COVID-19: Guidance – International

World Health Organization (WHO)

Coronavirus disease (COVID-19) Pandemic from the World Health Organization

Coronavirus disease (COVID-19) Outbreak from the World Health Organization: Regional Office for Europe

Coronavirus disease (COVID-19) advice for the public: Myth busters from WHO

Q&A on COVID-19, pregnancy, childbirth and breastfeeding from WHO

Clinical management of severe acute respiratory infection (‎SARI)‎ when COVID-19 disease is suspected: interim guidance, 13 March 2020, from WHO (accessed  21 March 2020) (another source)

At this point, there is no evidence that pregnant women present with increased risk of severe illness or fetal compromise. Pregnant and recently pregnant women who have recovered from COVID-19 should be enabled and encouraged to attend routine antenatal, postpartum care as appropriate. Additional care should be provided if there are any complications…

“Relatively few cases have been reported of infants confirmed with COVID-19 and they experienced mild illness. No vertical transmission has been documented. Amniotic fluid from six mothers positive for COVID-19 and cord blood and throat swabs from their neonates who were delivered by caesarean section all tested negative for SARS-CoV-2 by RT-PCR. Breastmilk samples from the mothers after the first lactation were also all negative for SARS-CoV-2…

“Infants born to mothers with suspected, probable or confirmed COVID-19 infection, should be fed according to standard infant feeding guidelines, while applying necessary precautions for IPC (infection prevention and control)…

“As with all confirmed or suspected COVID-19 cases, symptomatic mothers who are breastfeeding or practising skin-to-skin contact or kangaroo mother care should practise respiratory hygiene, including during feeding (for example, use of a medical mask when near a child if with respiratory symptoms), perform hand hygiene before and after contact with the child, and routinely clean and disinfect surfaces which the symptomatic mother has been in contact with…

“In situations when severe illness in a mother due to COVID-19 or other complications prevent her from caring for her infant or prevent 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 measures.

“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 they or their infants have suspected, probable or confirmed COVID-19 virus infection.

“Parents and caregivers who may need to be separated from their children, and children who may need to be separated from their primary caregivers, should have access to appropriately trained health or non-health workers for mental health and psychosocial support.”

Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: interim guidance, 17 March 2020 from WHO (accessed  21 March 2020) (another source)

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. She will also need to follow the other hygiene measures described in this document.”

UNICEF

Infant & Young Child Feeding in the Context of COVID-19 Brief No. 2 (V1) – March 30th, 2020

Coronavirus disease (COVID-19): What parents should know; How to protect yourself and your children. from UNICEF (accessed  21 March 2020)

Is it safe for a mother to breastfeed if she is infected with coronavirus?

“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.

“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.”

Baby Friendly Initiative Statement on Infant Feeding during the Covid-19 Outbreak, 17 March 2020, from Unicef UK Baby Friendly Initiative (accessed  21 March 2020 – quotes are from full statement)

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.

“When mothers are partially breastfeeding they can be encouraged to maximise the amount of breastmilk they are able to give or, if they choose, to be supported to return to full breastfeeding. If mothers are considering stopping breastfeeding it is worth having a sensitive conversation about the value of continuing during the Covid-19 outbreak.

“If you are breastfeeding while infected, there is currently no clinical evidence to suggest that the virus can be transmitted through breastmilk. Infection can be spread to the baby in the same way as to anyone in close contact with you. The benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk or by being in close contact with your child, however, this will be an individual decision and can be discussed with your midwife, health visitor or GP by telephone.

Formula Feeding: Parents should be encouraged to continue adhering to current guidance on washing and sterilizing equipment. Parents should be supported to bottle feed responsively, including pacing feeds and
limiting the number of people who feed their baby.”

COVID-19 Resources – Global Nutrition Cluster’s collected global, regional, and country-level resources for COVID-19

Coronavirus Disease (COVID-19) Summary of Guidance for Nutrition in Emergencies Practitioners from Global Technical Assistance Mechanism for Nutrition (GTAM)

COVID-19 Resources & Guidance from UNICEF UK Baby Friendly Initiative

Academy of Breastfeeding Medicine (ABM)

Anderson PO. Breastfeeding and Respiratory Antivirals: Coronavirus and Influenza. Breastfeed Med. 2020 Mar;15(3):128. doi: 10.1089/bfm.2020.29149.poa. Epub 2020 Feb 27.

ABM Statement on Coronavirus 2019 (COVID-19) from ABM. 10 March 2020. (accessed  21 March 2020)

At Home: A mother with confirmed COVID-19 or who is a symptomatic person-under-investigation (PUI) for COVID-19 should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast. 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. If possible, consider having someone who is well care for and feed the expressed breast milk to the infant.

“In Hospital: The choice to breastfeed is the mother’s and families.

“If the mother is well and has only been exposed or is a PUI 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.”