Covid 19 and breastfeeding

1. COVID-19 AND
BREASTFEEDING
MRS. NAMITA BATRA GUIN
ASSOCIATE PROFESSOR

2. BREASTFEEDING
• Breast milk is the best nutrient for infants, as it contains
antibodies that enhance the infant’s immune system
• WHO recommended that infants should be breastfed
exclusively for six months and continue breastfeeding
with appropriate complementary foods for up to two
years of age.
• Breastfeeding protects newborns from getting sick and
also helps protect them throughout their infancy and
childhood.
• Breastfeeding is particularly effective against infectious
diseases because it strengthens the immune system by
directly transferring antibodies from the mother.

3. COVID-19: introduction
• A respiratory disease caused by novel corona virus.
• Originated in Hubei, Wuhan in China
• Coronaviruses are the group of viruses that infects humans and animals.
• In Humans, the viruses causes respiratory infections like: common cold
and sometimes may lead to severe illness like pneumonia.
• The disease was declared as pandemic on 11th March 2020.

4. COVID-19: introduction
• Clinical manifestations ranges from :
• Uncomplicated illness: Patients with non-specific symptoms.
• Mild Pneumonia: Patient has cough but no difficulty in breathing
• Severe Pneumonia: Respiratory infection with respiratory rate >30 breaths /min
or severe respiratory distress or SpO2 <90% on room air.
• Acute Respiratory Distress Syndrome: Worsening of respiratory symptoms
within a week.
• Sepsis: Life threatening organ dysfunction
• Septic Shock: Persisting hypotension despite volume resuscitation
Source: www.mohfw.gov.in

5. TRANSMISSION
Droplet Mode: From infected patient’s coughs and sneezes or talks. Droplets
can travel up to 6 feet or 2meters distance. But the droplets do not linger in the
air. Patient is most contagious when they are symptomatic.
Fomite Mode: Touching the surfaces that has been touched by an infected
person, and has virus on it; and then touching your mouth, nose or eyes.
Faeco-oral route- to be researched
Transplacental: Few neonatal two cases detected, but needs thorough
investigation.
But there is not current evidence regarding, virus transmission
through breast milk.

6. COVID-19 AND BREASTFEEDING
• The pandemic has created undue stress among people.
• New mothers are vulnerable in this situation, as they worry about the new born child.
• This may lead to lot of anxiousness and they may be loaded with questions regarding the disease and its spread.
• They may also worry about specific measures to be taken to protect their child from getting infected and how to take
those measures.
• As Health professionals, we understand the mother and child’s needs.

7. TRANSMISSION OF VIRUS THROUGH
BREAST MILK
• CDC (Centers for Disease Control and prevention) reported in a study, that the
virus was not found in the breast milk of women with COVID-19 but antibodies to
fight it were found.
• It appears unlikely, therefore, that COVID-19 would be transmitted through
breastfeeding or by giving breastmilk that has been expressed by a mother who is
confirmed/suspected to have COVID-19.
• It is highly advisable to mothers with or without Covid-19 , to exclusively breastfeed
their child. However, they should undertake some precautions while doing so.

8. HYGIENE
RECOMMENDATIONS
DURING BREAST
FEEDING

9. 1. HANDWASHING
• Wash hands frequently with
soap and water or use alcohol-
based hand rub, especially
before touching the baby.
• 60% or higher alcohol based
sanitizer should be used as
hand rub.

12. 2. WEAR MASK
• Wear medical mask while feeding the child.
• Replace mask as soon as they become
damp.
• Dispose of masks immediately.
• Do not re-use a mask.
• Do not touch the front of the mask but
behind.
• NOTE: Never use face mask for newborn
and infants. Risk of suffocation.

14. 3. COUGH and
SNEEZE
ETIQUETTES
• Sneeze or cough into a
tissue, immediately dispose
of it and use alcohol-based
hand rub or wash hands
again with soap and clean
water.

15. 4. CLEAN HIGH-
TOUCH SURFACES
• Regularly clean and disinfect surfaces
• If a surface is dirty, first clean it with soap
or detergent and water. Then use a
disinfectant product containing alcohol (of
around 70 per cent) or bleach.
• Vinegar and other natural products are not
recommended.
• Diluted household bleach solutions may
also be used on some surfaces.

