• Lisa Grossman, RN, IBCLC

COVID-19 (Coronavirus) Information for Pregnant + Breastfeeding Mamas & Parents of Young Kids

Information about COVID-19 (Coronavirus) is evolving daily. I am including a summary of the current recommendations from the American Academy of Pediatrics (AAP), Academy of Breastfeeding Medicine (ABM), CDC (Centers for Disease Control and Prevention) and WHO (World Health Organization).


Current recommendations as of today, Friday, March 13, 2020 are as follows:


AAP (American Academy of Pediatrics):


Please visit this link for the AAP's most current critical updates and guidelines:

https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/2019-Novel-Coronavirus.aspx


https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/


Summary:

There is currently no vaccine available

Do not bring children into any healthcare facility unless necessary

Teach your children to avoid touching their face

Primary mode of transmission: Respiratory droplets (cough, sneeze)

Hand hygiene: Wash hands with soap + water for a minimum of 20 seconds

Coughing/sneezing: Teach young children to cough/sneeze into their "germ catcher" by bending the elbow and bringing it to their face (see photo below).



Experts discuss COVID-19 impact on children, pregnant women
https://www.aappublications.org/news/2020/03/12/coronavirus031220


Centers for Disease Control and Prevention (CDC):

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-guidance-breastfeeding.html


Summary:

Breastmilk & breastfeeding

The virus has not been detected in breastmilk as of yet and it is unknown if mother’s who test positive for COVID-19 can transmit the virus through breastmilk.


If a mother has a confirmed COVID-19 infection or is currently under investigation for COVID-19, the CDC currently recommends that these mother’s take ALL possible precautions to prevent transmission of the virus to her infant:

1) Wash hands before touching her infant

2) Wear a face mask while breastfeeding

3) Wash hands before touching any breast pump equipment, parts and bottles

4) Thoroughly wash all pump and/or bottle parts:

https://www.cdc.gov/healthywater/pdf/hygiene/breast-pump-fact-sheet-p.pdf

5) Have someone who is healthy & not infected with the COVID-19 virus bottle-feed expressed milk to her baby


Immediate post-birth inpatient recommendations for COVID-19 positive mothers:

"It is unknown whether newborns with COVID-19 are at increased risk for severe complications. Transmission after birth via contact with infectious respiratory secretions is a concern. To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued. See the considerations below for temporary separation:

The risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team. A separate isolation room should be available for the infant while they remain a PUI... The decision to discontinue temporary separation of the mother from her baby should be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials. The decision should take into account disease severity, illness signs and symptoms, and results of laboratory testing for the virus that causes COVID-19, SARS-CoV-2. Considerations to discontinue temporary separation are the same as those to discontinue transmission-based precautions for hospitalized patients with COVID-19. If colocation (sometimes referred to as “rooming in”) of the newborn with his/her ill mother in the same hospital room occurs in accordance with the mother’s wishes or is unavoidable due to facility limitations, facilities should consider implementing measures to reduce exposure of the newborn to the virus that causes COVID-19.

Consider using engineering controls like physical barriers (e.g., a curtain between the mother and newborn) and keeping the newborn ≥6 feet away from the ill mother. If no other healthy adult is present in the room to care for the newborn, a mother who has confirmed COVID-19 or is a PUI should put on a facemask and practice hand hygiene1 before each feeding or other close contact with her newborn. The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on transmission-based precautions in a healthcare facility."


Inpatient breastfeeding recommendations for COVID-19 positive mothers:

"During temporary separation, mothers who intend to breastfeed 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. If a mother and newborn do room-in and the mother wishes to feed at the breast, she should put on a facemask and practice hand hygiene before each feeding."



World Health Organization (WHO):


When & how to use a mask: 
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks 

Symptoms of COVID-19 per the WHO:

"The most common symptoms of COVID-19 are

- Fever

- Tiredness

- Dry cough

Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention."


How does COVID-19 spread?

"People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick. WHO is assessing ongoing research on the ways COVID-19 is spread and will continue to share updated findings.

Can the virus that causes COVID-19 be transmitted through the air? Studies to date suggest that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air.  See previous answer on “How does COVID-19 spread?”

Can CoVID-19 be caught from a person who has no symptoms? The main way the disease spreads is through respiratory droplets expelled by someone who is coughing. The risk of catching COVID-19 from someone with no symptoms at all is very low. However, many people with COVID-19 experience only mild symptoms. This is particularly true at the early stages of the disease. It is therefore possible to catch COVID-19 from someone who has, for example, just a mild cough and does not feel ill.  WHO is assessing ongoing research on the period of transmission of COVID-19 and will continue to share updated findings.

Can I catch COVID-19 from the feces of someone with the disease? The risk of catching COVID-19 from the feces of an infected person appears to be low. While initial investigations suggest the virus may be present in feces in some cases, spread through this route is not a main feature of the outbreak. WHO is assessing ongoing research on the ways COVID-19 is spread and will continue to share new findings. Because this is a risk, however, it is another reason to clean hands regularly, after using the bathroom and before eating."



Academy of Breastfeeding Medicine (ABM):

https://www.bfmed.org/abm-statement-coronavirus


https://www.liebertpub.com/doi/10.1089/bfm.2020.29149.poa?utm_source=sfmc&utm_medium=email&utm_campaign=BFM%20PR%20March%204%202020&d=3/4/2020&mcid=806077837



If I can answer any questions for you, please do not hesitate to contact me. South Bay Baby Care remains open for clients needing private, in-home services at this time. If you or a family member living in your home exhibits any symptoms of the Coronavirus, or you suspect that you may have been exposed to the virus, I kindly ask that your session be rescheduled for a later date. Thank you!


Lisa Grossman, BSN, RN, PHN, IBCLC, CLC, CLEC

lisa@southbaybabycare.com

www.southbaybabycare.com