefore general expressing guidelines apply. | |
Apply all general infection prevention measures. | ||
PUI and positive mothers should express in the area where they are isolated. | Prevent potential infection of non-infected areas and persons. | |
Do not share equipment for breastmilk expressing. | Milk particles can be left within any parts of the equipment and transferred to the next person. Any pathogens surviving on surfaces can be transferred via equipment [38, 49]. | |
Rinse all expressing equipment in clean, cold running water before sterilising. | Prevent proteins in milk to coagulate due to heat, cold water removes milk residue [38]. | |
Decant expressed milk into a clean container held by a healthy person wearing protective clothing. | Prevent transmission of the virus via container surface area potentially infected by positive mother via surfaces [42}. | |
Wipe down bottles with a viricidal agent of 1:10 diluted bleach. | Kill pathogens on surfaces, such as bottles handles by infected person [37]. | |
Wash expressing equipment with hot soapy water with domestic detergent, rinse under running water and dry with a paper towel. | ||
Sterilise equipment after each use [42]. | Kill pathogens [38]. | |
General infection control measures | ||
Personal hygiene | Washing hands often for 20 s with soap and water or using alcohol-based hand rub (based on 80% ethanol or 75% 2-propanol). | Prevent accidental transmission of pathogens via person-to-person contact [4, 47, 50]. |
Personal hygiene | Cover mouth and nose with a disposable tissue or elbow when coughing and sneezing. | Prevent accidental transmission of pathogens via air [4, 14]. |
Personal hygiene | Wash hands before and after contact with the infant. | Prevent accidental transmission of pathogens via person-to-person contact [38, 43, 44, 47, 48]. |
Environment | Thoroughly cook meat and eggs. | Prevent accidental transmission of pathogens in food sources [4]. |
Environment | Clean/disinfect contaminated surfaces immediately. | Prevent accidental transmission of pathogens via surfaces [43, 44, 49]. |
Surface disinfection with 0.1% sodium hypochlorite or 71% ethanol reduces coronavirus infectivity on surfaces within 1-min exposure time. | Human coronaviruses can remain infectious on surfaces for up to 9 days [49]. | |
Social distance | Keep mother and baby together and practice safe skin-to-skin contact and rooming-in. | Immediately after birth, during establishment of breastfeeding and whether mother or infant have suspected, probable, or confirmed COVID-19, 24 h/day [18, 43, 51]. |
Social distance | Avoid close contact with anyone who is coughing and/or sneezing. | Prevent accidental transmission of pathogens via air [4]. |
Social distance | Avoid crowds of people such as church gatherings, shopping malls and large events. | Prevent accidental transmission of pathogens via person-to-person contact or air [4]. |
Social distance | Do not allow anyone to kiss the infant and ask them to disinfect their hands when they come into the house or plan to touch the infant. | Prevent accidental transmission of pathogens via person-to-person contact [4]. |
Social distance | Do not allow anyone who is ill to visit the mother and infant. | Prevent accidental transmission of pathogens via person-to-person contact or air [4]. |
Mental health of mothers during COVID-19 pandemic | No need for alarm. | Children (aged 1–16 years) accounted for roughly 5% of total patients with COVID-19 in China, but frequently do not have a notable disease and no transfer via breastmilk has been confirmed [1, 5, 7, 13, 52]. |
Use self-isolation time to bond with infant at home. | Bonding improves relationships and mental health and overall wellbeing [51]. | |