Coronavirus and Breastfeeding

The spread of a strain of coronavirus (COVID-19) has been a high profile news topic since December 2019. At the time of writing (February 2022)  information is still regularly being updated on the incidence of the disease, the symptoms, variants and what control measures are appropriate. Initially there was confusion whether or not to continue breastfeeding if a nursing mother had symptoms of COVID-19. This article shares places to find official recommendations about coronavirus and breastfeeding.

Note: Information is subject to change as more is discovered about COVID-19—please check individual websites for the latest recommendations.

What is coronavirus?

COVID-19 or SARS-CoV-2 is a strain of coronavirus (a type of virus) that first came to public attention in December 2019. It is associated with a respiratory infection which affects breathing and the lungs. Symptoms can include a high temperature (fever), dry cough and shortness of breath however a number of other symptoms are possible. New variants may have different symptoms.1 For answers to general questions about the disease see:

Can you continue to breastfeed with COVID-19 disease?

Organisations with statements about breastfeeding with coronavirus include: UNICEF2, World Health Organisation3, La Leche League International4, Academy of Breastfeeding Medicine5 and Public Health England (UK government)6  All the above advocate for continuing to breastfeed while taking hygiene precautions, a selection are copied below.

Official statements

UNICEF (United Nations International Children’s Emergency Fund)

Can women with Covid-19 breastfeed?
Yes. There is a wealth of evidence that breastfeeding reduces the risk of babies developing infectious diseases. There are numerous live constituents in human milk, including immunoglobulins, antiviral factors, cytokines and leucocytes that help to destroy harmful pathogens and boost the baby’s immune system. There is currently no evidence that Covid-19 can be passed to the baby through breastfeeding. There is also evidence that mothers with Covid-19 pass their antibodies to their baby through breastmilk, thereby giving protection to their baby. Considering the protection that human milk and breastfeeding offers the baby and the minimal role it plays in the transmission of other respiratory viruses, it is important that we do all we can to continue to promote, protect and support breastfeeding. To facilitate breastfeeding, mothers and babies should be enabled to stay together as much as possible, to have skin-to-skin contact, to feed their baby responsively and to have access to ongoing support when this is needed.

World Health Organisation (WHO)

If the mother is too unwell to breastfeed or express breastmilk, explore the best alternatives to breastfeeding a newborn or young infant, in priority order, as follows: 1) donor human milk should be fed if available from a human milk bank; 2) if supplies are limited, prioritize donor human milk for preterm and low birthweight newborns; 3) wet nursing may be an option depending on acceptability to mothers and families, availability of wet nurses and services to support mothers and wet nurses. COVID-19 testing of a woman who is a potential wet nurse is not required.

La Leche League International

If someone who is breastfeeding becomes ill, it is important not to interrupt breastfeeding unless it becomes medically necessary. When any member of the family has been exposed, the infant has been exposed. Any interruption of breastfeeding may actually increase the infant’s risk of becoming ill and even of becoming severely ill.

Public Health England

There is currently no evidence to suggest that the COVID-19 virus can be transmitted through breast milk. However, COVID-19 infection can be passed on to a baby in the same way as it can to anyone in close contact with you. The current evidence is that children with COVID-19 get much less severe symptoms than adults. If you or a family member are feeding with formula or expressed milk, sterilise the equipment carefully before each use. You should not share bottles or a breast pump with someone else.

Joint guidance published by the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and Royal College of Paediatrics and Child Health says:

However you choose to feed your baby, the following precautions are recommended:

  • Wash your hands before touching your baby, breast pump or bottles
  • Try to avoid coughing or sneezing on your baby while feeding at the breast or from a bottle
  • Consider wearing a mask or face covering while feeding
  • Follow recommendations for pump/bottle cleaning after each use
  • Consider asking someone who is well to feed your expressed breast milk or formula milk to your baby
  • Babies should not wear face masks as this risks suffocation.

Face masks?

