CDC Guidance on Breastfeeding and Breast Milk Feeds during COVID 19 pandemic

The U.S. Centers for Disease Control and Prevention has issued Interim guidance on breastfeeding and breast milk feed for COVID-19 mothers.It may be adapted by state and local health departments to respond to rapidly changing local circumstances.

This interim guidance is intended for healthcare providers who care for breastfeeding women and infants who receive breast milk feeds in the context of coronavirus disease 2019 (COVID-19). This interim guidance is based on what is currently known about SARS-CoV-2, the virus that causes COVID-19, and the transmission of other viral respiratory pathogens. CDC will update this interim guidance as additional information becomes available. For breastfeeding guidance in the immediate postpartum setting, refer to Considerations for Inpatient Obstetric Healthcare Settings.

Key points are as follows-

1.Breast milk is the best source of nutrition for most infants. We do not know whether mothers with COVID-19 can transmit the virus via breast milk, but the limited data available suggest this is not likely to be a source of transmission.

2. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers.

3.A mother with confirmed COVID-19 should be counseled to take all possible precautions to avoid spreading the virus to her infant, including hand hygiene and wearing a cloth face covering.

Transmission of SARS-CoV-2 through breast milk

These considerations are based upon the limited evidence available to date about transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, and knowledge of other viruses that cause severe respiratory illness including influenza and severe acute respiratory syndrome coronavirus (SARS-CoV).

Breast milk is the best source of nutrition for most infants, and it provides protection against many illnesses. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. In limited studies on women with SARS-CoV-2 or SARS-CoV, these viruses have not been detected in breast milk. We do not know whether mothers with COVID-19 can transmit the virus via breast milk, but the limited data available suggest this is not likely to be a source of transmission.

Pasteurized donor human milk is important in the care of preterm infants. No information is currently available regarding the effect of pasteurization on SARS-CoV-2 but similar viruses are inactivated with this process. Disruptions in human milk donations may be seen during the COVID-19 pandemic. If hospitals have difficulty acquiring donor human milk, available supplies should be prioritized for preterm infants who will benefit most from human milk feeds.

Guidance on breastfeeding for mothers in the context of COVID-19

Whether and how to start or continue breastfeeding should be determined by the mother, in coordination with her family and healthcare providers.

A mother with suspected, probable, or confirmed COVID-19 should be counseled to take all possible precautions to avoid spreading the virus to her infant. She should be instructed to wash her hands using soap and water, especially if her hands are visibly soiled, before touching the infant. If soap and water are not available, she should use a hand sanitizer with at least 60% alcohol. Additionally, mothers should wear a cloth face covering while feeding at the breast. If expressing breast milk either by hand expression or with a breast pump, the mother should clean her hands, as instructed above, before touching any pump or bottle parts and wear a cloth face covering. Mothers should be educated about recommendations on how to properly clean and sanitize breast pumps. If possible, expressed breast milk should be fed to the infant by a healthy caregiver, who is not at high-risk for severe illness from COVID-19.

Breastfed infants of women with confirmed COVID-19

An infant being breastfed by a mother who is confirmed to have COVID-19 should be considered as having suspected COVID-19 for the purposes of infection control and prevention for the duration of the mother's recommended period of home isolation and 14 days thereafter. The same approach should be taken with respect to an infant who has any other ongoing, close contact with another person who has confirmed COVID-19. Mothers should be counseled to inform their child's healthcare provider that their child has had high-risk contact with a person confirmed to have COVID-19.

Well child checks and lactation services

Healthcare providers are encouraged to prioritize newborn care and vaccination of infants and young children (through 24 months of age) when possible. Given the potential challenges related to breastfeeding in the context of COVID-19, the need for weight checks and visual or laboratory assessment for jaundice, and the stressors of social distancing, every effort should be made to conduct newborn follow-up visits in person.

Alternative approaches, such as telemedicine, may be considered when providing lactation support services to breastfeeding dyads. Lactation service providers who must see a mother or infant with suspected or confirmed COVID-19 should follow recommended infection prevention and control measures, including the use of recommended personal protective equipment (PPE).