We do not yet have conclusive evidence whether COVID-19 is transmitted in breast milk but the close contact between mother and infant would be a more than enough exposure. Stopping exclusive breastfeeding is unlikely to be advisable. 
 

Jay

There is no reason at present to limit breastfeeding because of concerns that COVID19 can be transmitted through breast milk. These concerns are theoretical, whie breastfeeding, expecially in children less than 9 months old, is a huge known benefit.  It is not advisable to trade a known benefit for a possible risk.  That said the intimate conatct a mother has with her infant is the type of exposire that which results in transmission of the virus.  Both lactating women and healthy infants are not individuals at high risk from complications of COVID19

Hi Mija

I see your post in ENN forum and here are the most common questions i received from the field:

1. What are the precautions to be followed by lactating women, is it different from normal situations?

2. Can Corona virus be transmitted through breast milk? Or only through naso oral transmission?

3. Can the baby be infected by his/her mom?

4. What life saving measures to be taken if the virus proven to be transmitted through breast milk?

5. Should we encourage Breast milk substitutes or this is violation?

6. If the virus is not transmitted through breast milk but through naso oral transmission, can the mom breast pump her milk instead of direct contact with her baby?

Best

Thanks everybody for sending questions to me both through this forum and via my email. Keep on sending the questions and I will categorize and list them this weekend and put them back here on this forum and share via IFE CoreGroup. As for now, we are assessing what the main questions as a first step. Thanks, Mija 

hello,

Any updates on the mass gathering during TSFP distribution and precaution in the context of the novel COVID-19? please help. thanks 

Assessment of questions on Infant Feeding in the context of COVID-19

21 March 2020 3 pm USA EST Mija Ververs

Dear colleagues

Here the first list of all questions that were submitted to me on Infant Feeding and COVID-19 over the last 48 hours. I want to express appreciation to those that submitted questions. I took the liberty to rephrase some of the questions in order to combine a few together. The questions are categorized under some provisionary headings. The questions come from all over the world: from refugee settings, (NGO) health workers working in Europe, the Americas and Asia, to staff from hospitals in the USA, etcetera.

A.Transmission of the virus

1. As most people will not have access to face masks, is there a recommendation around ‘home made’ protective versions that would provide the best protection from mother-infant transmission. In other words: what alternative materials (second-best options) can be used and how to clean these?
2. Can the virus be transmitted through milk sharing, through containers and supplies and then might infect an infant or the infant’s family?
3. If women do not wish or cannot breastfeed (and they are a  suspected or confirmed case), is there guidance on whether they should have skin-to-skin with their infants after birth?
4. Is there a protocol to "disinfect" mother's skin prior to skin-to-skin contact with her infant?
5. What are the precautions to be followed by lactating women, is it different from normal situations?
6. Can the COVID-19  virus be transmitted through breast milk? Or only through naso-oral transmission?
7. Can the infant become infected by the mother?
8. What measures need to be taken if the virus will be proven to be transmitted through breast milk?
9. If the virus is not transmitted through breast milk but through naso-oral transmission, can the mother express the milk with a  breast pump instead of having direct contact with her infant?

B. Destruction of the virus

1. Is the virus destroyed by freezing (how long need to be the exposure and to what temperatures)?
2. What temperature is needed to destroy the virus in breastmilk?
3. How should mothers/family members effectively clean face masks (if in use)? Is soap and water enough, is hot water above a certain temp’ recommended, or are there other recommendations?

C. Recommendations from normative organisations

1. It seems there are discrepancies between guidance from CDC and from WHO, is that true? Can that be solved?  Mija Ververs: NOTE that guidance issued by CDC and WHO do not necessarily aim for the same audience, CDC’s guidance provided on breastmilk and breastfeeding on its website targets a domestic USA audience with a different context.
2. Some hospitals are using the perception of the disagreement on guidance from WHO and CDC as a rationale for separating all infants from mothers  when COVID-19 is suspected or confirmed. How can we avoid this?
3. What are the most important key messages that our organization should be sharing now? The CDC and WHO pages are too difficult for families to read.
4. What does the science tell us currently on breastmilk, breastfeeding and COVID-19  – is there some kind of factsheet that is referenced with peer-reviewed journal articles?
5. Some of the guidance from normative organizations state to use masks, PPE[1] and implement good IPC[2]. How is that possible if all these materials are not available and what are the alternatives?

