Skip to main content

Table 4 International organizations’ recommendations towards breastfeeding during the COVID-19 pandemic

From: Recommendations for breastfeeding during Coronavirus Disease 2019 (COVID-19) pandemic

Timeline

International organizations

Recommendations

Specific precautions

Feb 8, 2020

National Health Commission of the People’s Republic of Chinaa [14, 73]

• For mothers who are suspected or confirmed with COVID-19 or have not recovered after diagnosis, breastfeeding should be stopped. If the nucleic acid test of the suspected infected mother is negative twice in a row, the newborn can be transferred out of the isolation and observation area and be breastfed.

• Not available

March 10, 2020

Academy of Breastfeeding Medicine, ABMa [13]

• At home, mothers with confirmed COVID-19 infection should remain separate (home isolation precautions) from other family members and friends or neighbors including the infant, except for breastfeeding.

• In hospital, if the mother is well and has only been exposed or is a person-underinvestigation with mild symptoms, breastfeeding with careful precautions is a very reasonable choice. If the mother has COVID-19, it is still reasonable to choose to breastfeed and provide expressed milk for her infant.

• Precautions for breastfeeding directly at the breast.

✓ Washing her hands before touching the infant.

✓ Wearing a face mask.

• Precautions for expressing breast milk.

✓ Washing hands before touching any pump or bottle parts.

✓ Following recommendations for proper pump cleaning after each use.

✓ If possible, considering having someone who is well care for and feed the expressed breast milk to the infant.

• In the hospital, rooming-in (mother and infant stay in the same room without any other patients in that room) with the infant should keep in a bassinet 6 ft from the mother’s bed. Ideally, there should be another well adult who cares for the infant in the room.

Apr 26, 2020

Italian National Institute of Health, ISSa [10]

• If the mother is severely or critically ill, separation appears to be the best option, with attempts to express breast milk in order to maintain milk production.

• If the mother is asymptomatic or mildly affected, breastfeeding and rooming-in can be considered by the mother in coordination with healthcare providers.

• Precautions for breastfeeding directly at the breast.

✓ Cleaning hands.

✓ Using a face mask.

Jun 1, 2020

International Society of Ultrasound in Obstetrics and Gynecology, ISUOG b [76]

• If the mother is severely or critically ill, separation appears to be the best option, with attempts to express breast milk in order to maintain milk production.

• If the mother is asymptomatic or mildly affected, breastfeeding and colocation (also called rooming-in) can be considered by the mother in coordination with healthcare providers, or may be necessary if facility limitations prevent mother-infant separation.

• Precautions for breastfeeding directly at the breast.

✓ Washing hands.

✓ Wearing a three-ply surgical mask before touching the infant.

• Precautions for expressing breast milk.

✓ A dedicated breast pump should be used.

✓ The machine should be washed thoroughly, according to the manufacturer’s recommendations, after each use.

• In case of rooming-in, the infant’s cot should be kept at least 2 m from the mother’s bed, and a physical barrier such as a curtain may be used.

Jan 25, 2021

World Health Organization, WHOc [8, 77, 78]

• Mothers with suspected or confirmed COVID-19 should be encouraged to initiate or continue to breastfeed

• If suspected or confirmed infected mothers are well enough, they should keep skin-to-skin contact with their babies and breastfeed with appropriate precautions. Mothers with symptoms of COVID-19 are advised to wear a medical mask, but even if this is not possible, breastfeeding should be continued. For those who are too unwell to breastfeed, expressing milk and donor human milk could be considered.

• Precautions for breastfeeding directly at the breast.

✓ Washing hands frequently with soap and water or using alcohol-based hand rub and especially before touching the infant.

✓ Wearing a medical mask during any contact with the infant, including while feeding.

✓ Sneezing or coughing into a tissue, then disposing of it immediately and washing hands again.

✓ Routinely cleaning and disinfecting surfaces that mothers have touched.

March 29, 2021

American Academy of Pediatrics, AAPd [75]

• The AAP strongly supports breastfeeding as the best choice for infant feeding.

• Counsel families to consider delaying weaning and extending the duration of breastfeeding to maximize the protection conferred via human milk during the pandemic.

• If mothers choose not to breastfeed during the first week postpartum, pediatricians should consider asking family whether they might reconsider this choice, and engage in a discussion about the importance of breastfeeding and expressed human milk in protecting against infections and other diseases during this most vulnerable time.

• Precautions for breastfeeding directly at the breast.

✓ Proper hand washing with soap and water before handling the infant.

✓ Wearing a mask.

✓ When not nursing, the infant can be cared for by a healthy caregiver, if available, and/or maintained in a separate room or at least 6 ft away from the mother.