Wearing face masks has frequently been advocated during the pandemic as a strategy to reduce COVID-19 transmission although the quality of evidence to support this strategy is debated.789

At the time of writing the World Health Organisation website still advocates the use of a “medical mask” when a mother is near her baby if she has COVID-1910 however they also state (see excerpt below) that a mother should still breastfeed if she doesn’t have a medical face mask and that non-medical masks have not been evaluated:

If a mother confirmed/suspected to have COVID-19 does not have a medical face mask should she still breastfeed?

Yes. Breastfeeding unquestionably reduces neonatal and infant mortality and provides numerous lifelong health and brain development advantages to the infant/ child. Mothers with symptoms of COVID-19 are advised to wear a medical mask, but even if this is not possible, breastfeeding should be continued. Other infection prevention measures, such as washing hands, cleaning surfaces, sneezing or coughing into a tissue are also important.  Non-medical masks (e.g. home-made or cloth masks) have not been evaluated. At this time, it is not possible to make a recommendation for or against their use.

Facial interaction between parent and baby is extremely important for a child’s healthy development. On the use of face masks, the World Council for Health and UNICEF state:

Mask wearing is best avoided and is likely to be psychologically detrimental for babies and children especially. Mask wearing can also interfere with the bonding between mother and baby. Regular masks and face coverings do not prevent the spread of viral infections and are unlikely to reduce the risk of transmission.

When babies are being cared for on a postnatal ward neonatal unit, parents can be asked to wear a mask when entering and moving around the unit. However, providing that they are asymptomatic, steps should be taken to enable them to interact with their babies without wearing a mask.

Early attachment between the mother (and/or other parent) and baby is critically important for the baby’s wellbeing and development. It is important to support new mothers to keep their babies close to them so that they can respond instinctively through gazing, stroking and talking. Infant cues such as smiling, crying or other facial expressions are powerful motivators of maternal behaviour, helping the mother to communicate and form attachments with her baby. In response, the baby learns to recognise his mother’s face, posture, tone of voice and to form a secure attachment. The baby’s brain grows rapidly from birth and at one year will have developed 70 per cent of its ‘wiring’ for the future and 90 per cent by age three. The development of positive neural pathways is significantly impacted by early parent-infant relationships.

Research

One small study found that breast milk from infected mothers did not contain the virus.

Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus.

The following article reviews subsequent research: Breastfeeding During the COVID-19 Pandemic – A Literature Review for Clinical Practice 14 September 2020 [accessed 11 Feb 2022]

Scientist looking down a microscope
One small study found that breast milk from infected mothers did not contain the virus

Medications

There are several places online to check the compatibility of medications with breastfeeding—see Medications and Breastfeeding. Useful information sheets include Cough and Cold Remedies and Breastfeeding and Breastfeeding and Influenza by The Breastfeeding Network.

COVID-19 vaccination and breastfeeding

There is limited safety data around COVID vaccines during lactation (or pregnancy) as vaccine manufacturers did not include breastfeeding or pregnant women in their initial safety trials.1112 One vaccine manufacturer recorded side effects in a small number of infants exposed to the vaccine via breastfeeding up to February 2021.13 Side effects included fever, rash, sickness, diarrhoea, irritability, poor feeding, insomnia, lethargy, tummy ache, allergy, crying, belching and pain. The World Council for Health says:

It is unknown as to whether the Covid-19 vaccines are excreted in breast milk.
Additionally, the Covid-19 vaccines, contain novel ingredients; it is unknown as to whether these ingredients pass into breast milk and the effects on babies have not been investigated.
A study by Pfizer released under a freedom of information request, demonstrated that ingredients of the Covid-19 vaccines did not remain in the arm, but spread throughout the body (a bio-distribution study). Therefore it is possible that breast milk could be contaminated by the vaccines.