D. Recommendations from health workers

1. In various European countries mothers who contract COVID-19 are being told not to breastfeed or feed their infants their expressed breastmilk. Some mothers are advised to top up breastmilk with infant formula after one month. How can we best reach on international scale physicians, in particular, so they provide appropriate advice? (e.g., major physician blog, Lancet)

E. Mechanisms of the provision of technical assistance and materials

1. Is there a mechanism at CDC/USA Government for creating a Help Desk where questions can be addressed.
2. Have countries set up specific Help Desks/Helplines and are there experiences and lessons learned to be shared?
3. We are working in a refugee setting and intend to increase awareness on breastfeeding in the context of COVID. We are looking for visuals and brochures to go with our promotion. Do these materials already exist? And if so, can they be shared?

F. Provision of milk

1. Should organizations respond to the infant formula shortages in our community and how should that be done?
2. Is there guidance for milk banks to scale up their work in emergency response to COVID-19?
3. Should we encourage the use of breast milk substitutes or this is violation of The Code (WHO’s International Code of Marketing Breastmilk Substitutes)?

G. Testing on COVID-19 of breast milk

1. Are there currently any laboratories that have the capacity to test for COVID-19 virus in milk samples of mothers with COVID-19?
2. Does CDC or WHO have an insight to which laboratories are doing this or planning to do so?
3. Are there tests available for human milk banks?
4. Without testing, should milk sharing be stopped?
5. Are there tests being used to identify COVID-19 in human milk or antibodies in human milk?

H. Miscellaneous

1. Are there certain precautions (IPC, messaging) we need to take during food distributions targeted for pregnant and lactating women?

[1]PPE = Personal Protective Equipment

[2]IPC =  Infection Prevention Control

One more question i got from the field If the baby has any one of the TFC admission indications and this baby is a corona suspected case. What is the approach to manage this baby in TFC? Best

Dear all,

We are expecting the release of 2 briefing notes in the coming days from UNICEF, developed together with the Global Nutrition Cluster (GNC) and Global Technical Assistance Mechanism (GTAM) on:

1. Infant and Young Child Feeding (IYCF) in the context of COVID-19.

2. Nutrition Programming in the context of COVID-19, describing key measures to consider for inpatient, outpatient and community/campaign-based nutrition programmes in contexts with no/partial/full mobility restrictions. 

Both documents will be available and posted here by Friday March 27th, then updated every 10 days as new evidence continues to emerge.

An overview of the available scientific journal data on breastmilk and COVID-19 developed by Mija will also be shared imminently. 

Thanks again for sharing your questions and concerns on en-net. 

Please see below a link to the review by Mija and her colleague of published journal articles on breastmilk and Covid-19:

https://www.ennonline.net/breastmilkbreastfeedingpregnancycovid19

Assessment of questions on Infant Feeding in the context of COVID-19

21 March 2020 3 pm USA EST Mija Ververs

UPDATE 24 March 8 pm USA EST Mija Ververs

Dear colleagues

Here the second list of all questions that were submitted to me on Infant Feeding and COVID-19 over the 4 days. This is an UPDATE and the more recent questions are marked in italics. Again,  I want to express appreciation to those that submitted questions. I took the liberty to rephrase some of the questions in order to combine a few together. The questions are categorized under some provisionary headings. The questions come from all over the world: from refugee settings, (NGO) health workers working in Europe, the Americas, Africa and Asia, to staff from hospitals in the USA and many other countries, etcetera.