• Precautions for expressing breast milk.

✓ Wearing a mask.

✓ Thoroughly cleaning her hands as well as any pump parts, bottles, and artificial nipples.

✓ The expressed milk can be fed to the infant by a healthy caregiver.

June 17, 2021

Centers for Disease Control and Prevention, CDCd [70,71,72]

• 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.

• People without suspected or confirmed COVID-19 and who have not been in close contact with someone who has COVID-19, or who have been fully vaccinated for COVID-19 do not need to take special precautions when feeding at the breast or expressing milk.

• When a lactating caregiver’s milk is not available, pasteurized donor human milk is important for preterm infants. If hospitals have difficulty acquiring donor human milk, available supplies should be prioritized for preterm infants who will benefit most from breast milk.

• Precautions for breastfeeding directly at the breast.

✓ Wearing a mask when they are less than 6 ft from the child during feeding.

✓ Washing hands with soap and water for 20 s before each feeding.

• Precautions for expressing breast milk.

✓ A dedicated breast pump should be used.

✓ Wearing a mask when they are less than 6 ft from the child during expression and wash hands with soap and water for 20 s before touching any pump or bottle parts and before expressing breast milk.

✓ Following recommendations for proper pump cleaning after each use. Clean all parts that come into contact with breast milk.

✓ Consider having a healthy caregiver who does not have COVID-19, is not at increased risk for severe illness from COVID-19, and is living in the same home feed the expressed breast milk to the baby. If the caregiver is living in the same home or has been in close contact with you, they might have been exposed. Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and during their own quarantine period after you complete isolation.

• In the hospital, engineering controls like physical barriers are used (e.g., placing the neonate in a temperature-controlled isolator), and the neonate is kept ≥6 ft away from the mother as much as possible.

• In a workplace with a multiuser lactation room, efforts should be made to implement engineering and administrative controls to enable physical distancing (e.g., spacing lactation stations at least 6 ft apart, installing physical shields between lactation stations, staggering lactation schedules, encouraging telework).

Jul 29, 2021

United Nations International Children’s Emergency Fund, UNICEFd [16, 74]

• For suspected or confirmed infected mothers who are well enough to breastfeed, breastfeeding should be continued with appropriate precautions.

• For those who are too unwell to breastfeed, expressing milk and donor human milk could be considered.

• Precautions for breastfeeding directly at the breast.

✓ Wearing a mask if available.

✓ Washing hands before and after contact.

✓ Cleaning/disinfecting surfaces.

• Express milk should be given to infant via a clean cup and/or spoon – all while following the same precautions.

Nov 2 2021

Royal College of Obstetricians and Gynecologists, RCOGe [15]

• Breastfeeding should be recommended to all women in line with usual guidance.

• Women with suspected or confirmed COVID-19 should remain with their baby and be supported to practice skin-to-skin/kangaroo care, if the newborn does not require additional medical care at this time.

• Adopt a precautionary approach for a woman who has suspected or confirmed COVID-19 and whose baby needs to be cared for on the neonatal unit to minimize any risk of women-to-infant transmission; at the same time, involve parents in decisions, mitigating potential problems for the baby’s health and wellbeing and for breastfeeding, bonding and attachment.

• Women and their families should be informed that infection with COVID-19 is not a contraindication to breastfeeding. Women should be supported to make an informed decision about how they feed their baby. Women who choose to breastfeed should be supported to do so, even if they have probable or confirmed COVID-19.

• When a woman is not well enough to care for her own infant or where direct breastfeeding is not possible, support her to express her breast milk by hand or using a breast pump, and/or offer access to donor breast milk.

• Precautions for breastfeeding directly at the breast.

✓ Washing hands before touching the infant.

✓ Trying to avoid coughing or sneezing on the infant while feeding at the breast.

✓ Considering wearing a face mask while breastfeeding, if available.

• Precautions for expressing breast milk.

✓ Washing hands before touching breast pump or bottles.

✓ Following recommendations for pump cleaning after each use.

✓ Considering asking someone who is well to feed expressed breast milk to the infant.

• If mothers are expressing breast milk in hospital, a dedicated breast pump should be used.

  1. aNo updates were found
  2. bThe earlier version of the ISUOG’s Guidance [12] was published on Mar 20, 2020. There is no change in breastfeeding recommendations between the earlier version and the updated version
  3. cThe earlier version of the WHO Guidance [79] was published on May 27, 2020. There is no change in breastfeeding recommendations between the earlier version and the updated version
  4. dThis is the updated version. The earlier version was not available
  5. eThe current breastfeeding recommendation was added in version 11 published on July 24, 2020 [15], with no changes since then