Coronavirus and Breastfeeding

The spread of a new strain of coronavirus (COVID-19) is currently a high profile news topic. Information is regularly updated on the spread of the disease, the symptoms and how to minimise infection but it can be difficult to find information about whether to continue breastfeeding if a nursing mother has 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 this new virus—please check individual websites for the latest recommendations.

What is coronavirus?

Coronavirus (COVID-19 or SARS-CoV-2) is a new virus that was first recorded in December 2019. It causes a respiratory infection which affects breathing and the lungs. Symptoms can include a high temperature, cough, shortness of breath and in severe cases may cause pneumonia. For answers to general questions about the disease see:

Can you continue to breastfeed with coronavirus disease?

UNICEF, World Health Organisation, La Leche League International, Centers for Disease Control and Prevention, the Academy of Breastfeeding Medicine and Public Health England (UK government) have all issued statements about having coronavirus and breastfeeding (see below). They all advocate continuing to breastfeed while taking hygiene precautions such as frequent hand washing.

Face masks?

Most sources mention wearing a protective face mask when in close contact with the baby to minimise the risk of airborne infection. Although Public Health England does not recommend face masks for the general public—stating there is no evidence that they are beneficial outside a healthcare environment1—they endorse guidance from the Royal Colleges (see below) to consider wearing a face mask while breastfeeding if one is available.

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. 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 seems sensible to do all we can to continue to promote, protect and support breastfeeding.

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.

For symptomatic mothers well enough to breastfeed, this includes 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 – as should be done in all cases where anyone with confirmed or suspected COVID-19 interacts with others, including children.

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 – all while following the same infection prevention methods.

World Health Organisation (WHO)

Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother [could] can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby.

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 [infection prevention and control] measures.

Fact sheet: The World Health Organisation has produced a comprehensive fact sheet to accompany the above document Frequently Asked Questions: Breastfeeding and COVID-19 For health care workers, 28 April 2020.

La Leche League International

when any member of the family has been exposed, the infant has been exposed. Hence, any interruption of breastfeeding may actually increase the infant’s risk of becoming ill and even of becoming severely ill.

If someone becomes ill enough to require hospitalization, the baby should be allowed to continue breastfeeding if at all possible

if an interruption of breastfeeding is deemed medically necessary, hand expressing or pumping the milk is encouraged. In such cases, the expressed milk, which contains multiple immune factors, may be fed to the baby to help prevent the baby from getting the infection or to help reduce the severity and duration of an infection if the baby does get sick.

Centers for Disease Control and Prevention (CDC)

  • If you have COVID-19 and choose to breastfeed:
    – Wear a cloth face covering while breastfeeding and wash your hands before each feeding.
  • If you have COVID-19 and choose to express breast milk:
    –  Use a dedicated breast pump.
    –  Wear a cloth face covering during expression and wash your hands before touching any pump or bottle parts and before expressing breast milk.
    – Follow recommendations for proper pump cleaning after each use, cleaning all parts that come into contact with breast milk.
    – If possible, expressed breast milk should be fed to the infant by a healthy caregiver who does not have COVID-19, is not at high-risk for severe illness from COVID-19, and is living in the same home.

Academy of Breastfeeding Medicine

If the mother is well and has only been exposed or is a PUI [person-under-investigation] with mild symptoms, breastfeeding is a very reasonable choice and diminishing the risk of exposing the infant to maternal respiratory secretions with use of a mask, gown and careful handwashing is relatively easy.

If the mother has COVD-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.

Public Health England

There is currently no evidence to suggest that the virus can be transmitted through breast milk. Infection can be spread to the baby in the same way as to anyone in close contact with you. The current evidence is that children with coronavirus get much less severe symptoms than adults. The benefits of breastfeeding outweigh any potential risks of transmission of the virus through breast milk or by being in close contact

Public Health England directs parents to joint guidance published by the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and Royal College of Paediatrics and Child Health:

When you or anyone else feeds 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
  • Consider wearing a face mask while breastfeeding, if available
  • Follow recommendations for pump cleaning after each use
  • Consider asking someone who is well to feed your expressed breast milk to your baby.

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.

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.

Maximising milk supply

Breast milk has many antimicrobial factors to protect a baby or toddler against infections and support their immune system.2 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.

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:

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 [or not] they or their infants have suspected, probable 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.

Whether or not the mother or her baby has suspected, probable or confirmed Covid-19, she should be enabled to remain with her baby, practice skin-to-skin contact and room-in throughout the day and night, especially after birth and during the establishment of breastfeeding.

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 as more is discovered about this particular virus—checking individual websites for the latest updates is recommended.