A. Transmission of the virus

1. As most people will not have access to face masks, is there a recommendation around ‘home made’ protective versions that would provide the best protection from mother-infant transmission. In other words: what alternative materials (second-best options) can be used and how to clean these?
2. Can the virus be transmitted through milk sharing, through containers and supplies and then might infect an infant or the infant’s family?
3. If women do not wish or cannot breastfeed (and they are a  suspected or confirmed case), is there guidance on whether they should have skin-to-skin with their infants after birth?
4. Is there a protocol to "disinfect" mother's skin prior to skin-to-skin contact with her infant?
5. What are the precautions to be followed by lactating women, is it different from normal situations?
6. Can the COVID-19  virus be transmitted through breast milk? Or only through naso-oral transmission?
7. Can the infant become infected by the mother?
8. What measures need to be taken if the virus will be proven to be transmitted through breast milk?
9. If the virus is not transmitted through breast milk but through naso-oral transmission, can the mother express the milk with a  breast pump instead of having direct contact with her infant?
10. We are told that some people remain asymptomatic then the body naturally fights the virus until they get cured but during the period they can still infect somebody. What are the risk factors of such people to the children whom they breast/ have direct contact?
11. In case breastfeeding has been discontinued and COVID 19 infected mother has been treated and discharged cured, how soon after can the child be breastfed again?
12. Is there official guidance on whether infected women, who are planning not to breastfeed, should have skin-to-skin with their infants after birth?
13. Can the mother still breastfeed if she is infected by COVID-19? If yes, how can that be done concretely?
14. What measures do we need to consider for a breastfeeding/infant formula feeding mother that has COVID-19 symptoms?
15. Has there been any evidence that breastfeeding puts the woman at higher risk of Covid 19, or other complications?
16. Is there any evidence based milk storage guidelines for patients postpartum with suspected or confirmed cases of COVID-19?

B. Destruction of the virus

1. Is the virus destroyed by freezing (how long need to be the exposure and to what temperatures)?
2. What temperature is needed to destroy the virus in breastmilk?
3. How should mothers/family members effectively clean face masks (if in use)? Is soap and water enough, is hot water above a certain temp’ recommended, or are there other recommendations?

C.Recommendations from normative organisations

1. It seems there are discrepancies between guidance from CDC and from WHO, is that true? Can that be solved?  Mija Ververs: NOTE that guidance issued by CDC and WHO do not necessarily aim for the same audience, CDC’s guidance provided on breastmilk and breastfeeding on its website targets a domestic USA audience with a different context.
2. Some hospitals are using the perception of the disagreement on guidance from WHO and CDC as a rationale for separating all infants from mothers when COVID-19 is suspected or confirmed. How can we avoid this?
3. What are the most important key messages that our organization should be sharing now? The CDC and WHO pages are too difficult for families to read.
4. What does the science tell us currently on breastmilk, breastfeeding and COVID-19  – is there some kind of factsheet that is referenced with peer-reviewed journal articles?
5. Some of the guidance from normative organizations state to use masks, PPE[1] and implement good IPC[2]. How is that possible if all these materials are not available and what are the alternatives

D. Recommendations from health workers

1. In various European countries mothers who contract COVID-19 are being told not to breastfeed or feed their infants their expressed breastmilk. Some mothers are advised to top up breastmilk with infant formula after one month. How can we best reach on international scale physicians, in particular, so they provide appropriate advice? (e.g., major physician blog, Lancet)
2. Some neonatologists state that skin to skin can cause the infant to catch COVID-19. With so limited evidence, is that correct advice?
3. Some hospitals are apparently implementing a protocol to "disinfect" mother's skin prior to skin-to-skin after birth for COVID-19. Where is this practice coming from and how do we address it?

E. Mechanisms of the provision of technical assistance and materials

1. Is there a mechanism at CDC/USA Government for creating a Help Desk where questions can be addressed.
2. Have countries set up specific Help Desks/Helplines and are there experiences and lessons learned to be shared?
3. We are working in a refugee setting and intend to increase awareness on breastfeeding in the context of COVID. We are looking for visuals and brochures to go with our promotion. Do these materials already exist? And if so, can they be shared?

F. Provision of milk

1. Should organizations respond to the infant formula shortages in our community and how should that be done?
2. Is there guidance for milk banks to scale up their work in emergency response to COVID-19?
3. Should we encourage the use of breast milk substitutes or this is violation of The Code (WHO’s International Code of Marketing Breastmilk Substitutes)?

