(updated 8 April 2020) See below for all the in-depth information & references…
There is currently no clinical evidence to suggest that the virus can be transmitted through breastmilk. To date, the virus has not been found in samples of amniotic fluid or breastmilk. Infection control measures are concentrated on avoiding the spread of COVID-19 through respiratory droplets.
Per the World Health Organization, “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.”
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Keep an eye on the latest guidance from your national government and the World Health Organization (WHO), as these could change as more information becomes available.
No symptoms of COVID-19?
Everyone: Practice social distancing, frequent hand washing, and other measures recommended to prevent infection.
Breastfeeding: Keep Breastfeeding. If you’re thinking about weaning, consider waiting until the health emergency is over.
Pumping: Wash hands before touching pump or bottle parts. Follow best practices for pump cleaning.
Combination Feeding: Maximize the amount of breastmilk your child gets. If it’s an option, consider increasing supply or relactation.
Formula Feeding: Follow best practices for preparing formula and sterilizing equipment.
Anyone not feeding at the breast: Limit the number of people who feed your baby.
If you have COVID-19 (or suspect you have it)
(Symptoms of Coronavirus from the CDC)
Everyone:
- Wash hands frequently with soap & water; Routinely clean and disinfect surfaces that you may have touched
- Avoid the spread of COVID-19 through respiratory droplets (use a face mask or mouth/nose covering)
- Avoid close contact (<3-6 ft) with others who are well
- Follow all other currently recommended measures for preventing infection
If you are breastfeeding:
- Continue breastfeeding if possible
- Wash hands before and after feeding/holding baby (wash frequently if you’re holding baby much of the time)
- Wear a mask or mouth/nose covering whenever you are near baby (to keep respiratory droplets from contacting baby)
- Avoid touching eyes, nose & mouth (yours and baby’s)
- Skin-to-skin contact is encouraged and should be supported
If you are pumping:
- Wash hands before and after expressing milk or touching pump, bottles, or other feeding equipment
- Follow best practices for pump cleaning
All caregivers:
- If possible, have a healthy person care for and feed baby for any feedings where baby is not breastfed
- All caregivers & helpers should wash hands before and after caring for baby, and avoid the spread of COVID-19 through respiratory droplets
- If formula is used, follow best practices for preparing formula and sterilizing equipment
Severely ill mothers who are hospitalized:
- If possible, keep mother and baby together and support mother to breastfeed
- Help to express milk if mother and baby are separated
Keeping it Clean: Cleaning Pumps & Safe Preparation of Formula
How to Keep Your Breast Pump Kit Clean from the CDC (en español)
How to prepare infant formula and sterilise feeding equipment to minimise the risks to your baby from Unicef UK Baby Friendly Initiative
Social Distancing, Quarantine, & Self-Isolation
Tips For Social Distancing, Quarantine, And Isolation During An Infectious Disease Outbreak from the Substance Abuse and Mental Health Services Administration (SAMHSA)
Social Distancing: Why Keeping Your Distance Helps Keep Others Safe from the American Academy of Pediatrics
A guide to self-isolation or quarantine with Covid-19 by two Australian GPs, Dr Wendy Burton, MBBS FRACGP (Hon) and Dr Kat McLean, MBChB FRACGP FRNZCGP
Journal Articles: Breastmilk samples negative
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020 Feb 12;395(10226):809-815. doi: 10.1016/S0140-6736(20)30360-3.
Cui Y, et al. A 55-Day-Old Female Infant Infected With 2019 Novel Coronavirus Disease: Presenting With Pneumonia, Liver Injury, and Heart Damage. Journal of Infectious Diseases. 2020 Mar 17;jiaa113. doi:10.1093/infdis/jiaa113.
Dong L, Tian J, He S, et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA. 2020 Mar 26. doi:10.1001/jama.2020.4621
Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, Bao Y, Sun Y, Huang J, Guo Y, Yu Y, Wang S. Perinatal Transmission of COVID-19 Associated SARS-CoV-2: Should We Worry? Clin Infect Dis. 2020 Mar 17. pii: ciaa226. doi: 10.1093/cid/ciaa226.
