By: Dr Shalini Chico, Consultant Neonatologist and Pediatrician, Fortis La Femme Hospital, Bangalore
The COVID 19 pandemic has brought about unprecedented challenges in the health system, the world over, including breastfeeding. With a large section of resources being dedicated to care of suspected or confirmed cases of Covid-19 and the disruption of services and interventions over the past few months, it is estimated that there will be a significant increase in global new-born and child deaths.
Breastmilk plays a key role in preventing life threatening infections in infants during this pandemic, thus reducing the burden on the health system.
From all the research and evidence that has been reviewed on Breastfeeding during the Covid 19 pandemic, the WHO , UNICEF and other global organisations have unequivocally recommended,
- continuation of breastfeeding
- rooming-in
- skin-to-skin contact, and
- Kangaroo mothercare, with due precautions, irrespective of the maternal Covid status.
Keeping the mother and baby together helps in better temperature control in baby, decreased stress for the mother, and successful breastfeeding. Promotion and distribution of infant milk substitutes and feeding bottles during the Covid-19 pandemic is harmful and should be condemned.
FAQ’s about COVID 19 and Breastfeeding
1.Can covid 19 pass through breastmilk?
NO. Research so far has not detected the“Replication competent Active Covid virus”in breast milk.
Limited evidence has detected strands of the viral RNA in breastmilk, which is not the same as finding a viable and infective virus which is capable of causing infection in the baby. There is no reason to stop breastfeeding even if the mother is detected to be COVID positive.
Breastfeeding benefits outweigh the potential risks of transmissionand illness associated with Covid-19.
2. How can women with suspected or confirmed Covid 19 safely Breastfeed?
Though the virus does not pass through breastmilk, there is a chance of spread through respiratory droplets/contact, which can be minimised if appropriate infection prevention and control measures are observed:
- Wash hands frequently with soap and waterand use an alcohol-based hand rub before touching baby.
- Wear a medical mask during any contact with baby, including breastfeeding, to prevent spread of infection via respiratory droplets.
- Sneeze or cough into a tissue. Dispose of it immediately in a closed bin and then wash hands again.
- Frequently disinfect surfaces that the mother has touched.
3. Why is breastfeeding during the Covid 19 pandemic important?
Antimicrobial factors, cytokines, anti-inflammatory factors specific to the infection that the mother is exposed to, are present in breastmilk. Studies have shown that there is a strong expression of secretory IgA antibodies specific to Covid 19 virus, in the breastmilk of mothers who have tested positive for the infection.
Mothers should be supported to initiate breastfeeding within 1 hr of birth, and exclusively breastfeed till 6 months of age, after which age appropriate complimentary feeding is to be started, while breastfeeding can continue till the child is 2 years of age.
4. What if the mother/ neonate is too sick to breastfeed?
The ideal scenario would be to practice rooming-in. Ensure the baby and mother are in the same room, next to each other, in a dedicated covid postnatal ward, to ensure exclusive and un-hampered breastfeeding. This can be and is being implemented in mothers who are covid positive, but not seriously ill.
In cases where the mother and baby have to be separated, either because the mother needs intensive care , or the neonate is preterm requiring NICU care, the next best option would be to use expressed breast milk (pumped milk from the mother is sent across to the baby and fed by a pallada/spoonor tube feed if the baby is too preterm).
If the baby is otherwise healthy and not requiring ICU care, a dedicated healthy care giver should be assigned to feed baby the pumped milk. If the mother is unable or unavailable to give expressed breast milk, Donor Human Milk is advisable. However, in the present scenario, with imposed lockdowns, paucity of staff and decreased numbers of donors, this scarce resource is reserved for preterm babies in the NICU.
Conclusion:
The risk of Covid 19 infection is low in infants. The infection is typically mild, and can be prevented by appropriate precautions as described. Conversely, the consequences of not breastfeeding/ giving breastmilk substitute formulas can be severe. Making the infant vulnerable to all the other infections which breastmilk protects against,especially at a time where health and community services are disrupted and/orlimited.