Breastfeeding During COVID-19 Pandemic Compiled by: dr. Ranti A Hannah, SpA, IBCLC An outbreak of a novel coronavirus named “SARS-CoV-2” causing respiratory disease termed coronavirus disease 2019 (COVID-19) which originated in Wuhan, China has spread globally in the last months and declared as a pandemic. How can we advise breastfeeding mothers during this time? As new information is emerging daily, these are a few frequently-asked questions based on guidelines about breastfeeding and COVID-19 to date. Can COVID-19 be transmitted through breastmilk? In limited case series on women with COVID-19 and other coronavirus infections reported to date, no evidence of SARS-CoV-2 has been detected in the breast milk; however, it is not yet known if COVID-19 can be transmitted through breast milk (ie, infectious virus in the breast milk).1,2 Is it safe for a mother with COVID-19 to breastfeed? All mothers in affected and at-risk areas who have symptoms of fever, cough or difficulty breathing, should seek medical care early, and follow instructions from a health care provider. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and health care practitioners.1 Currently, the primary concern is not whether the virus can be transmitted through breastmilk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding.1 The choice to breastfeed is the mother’s and families. Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions.3 If the mother is well and has only been exposed or is a person under investigation (PUI) with mild symptoms, breastfeeding is a very reasonable choice and diminishing the risk of exposing the infant to maternal respiratory secretions is possible.2 For symptomatic mothers well enough to breastfeed, necessary precautions include wearing a mask when near a child (including during feeding), washing hands before and after contact with the child (including feeding), and cleaning/disinfecting contaminated surfaces.2,3 If a mother is too ill, she should be encouraged to express milk and give it to the child via a clean cup and/or spoon by someone who is well. 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.2,3 How to safely breastfeed at self-isolation? 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. Ideally there is another uninfected adult to care for the infant’s needs including feeding the infant expressed breastmilk if the mother is expressing milk and working to maintain her supply of milk. 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. It may be useful to involve a healthcare professional and/or the health department in the decision to discontinue home isolation precautions.2 How to breastfeed during isolation in the hospital? If the mother has COVID-19, there may be more worry, but it is still reasonable to choose to breastfeed and provide expressed milk for her infant. Limiting the infant’s exposure via respiratory secretions may require more careful adherence to the recommendations depending on the mother’s illness.2 There are several choices in the hospital concerning housing for a breastfeeding mother and her infant.BANNER 728 x 90 a. Rooming-in(mother and baby stay in the same room without any other patients in that room) with the infant kept in a bassinet 6 feet from the mother’s bed and taking precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, for direct contact with the infant and while feeding at the breast. Ideally, there should be another well adult who cares for the infant in the room.2 b. Temporary separation– primarily because the mother is sick with the COVID-19 infection and needs medical care for herself in the hospital. Mothers who intend to breastfeed / continue breastfeeding should be encouraged to express their breast milk to establish and maintain milk supply. If possible, a dedicated breast pump should be provided. Prior to expressing breast milk, mothers should practice hand hygiene. After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected per the manufacturer’s instructions. This expressed breast milk should be fed to the newborn by a healthy caregiver.2 References Centers for Disease Control and Prevention (CDC) Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation for COVID-19 ACADEMY OF BREASTFEEDING MEDICINE (ABM) STATEMENT ON COVID-19. March, 10, 2020. UNICEF Coronavirus-19 Disease (COVID-19): What Parents Should Know. How to protect yourself and your children.