Kam KQ, Yung CF, Cui L, Lin Tzer Pin R, Mak TM, Maiwald M, Li J, Chong CY, Nadua K, Tan NWH, Thoon KC. A Well Infant With Coronavirus Disease 2019 With High Viral Load. Clin Infect Dis. 2020 Feb 28. pii: ciaa201. doi: 10.1093/cid/ciaa201.
Li Y, et al. Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerging Infectious Diseases. 2020 Mar 5;26(6):10.3201/eid2606.200287. doi:10.3201/eid2606.200287.
Liu W, et al. Coronavirus Disease 2019 (COVID-19) During Pregnancy: A Case Series. Preprints. 2020 Feb 25; 2020020373.
Wang S, et al. A Case Report of Neonatal 2019 Coronavirus Disease in China. Clinical Infectious Diseases. 2020 Mar 12;ciaa225. doi:10.1093/cid/ciaa225.
Zhang YH, Lin DJ, Xiao MF, Wang JC, Wei Y, Lei ZX, Zeng ZQ, Li L, Li HA, Xiang W. 2019-novel coronavirus infection in a three-month-old baby. Chinese Journal of Pediatrics (Zhonghua Er Ke Za Zhi). 2020 Feb 11;58(0):E006. doi: 10.3760/cma.j.issn.0578-1310.2020.0006. In Mandarin Chinese only.
Journal Articles: More
Anderson PO. Breastfeeding and Respiratory Antivirals: Coronavirus and Influenza. Breastfeed Med. 2020 Mar;15(3):128. doi: 10.1089/bfm.2020.29149.poa. 27 Feb 2020.
Baud D, Giannoni E, Pomar L, Qi X, Nielsen-Saines K, Musso D, Favre G. COVID-19 in pregnant women: Authors’ reply. The Lancet. 2020 Mar 17. https://doi.org/10.1016/S1473-3099(20)30192-4
Breslin N, et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. American Journal of Obstetrics & Gynecology. 2020 April 6. Early release.
CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep. ePub: 6 April 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6914e4
Chin AW, Chu JT, Perera MR, Hui KP, Yen HL, Chan MC, Peiris M, Poon LL. Stability of SARS-CoV-2 in different environmental conditions. The Lancet Microbe. 2020 April 2. DOI:10.1016/S2666-5247(20)30003-3.
Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. Pediatrics. 2020 Mar 16. pii: e20200702. doi: 10.1542/peds.2020-0702.
Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020 Mar 4. pii: S0163-4453(20)30109-2. doi: 10.1016/j.jinf.2020.02.028.
Marinelli KA, Lawrence RM. Safe Handling of Containers of Expressed Human Milk in all Settings During the SARS-CoV-2 (COVID-19) Pandemic. Journal of Human Lactation. 2020 April 6. doi.org/10.1177/0890334420919083.
Rasmussen SA, Thompson LA. Coronavirus Disease 2019 and Children: What Pediatric Health Care Clinicians Need to Know. JAMA Pediatr. 2020 April 3. doi:10.1001/jamapediatrics.2020.1224
Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA. 2020 Feb 14. doi: 10.1001/jama.2020.2131.
Zeng H, Xu C, Fan J, et al. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA. 2020 March 26. doi:10.1001/jama.2020.4861
Zeng L, Xia S, Yuan W, et al. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatr. 26 March 2020. doi:10.1001/jamapediatrics.2020.0878
Masks
Everyone Thinks They’re Right About Masks: How the coronavirus travels through the air has become one of the most divisive debates in this pandemic by Ed Yong (The Atlantic)
Davies A, Thompson KA, Giri K, Kafatos G, Walker J, Bennett A. Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep. 2013 Aug;7(4):413-8. doi: 10.1017/dmp.2013.43.
MacIntyre CR, Seale H, Dung TC, Hien NT, Nga PT, Chughtai AA, Rahman B, Dwyer DE, Wang Q. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015 Apr 22;5(4):e006577. doi: 10.1136/bmjopen-2014-006577.
van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One. 2008 Jul 9;3(7):e2618. doi: 10.1371/journal.pone.0002618.