Government statements around the safety of COVID-19 vaccination while breastfeeding include:

Public Health England, United Kingdom

There is no known risk associated with being given a non-live vaccine whilst breastfeeding. JCVI [The Joint Committee on Vaccination and Immunisation] advises that breastfeeding women should be offered any suitable COVID-19 vaccine. Emerging safety data is reassuring: mRNA was not detected in the breast milk of recently vaccinated women (Golan et al, 2021) and protective antibodies have been detected in breast milk (Gray et al, 2021)
The developmental and health benefits of breastfeeding are clear and should be discussed with the woman, along with her clinical need for immunisation against COVID-19.

 Centers for Disease Control and Prevention (USA)

Maximising milk supply

Breast milk has many antimicrobial factors to protect a baby or toddler against infections and support their immune system.14 The more breast milk they can have the stronger the protective effect but even small amounts can be helpful. For information about maintaining or increasing a breast milk supply or for help with returning to breastfeeding (relactation), useful links include:

A breastfeeding specialist e.g. an International Board Certified Lactation Consultant (IBCLC) can provide tailored support and information to maximise a mother’s breast milk supply or bring back a milk supply after breastfeeding has ended. And see the next section for more places to find help with common breastfeeding challenges during social isolation.

Breastfeeding support during social isolation

Although face to face breastfeeding support may not be possible during isolation phases against the spread of the virus, breastfeeding help is still available. For a discussion of the different levels of breastfeeding support generally see Why Hire an IBCLC? and for additional options during social isolation see:

  • Information online. Breastfeeding Support (this website) offers help and information on a variety of breastfeeding challenges.
  • Telephone support. Breastfeeding counsellors are very skilled at helping with many common breastfeeding challenges by telephone. In the United Kingdom contact the National Breastfeeding Helpline or contact La Leche League GB’s Helpline. For telephone support internationally search for a La Leche League Leader in your country via La Leche League International’s Get Help page and the Australian Breastfeeding Association has a Breastfeeding Helpline in Australia.
  • Online support. Some breastfeeding charities offer support online e.g. La Leche League GB has provision for submitting a Help Request or has live chat availability on their website.
  • Online meetings. Several local breastfeeding support groups will be hosting meetings through social media or online video conferencing instead of face to face.
  • Specialist support. Some IBCLC lactation consultants may offer one-to-one consultations through video link if they are unable to visit in person—see Find an IBCLC Lactation Consultant, on the Lactation Consultants of Great Britain website.

Coronavirus and pregnancy

For answers to common questions about having COVID-19 during pregnancy see Coronavirus Infection and Pregnancy from the Royal College of Obstetricians and Gynaecologists and Covid-19 and pregnancy: Guidance for healthy moms and babies from World Council for Health.

Skin-to-skin contact after birth

The Royal Colleges, UNICEF and the World Health Organisation recommend mothers and babies should stay together after birth even if they have symptoms of coronavirus or a confirmed COVID-19 infection:

Mother and infant should be enabled to remain together while rooming-in throughout the day and night and practise skin-to-skin contact, including kangaroo mother care, especially immediately after birth and during establishment of breastfeeding, whether they or their infants have suspected or confirmed COVID-19 virus infection.

Can parents touch and hold their newborn baby if they have Covid-19?
Yes, touch, comfort and communication are vital for the baby’s wellbeing and development. Good hygiene habits are important and will keep the risks to baby as low as possible. It is also useful to refer to the practical information provided by the UK governments and the World Health Organization (WHO).

Should mothers and babies be separated during the Covid-19 outbreak?
No. There is good evidence that the baby is safer when mothers and babies remain together and practice skin-to-skin contact and rooming in during the day and night, whether or not the mother or her baby has suspected, probable or confirmed Covid-19.

summary of official guidance around breastfeeding when the mother has COVID-19

Summary

Breast milk has many specially targeted immune factors and breastfeeding can help protect a baby against many infections and diseases. UNICEF, World Health Organisation, La Leche League International, Centers for Disease Control and Prevention, the Academy of Breastfeeding Medicine and Public Health England have all issued statements about breastfeeding during coronavirus infection. The general consensus is to continue breastfeeding while taking careful hygiene precautions to minimise risk of infection.

Information is subject to change from health and governmental bodies—checking individual websites for the latest updates is recommended.