ABM Statement on Coronavirus 2019 (COVID-19) March 10, 2020 Please note: information about COVID-19 transmission is emerging daily. The Academy of Breastfeeding Medicine’s recommendations are current as of the publication date. Please consult resources such as the CDC and the WHO for the most recent guidance. Transmission of COVID-19 through breast milk Much is unknown about how COVID-19 is spread. Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, like how influenza (flu) and other respiratory pathogens spread. In limited studies on women with COVID-19 and another coronavirus infection, Severe Acute Respiratory Syndrome (SARS-CoV), the virus has not been detected in breast milk; however we do not know whether mothers with COVID-19 can transmit the virus via breast milk. Breast milk provides protection against many illnesses. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. CDC has no specific guidance for breastfeeding during infection with similar viruses like SARS-CoV or Middle Eastern Respiratory Syndrome (MERS-CoV) also both Corona viruses. In a similar situation to COVID-19, the CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant. Given low rates of transmission of respiratory viruses through breast milk, the World Health Organization states that mothers with COVID-19 can breastfeed. Current CDC guidance on COVID-19 and breastfeeding is available here.



At Home: A mother with confirmed COVID-19 or who is a symptomatic person-under-investigation (PUI) for COVID-19 should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well care for and feed the expressed breast milk to the infant. Hand hygiene includes use of alcohol-based hand sanitizer that contains 60% to 95% alcohol before and after all contact with the affected mother, contact with potentially infectious material, and before putting on and upon removal of personal protective equipment, including gloves. Hand hygiene can also be performed by washing with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to alcohol-based hand sanitizer. Persons 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. Ideally there is another uninfected adult to care for the infant’s needs including feeding the infant expressed breastmilk if the mother is expressing milk and working to maintain her supply of milk. The mother should practice careful handwashing and use of a mask as noted above for at least 5-7 days until cough and respiratory secretions are dramatically improved. It may be useful to involve a healthcare professional and/or the health department in the decision to discontinue home isolation precautions. In Hospital: The choice to breastfeed is the mother’s and family's. If the mother is well and has only been exposed or is a PUI with mild symptoms, breastfeeding is a very reasonable choice and diminishing the risk of exposing the infant to maternal respiratory secretions with use of a mask, gown and careful handwashing is relatively easy. If the mother has COVD-19, there may be more worry, but it is still reasonable to choose to breastfeed and provide expressed milk for her infant. Limiting the infant’s exposure via respiratory secretions may require more careful adherence to the recommendations depending on the mother’s illness. There are several choices in the hospital concerning housing for a breastfeeding mother and her infant. Rooming-in (mother and baby stay in the same room without any other patients in that room) with the infant kept in a bassinet 6 feet from the mother’s bed and taking precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, for direct contact with the infant and while feeding at the breast. Ideally, there should be another well adult who cares for the infant in the room. Temporary separation – primarily because the mother is sick with the COVID-19 infection and needs medical care for herself in the hospital. Mothers who intend to breastfeed / continue breastfeeding should be encouraged to express their breast milk to establish and maintain milk supply. If possible, a dedicated breast pump should be provided. Prior to expressing breast milk, mothers should practice hand hygiene. After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected per the manufacturer’s instructions. This expressed breast milk should be fed to the newborn by a healthy caregiver. Mothers and families may need additional guidance and support to continue breastfeeding, to utilize expressed breast milk, to maintain her milk production and to store milk for later use while the mother is sick with COVID-19. Translations Chinese Translation

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