What now? Information for breastfeeding mothers and lactating people who test positive for COVID-19

With case rates in Australia through the roof I figured this was something I might need to know about, and you might too.

****This blog provides general information only and does not replace medical advice or conversations with your care providers. All information is true and correct to the best of my knowledge as at 4/1/22 and all sources listed below were accessed on this date. Always seek medical care if you are concerned about your or your child’s health.****

Is it safe to keep feeding my milk to my baby if I test positive?

The Centers for Disease Control and Prevention (USA) notes that "current evidence is that breast milk is not likely to spread the virus to babies". [1]

The World Health Organisation, NSW Health and the Australian Breastfeeding Association also agree that the long-term benefits of continuing to provide your milk to your baby outweigh the long-term risks of stopping. [2, 3, 4]

Immune factors are present in human milk when you have been vaccinated or infected, so your milk is kind of like their medicine as well as their food! [5]

How can I reduce risk of transmission when feeding/pumping?

The NSW Health website [3] advises taking special precautions when feeding your baby, expressing breastmilk, practising skin to skin contact, or when you are closer than 1.5 metres from your baby:

• Wash your hands frequently with soap and water or using alcohol-based hand rub (>60% alcohol) especially before touching your baby, pumps or bottles
• wear a surgical mask yourself (single use, replace it as needed, don't touch it!). DO NOT PUT A MASK ON YOUR BABY - it’s a suffocation risk.
• sneeze/cough into your elbow or a tissue (dispose of it ASAP) then use of alcohol-based hand rub or wash your hands with soap and water
• regularly clean and disinfect surfaces and feeding utensils if expressing milk or preparing bottles.

I would also suggest that good ventilation (e.g. being outdoors or having windows open if possible) and feeding in a position where your (masked) breath is directed away from them could be useful (one example would be lying flat on your back with head turned away).

Would it be safer for me to pump though?

Unless you are too sick to breastfeed/bodyfeed directly, or you and your baby are separated, there is no need to pump instead of feed directly.[4]

Some people don't respond to pumps well, and it is a hugely labour and time-intensive process (as well as an expensive one to set up), and the pump parts, bottles etc. can still become contaminated.

Even if you somehow get stuck without a mask, the World Health Organisation still recommends feeding directly at the breast over using other human milk substitutes.[2]

What if I am too sick to feed my baby?

If you are well enough to express, have the resources to do it and a more-well-than-you-ideally-COVID-negative helper to feed the baby expressed milk, do that. You can phone the National Breastfeeding Helpline for advice on frequency, maintaining supply, avoiding mastitis etc. on 1800 626 286.

The World Health Organisation suggests these options for feeding, in this order: direct feeding at the breast/chest, expressed milk from the parent, human donor milk (either expressed or by wet nursing, where another person feeds the baby) and infant formula.[2]

Will COVID-19 affect my supply?

There is no evidence I've seen that suggests COVID-19 directly impacts milk supply. That said, supply can drop when you're ill, particularly when you have fevers and/or dehydration. Try to keep your fluids up and seek advice during your infection and support afterwards if needed.

Again, you can call the National Breastfeeding Helpline for support on 1800 626 826 or get in touch with a lactation consultant via the "Find a Lactation Consultant" tool on the LCANZ website (www.lcanz.org). The "Increasing Supply" ABA article may also be helpful.[6]

What if my baby gets sick too?

COVID-19 is generally mild in children but can become severe in some cases. The most common symptoms are fever, cough, runny nose and gastrointestinal symptoms (diarrhoea, nausea, vomiting and stomach ache).[7] Allow them to feed as much as they like, knowing that this may take longer or be more frequent with a stuffy nose.

If your baby is in hospital and you are not with them, you can continue to express milk for them. You can ask to borrow a pump from the hospital, hire one from the Australian Breastfeeding Association, source one privately or hand express.[8] There will be special procedures to follow for safely expressing and transporting your milk to your child in hospital if you are COVID-positive, so talk to their care team about their requirements.

What are the Red Flags for a sick baby?

From NSW Health [3]:

"Poor feeding and lethargy are often signs of illness in a baby, and should be followed up promptly... If you have any concerns about your baby, please seek medical advice by calling your GP, child and family health nurse, Health Direct on 1800 022 222 (24-hour helpline) or attend your nearest Emergency Department."

A fantastic post by Dr Niamh Lynch [9] suggests these red flags to look out for and act fast:

- Persistent high temperature

-Coughing so much it interferes with feeding

-Rapid breathing (i.e. >60 breaths per minute in a 6 month old)

-Dry nappies (indicating dehydration)

-Working hard to breathe - wheeze, chest wall sucking in each breath

-Lethargy - drowsiness, lack of interest in surroundings

Helpful numbers mentioned (for readers in Australia, all are free call and operate 24/7):

National Breastfeeding Helpline (free, 24 hours) - 1800 626 286

HealthDirect helpline (free, 24 hours) - 1800 022 222

Ambulance - 000

References

1. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/pregnancy-breastfeeding.html
2. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19-breastfeeding
3. https://www.health.nsw.gov.au/Infectious/covid-19/communities-of-practice/Pages/guide-pregnant-women-and-new-parents.aspx#feed
4. https://www.breastfeeding.asn.au/bfinfo/covid-19
5. https://accpjournals.onlinelibrary.wiley.com/doi/full/10.1002/phar.2649
6. https://www.breastfeeding.asn.au/bf-info/common-concerns%E2%80%93mum/supply
7. https://www.pregnancybirthbaby.org.au/coronavirus-covid-19-and-kids
8. https://raisingchildren.net.au/newborns/breastfeeding-bottle-feeding/expressing-working-travelling/expressing-breastmilk
9. https://www.instagram.com/p/CX_zS5psgai/?utm_medium=copy-link