Best Practices for COVID-19–Positive or Exposed Mothers—Breastfeeding and Pumping Milk

Sandra E. Sullivan; Lindsay A. Thompson

doi:10.1001/jamapediatrics.2020.3341

JAMA Pediatrics Patient Page

October 26, 2020

Best Practices for COVID-19–Positive or Exposed Mothers—Breastfeeding and Pumping Milk

Sandra E. Sullivan, MD, IBCLC¹; Lindsay A. Thompson, MD, MS^1,2

Author Affiliations Article Information

¹Department of Pediatrics, University of Florida College of Medicine, Gainesville
²Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville

JAMA Pediatr. 2020;174(12):1228. doi:10.1001/jamapediatrics.2020.3341

Breast milk protects infants from many illnesses and is the best food for most infants.

During the coronavirus disease 2019 (COVID-19) pandemic, mothers who may be exposed or infected might be unsure about feeding their infant breast milk. Mothers, along with their family and health care professionals, should decide whether and how to start or continue breastfeeding. We do not know if mothers with COVID-19 can spread the virus to infants through breast milk, but it is unlikely based on what we do know. Women who have had COVID-19 have high amounts of antibodies to the virus in their breast milk, which coat the inside of infants’ noses and mouths, helping to block infection. Fresh (not frozen) milk is ideal because it is has live infection-fighting cells and offers the most protection.

If you test positive for COVID-19 and want to breastfeed or express breast milk, follow these guidelines: (1) Wash your hands before and after touching your infant or any pump or bottle parts. (2) Avoid using a pump that is shared by others. (3) Wear a mask or cloth face covering during breastfeeding or pumping. (4) Follow manufacturer instructions for proper pump cleaning after each use, cleaning all parts that come into contact with skin or breast milk. (5) If possible, pumped 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.

If you are breastfeeding and may have been exposed to COVID-19 and/or work in a setting with increased risk of exposure to the virus, such as a health care professional or first responder, limiting duties or isolating from your family are not currently recommended. As always, your employer should provide access to a private, nonbathroom space for you to pump milk. Clean your hands routinely, whether breastfeeding or pumping milk. Clean all pump and collection kit parts as directed by the manufacturer. Some women may wish to follow the guidelines above for those who have COVID-19, in addition to these suggestions: (1) Upon returning home, you may choose to take off shoes, immediately wash work clothing, and shower. (2) You can continue your usual work while following workplace guidelines. (3) You may wish to work with supervisors to limit high-risk situations, especially with people testing positive for COVID-19. (4) You may wish to clean areas that are touched a lot in work lactation rooms when you go in and out of the room. (5) Cleaning the outside of milk bottles or bags is not currently recommended. (6) If your infant has risk factors such as age younger than 2 months, born early, heart defect, severe lung disease, or severe immune problems, you may wish to isolate from your infant while providing your milk (see above guidelines for those who have tested positive for COVID-19).

As we learn more about COVID-19 and breastfeeding, this advice may change. For now, we know protecting breastfeeding and breast milk is best.

For More Information

Centers for Disease Control and Prevention: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html
American College of Obstetrics and Gynecology: https://www.acog.org/patient-resources/faqs/pregnancy/coronavirus-pregnancy-and-breastfeeding
Academy of Breastfeeding Medicine: https://www.bfmed.org/covid-19-resource-page

The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, email reprints@jamanetwork.com.

Article Information

Published Online: October 26, 2020. doi:10.1001/jamapediatrics.2020.3341

Conflict of Interest Disclosures: None reported.

1 Comment for this article

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November 25, 2020

Building Resilience Dividends for Breastfeeding in COVID19 Times

Sushma Nangia, MBBS, MD(Peds), DM(Neon) | Director professor and Head, Neonatology, Lady Hardinge Medical College & Kalawati Saran Children's Hospital, New Delhi, India.

The portrayal of best practices by Sullivan et al.1, is a commendable initiative to promote breastfeeding amid the pandemic, however we have a different viewpoint based on currently available evidence.
Author have mentioned that antibodies present in breastmilk coat the nose and mouth of the baby helping to block the infection by SARS CoV 2 virus. There is evidence in the literature that mothers who have had COVID 19 infection have antibodies in their breastmilk. These antibodies are purported to provide protection against this infection to their breastfeeding infants. It is however, pertinent to note that the mode of action and protection provided by antibodies is still unknown2. We suggest to add the word “might” as it currently lacks evidence, however is most likely scenario.
The authors rightly state that fresh (not frozen) milk is ideal, however, this write up emphasizing pumping (requiring storage) poses a challenge to the concept of freshness. COVID 19 infected mother is unlikely to be working and related workplace pumping and storage might not be relevant to her. All other working mothers can pump and store milk without concern related to freshness of the milk.
A COVID 19 positive mother should be informed about the safety and goodness of directly breastfeeding her infant with best practices addressing hand hygiene, 6 feet distancing from baby (with healthy caregiver), cleaning of frequently touched surfaces, and use of face mask (3-ply/N-95 but not cloth cover) while feeding. Breastmilk needs to be hand expressed or pumped and fed fresh in case of maternal infant separation due to illness in either one.
In addition, the best practices highlighted might not be directly replicable to LMICs (representing 6.5 billion people3- 3/4th of globe’s population) due to the social stigma associated with COVID 19 and preconceived myths prevailing amongst the decision-makers in the family milieu influencing breastfeeding and child-rearing. These get compounded by misinformation, leading to non-initiation or premature cessation of breastfeeding. Also, parental concern for their infant’s safety might add to the avoidance of breastfeeding.4
This patient information page could provide valuable guidance worldwide by quashing such myths. In India, a few digital and tele-health approaches have been undertaken to curtail the dampening effect of the pandemic.5 We suggest that good practices be promoted by aggressive campaigning for promoting breastfeeding through electronic and print media, establishing central multilingual 24x7 breastfeeding helpline and by maintaining this approach in coming months.
Collective efforts by federal agencies, professional bodies and other stakeholders are required to protect, promote, and support breastfeeding in these challenging times.
Conflict of Interest: None.
References:
1. Sullivan SE, Thompson LA. Best Practices for COVID-19–Positive or Exposed Mothers—Breastfeeding and Pumping Milk. JAMA Pediatr. Published online October 26, 2020. doi:10.1001/jamapediatrics.2020.3341
2. Breastfeeding and COVID-19. Accessed November 2, 2020. https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19
3. Population, total - Low & middle income | Data. Accessed November 2, 2020. https://data.worldbank.org/indicator/SP.POP.TOTL?locations=XO
4. Oncel MY, Akın IM, Kanburoglu MK, et al. A multicenter study on epidemiological and clinical characteristics of 125 newborns born to women infected with COVID-19 by Turkish Neonatal Society. Eur J Pediatr. Published online August 10, 2020. doi:10.1007/s00431-020-03

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