Even though, for reasons not yet yet known, the mortality rate of COVID-19 in infants is lower compared to older people, they are still at risk of getting the disease.
During this pandemic, in which health practitioners recommend physical distancing to avoid virus transmission, mothers may wonder whether they should continue to breastfeed their children.
The World Health Organisation (WHO), the US Centers for Disease Control and Prevention (CDC), the International Lactation Consultant Association (ILCA) and the United Nations International Children’s Emergency Fund (UNICEF) recommend mothers continue breastfeeding during the COVID-19 pandemic.
Human milk has essential nutrients which support babies’ immune systems. The act of breastfeeding can also be a soothing activity that can relieve a mother’s stress and anxiety during this time of crisis.
Breastfeeding is important to the baby
At the time of writing, there has not yet been much published research regarding breastfeeding during the COVID-19 pandemic. Most research is still ongoing.
One published study with a small number of participants, found no SARS-CoV-2 (the virus that causes COVID-19) in the breastmilk of infected mothers. This indicates the virus cannot be passed on through breastmilk.
Social distancing measures and policies to work and stay at home have led to unemployment and a loss of income for many people.
Reduction or loss of income can make it difficult to ensure quality nutrition, especially for parents with young children.
Breastfeeding is one way to ensure infants continue to get quality nutrition that can protect them from infectious diseases.
Breastfeeding can also benefit a mother’s health, including her mental health.
Breastfeeding can reduce stress, anxiety, negative emotions and increasing bonding between mother and baby.
Breastfeeding safely
To reduce the risk of COVID-19 transmission, health authorities recommend good personal hygiene such as frequent hand washing and covering the mouth with a sleeve or tissue when coughing and sneezing, as well as keeping a safe social distance.
If an infected mother still wants to and can breastfeed, she must be encouraged and supported to do so.
She also needs to practice good personal hygiene, such as washing hands before and after breastfeeding. It is advised that she wears a surgical mask during breastfeeding to minimise the risk of transmission.
If an infected mother needs to be admitted to hospital, she should be encouraged and supported to express breastmilk, which is squeezing milk out of the breasts for storage. This should be discussed with the father or other caregiver who can help the mother store expressed milk and feed it to the infant.
Expressing and storing breastmilk safely
Expressing and storing breastmilk during a pandemic is the same procedure as when done under normal conditions. But there is an additional focus on frequent hand washing before touching equipment, as well as sterilisation of breast-pumps, feeding bottles and other equipment.
If a mother’s condition doesn’t permit her to express breastmilk, the next option in Indonesia is to find a wet nurse or breastmilk donor. Currently, Indonesia doesn’t have a human milk bank. And in other countries human milk banks mostly only provide expressed breastmilk to premature babies and other sick babies in the neonatal intensive care units (NICUs).
Many mothers donate their breastmilk online. Before deciding to take breastmilk from a donor, parents need to assess the donor’s health history, such as whether they have tested positive for HIV or hepatitis, tuberculosis or have a history of cancer.
Once they receive the breastmilk, it’s wise to perform flash heating or pasteurisation (both are heating process that kill any harmful bacteria or viruses that may be in the milk) before feeding it to the baby.
Formula is the last option
Formula feeding is the last option to feed babies. Parents whose income has been reduced may not be able to purchase formula milk. Caregivers need to have access to clean water and electricity for safe formula making and equipment sterilisation.
It’s not recommended to donate formula milk as not all people have access to clean water and electricity during this period for safe formula making.
If the baby is more than six months old, parents can focus on complementary foods – such as pureed, mashed or semi-solid food combinations of carbohydrate, meat, fruit and vegetables – to fulfil their baby’s nutritional needs.
WHO has guidelines governments to help feed infants and young children in emergencies, including during the COVID-19 pandemic. The government needs to assess and analyse the local conditions and available resources, including calculating the amount of babies and young infants in the country, as well as their health status.
Breastmilk is a safe and sustainable food source during an emergency. Therefore WHO recommends considering relactation, a process which may help women’s breasts produce milk again, in a mother who does not breastfeed their baby.
The government can allocate resources to ensuring skilled health providers (who have had training in breastfeeding counselling) are available, as well as other necessarily equipment to assist mothers to relactate or continue breastfeeding in this emergency situation.