16. COVID-19 POSITIVE MOTHER
• Covid-19 positive mothers should breastfeed the child. As it will
prevent the child from various illness.
• General hygiene measures should be taken by the mother to prevent
spread of infection, while breastfeeding the child.
• Measures include: Handwashing, wearing medical mask, using tissue for
sneezing and coughing and disinfecting the high-touch surfaces.
• If the mother does not have a medical mask, she can use mask
prepared at home (Should have three layers), while breastfeeding the
child.

17. COVID-19 POSITIVE MOTHER
• If a mother is suspected/confirmed to have Covid-19, coughs over
exposed breast or chest, then she should gently wash breast with soap
and warm water for at least 20 seconds, prior to feeding.
• However, it is not necessary to wash the breast before every breastfeed
or prior to expressing milk.
• In no case mother who is confirmed/suspected case to have covid-19
and is breastfeeding, should ‘top-up’ with an infant formula milk.
• Counsel and support the mother to optimise positioning and
attachment to ensure adequate milk production.

18. COVID-19 POSITIVE MOTHER WITH
SEVERE CLINICAL MANIFESTATIONS
• Mother, with severe clinical manifestations of covid-19, due to
which she could not breastfeed the child, should:
• Start to breastfeed when she feels well enough to do so. There is no
fixed time interval to wait after confirmed/suspected COVID-19.
There is no evidence that breastfeeding changes the clinical course
of COVID-19 in a mother.
• Be supported in her general health and nutrition to ensure full
recovery. She should also be supported to initiate breastfeeding or
relactate (restarting breastfeeding after a gap).

19. BEST ALTERNATIVES TO
BREASTFEEDING A NEWBORN

20. EXPRESSED MILK
• Expression of breastmilk is primarily done through hand expression or
with the use of a mechanical pump only when necessary.
• The choice of expression of breast milk depends upon mother’s
preference, availability of equipment, hygiene conditions and cost.
• Expressing breastmilk is also important to sustain milk production so
that mothers can breastfeed when they recover.
• The mother, and anyone helping the mother, should wash their hands
before expressing breastmilk or touching any pump or bottle parts and
ensure proper pump cleaning after each use.

21. EXPRESSED MILK
• The expressed breastmilk should be fed to the child preferably using a
clean cup and/or spoon (easier to clean), by a person who has no signs
or symptoms of illness and with whom the baby feels comfortable.
• The mother/caregiver should wash their hands before feeding the
newborn/infant.

22. DONOR HUMAN MILK
• If the mother is unable to express milk and milk is available from a
human milk bank, donor human milk can be fed to the baby while the
mother is recovering.

23. OTHER
• Wet-Nursing: Another woman breastfeeding or caring for the child. It
may be an option depending on acceptability to mothers/families,
cultural acceptability, availability of wet-nurses and services to support
mothers/wet-nurses.
• Formula Milk: Infant formula milk with measures to ensure that it is
feasible, correctly prepared, safe and sustainable. (only when other
methods are unavailable).

24. USING
BREASTPUMPS:
Hygienic measures

25. MEASURES .. WHEN USING BREASTPUMPS
• Should only be used by the mothers who are not able to breastfeed due
to severe illness by Covid-19 .. Following measures needs to be taken:
• 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.
• 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.
• Do not touch the pumped milk

26. MEASURES .. WHEN USING BREASTPUMPS
• Clean all parts of the pump, that come in contact with the breastmilk, thoroughly with
soap and warm water.
• Exterior of the entire pump should be properly disinfected using 70% ethanol or
another alcohol-based disinfectant that is active against SARS-CoV-2.
• Use dedicated brush to scrub the pump parts.
• Rinse by holding items under running water, or by submerging in fresh water for 10-15
seconds.
• Allow to air-dry thoroughly.
• Do not use towel to rub or pat items dry because doing so may transfer germs to the
items.
• For extra germ removal, sanitization can be done by using steam or boiling water for 5
mins.

27. STORAGE OF EXPRESSED MILK
• Use breast milk storage bags or clean food-grade containers with tight
fitting lids made of glass or plastic to store expressed breast milk.
• Never store breast milk in disposable bottle or plastic bags.
• Freshly expressed or pumped milk can be stored:
• At room temperature (77°F or colder) for up to 4 hours.
• In the refrigerator for up to 4 days.
• In the freezer for about 6 months is best; up to 12 months is acceptable.

28. STORAGE TIPS
• Label the expressed milk.
• Do not store breast milk in the door of the refrigerator or freezer.
• Freeze breast milk in small amounts of 2 to 4 ounces (or the amount
that will be offered at one feeding) to avoid wasting breast milk that
might not be finished.
• When freezing breast milk, leave about an inch of space at the top of
the container because breast milk expands as it freezes.
• Never refreeze thawed milk.

29. Human milk storage guidelines
Source: www.cdc.gov

30. FEEDING STORED MILK
• Warm breast milk by placing the container of breast milk into a
separate container or pot of warm water for a few minutes or by running
warm (not hot) tap water over the container for a few minutes.
• Do not heat breast milk directly on the stove or in the microwave.
• Swirl the breast milk to mix the fat, which may have separated.
• The leftover breast milk can still be used within 2 hours after the baby is
finished feeding. After 2 hours, leftover breast milk should be
discarded.

31. ACTIONS FOR
HEALTH FACILITIES
AND STAFF

32. • Do not promote breastmilk substitutes, feeding bottles, teats, pacifiers or
dummies
• Help in practicing skin-to-skin contact, and rooming-in throughout the day
and night, especially straight after birth during establishment of breastfeeding,
whether or not the mother or child has suspected, probable, or confirmed
COVID-19.
• Promote relactation, wet nursing and donor human milk in mothers with
severe manifestations of covid-19, when they are too unwell to breastfeed.

33. • Provide breastfeeding counselling, basic psychosocial support, or
practical feeding support.
• Support can be provided at community level by trained health
professionals and peer groups in the community.

34. RECOMMENDATIONS BY UNICEF
• 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.
• Temporary separation – In case of mother’s hospitalization because of severity of disease.
Mothers 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. This expressed breast milk should be fed to
the newborn by a healthy caregiver.

35. RECOMMENDATIONS BY UNICEF
• Skin to skin Contact: Placing the child immediately in skin-to skin contact with mother. It improves
thermal regulation of newborn and several other physiological outcomes, and is associated with
reduced neonatal mortality. It also enables early initiation of breastfeeding. The numerous benefits
of skin-to-skin contact and breastfeeding substantially outweigh the potential risks of transmission
and illness associated with COVID-19.
• Follow standard newborn feeding guidelines with precautionary measures:
• Initiate breastfeeding within 1 hour of the birth.
• Continue exclusive breastfeeding for 6 months, then introduce adequate and safe
complementary foods at age 6 months.
• Continue breastfeeding up to 2 years of age or beyond.

36. RECOMMENDATIONS BY UNICEF
• The aim of recommendations is to improve the immediate and lifelong
survival, health and development of their newborns and infants.
• These recommendations consider the likelihood and potential risks of
COVID-19 in infants and also the risks of serious illness and death
when infants are not breastfed.

37. DECISION TREE FOR
HEALTH AND
COMMUNITY
SETTINGS

39. IMPORTANT
MESSAGES
COVID-19 has not been detected in the breastmilk of any
mother with confirmed/suspected COVID-19
Newborns and infants are at low risk of COVID-19
infection. Among the few cases of confirmed COVID-19
infection in young children, most have experienced only
mild or asymptomatic illness.
Breastfeeding and skin-to-skin contact significantly reduce
the risk of death in newborns and young infants and provide
immediate and lifelong health and development advantages.
The numerous benefits of breastfeeding substantially
outweigh the potential risks of transmission and illness
associated with COVID-19.

40. SUMMARY
• Breastmilk is the best source of nutrition for infants, including infants whose mothers have confirmed or suspected
coronavirus infection.
• As long as an infected mother takes appropriate precautions—she can breastfeed her baby.
• Breastmilk contains antibodies and other immunological benefits that can help protect against respiratory diseases.
• A growing body of evidence supports the importance of breastfeeding for a child’s growth, development, and health, as
well as for helping them avoid obesity and noncommunicable diseases later in life.

41. References
1. https://www.medela.com/breastfeeding/mums-journey/covid-19-information-concerning-breastfeeding
2. https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Breastfeeding-During-COVID-19.aspx
3. http://www.emro.who.int/nutrition/nutrition-infocus/breastfeeding-advice-during-covid-19-outbreak.html
4. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html
5. https://www.who.int/docs/default-source/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_1
6. https://www.cdc.gov/healthywater/hygiene/healthychildcare/infantfeeding/breastpump.html
7. https://www.unicef.org/eap/breastfeeding-during-covid-19
8. https://waba.org.my/v3/wp-content/uploads/2020/04/Publications-and-references-on-COVID-19-revised.pdf
9. https://www.cdc.gov/breastfeeding/pdf/preparation-of-breast-milk_H.pdf
10. https://www.cdc.gov/healthywater/pdf/hygiene/breast-pump-fact-sheet-p.pdf

42. THANK
YOU