G. Testing on COVID-19 of breast milk

1. Are there currently any laboratories that have the capacity to test for COVID-19 virus in milk samples of mothers with COVID-19?
2. Does CDC or WHO have an insight to which laboratories are doing this or planning to do so?
3. Are there tests available for human milk banks?
4. Without testing, should milk sharing be stopped?
5. Are there tests being used to identify COVID-19 in human milk or antibodies in human milk?

H. IYCF Programmes in humanitarian context

1. Are there certain precautions (IPC, messaging) we need to take during food distributions targeted for pregnant and lactating women?
2. What community approach (without gathering) should we take to continue services in mother-baby or IYCF corners as the mothers may need these services more than ever in the face of panic/fear of infection?
3. How can group counselling sessions on breastfeeding be conducted given the fact that group setups are abolished?

I. Miscellaneous

1. Are the benefits and harms of the many recommendations that circulate and that consider separation mother from infant adequately mapped out with respect to the following:
   • Impact of separation on breastfeeding initiation and maintenance for short and long term & impacts on overall morbidity and mortality
   • Consequences of insufficient breastfeeding for an immune response to SARSCoV2
   • Impact of lack of skin to skin contact on breastfeeding as well as on maternal & infant health (including mental health)
   • Impacts of no physical contact between mother and baby for 14 days in the newborn period 
   • Implementation in real-world of separation post discharge in home setting (and likelihood of exposure there)
   • Likely exposures of baby to the virus by being handled by multiple HCWs who have high likelihood of exposure, with many who lack sufficient PPE
   • Implementation of these guidelines in the middle of a surge where hospital capacity is exceeded multiple-fold
   • Potential disruptions in the infant formula supply chain
   • Lactation difficulties postpartum leading to lactation failure in context of shortages
   • Impact of the above on vulnerable populations already at higher risk for insufficient breastfeeding 
2. What is the evidence base for the recommendation for separation for PUI[3]/confirmed infected mothers?
3. Are PUI/infected mothers provided with the opportunity to participate in informed decision making about their own and their infant's care especially when evidence is quite limited?

[1]PPE = Personal Protective Equipment

[2]IPC =  Infection Prevention Control

[3] PUI = Person Under Investigation

Dear all,

As a contribution to the coronavirus pandemic response, UNSCN has compiled a list of available resources and key readings with a focus on nutrition and food systems. The list is available here.

This list will be continually updated and expanded as more resources become available.

Best wishes,

Tamsin

Hi, 

Have the Antiviral properties in breastmilk of someone who is negative for COVID-19 been tested to know if it can possibly combat the virus? 
 

My daughter is currently a preemie in the NICU, and as regulations get stricter and stricter or visitation is becoming limited. So if our hospital follows others in the country and shuts down visits altogether, if there is an outbreak in the hospital, will my healthy breastmilk combat the virus. I know many people have not thought of it yet, but I'm hoping someone does the research. 

Dear Anonymous37608,

Please can I direct you to the discussion thread on CMAM mitigation strategies in light of COVID-19 for a response to your question?

All the best,

Isabelle

Dear Tanya

Kindly see attached list of questions from ESA. some of the questions could be overlapping with what you have

1. Coordination

1. What are the COVID-19 implications on nutrition?
2. How can nutrition position itself in COVID-19 management?
3. What are the key nutrition messages that can be integrated in risk communication?
4. What is the key action for integration of nutrition in case management in the context of COVID-19?
5. What are the current SOPs for nutrition management in the context of COVID-19?
6. What will be coordination mechanism for nutrition programs with other sectors Health, WASH ….?
7. The government priority now is related to procurement of sanitary materials, facemask, immediate items related to prevention of COVID-19.  What will be our role on such a request?
    

1. Management of acute malnutrition

1. What is the programming implication of COVID-19 on management of acute malnutrition?
2. What is the current guidance on screening of children and pregnant mothers in the context of COVID-19?
3. What is the current guidance on management of acute malnutrition in the context of COVID-19?
4. What approach do we follow to sustain early detection/screening and management of AM in context of COVID-19?
5. How can we advocate and ensure in the worst context SAM children are served? What approach do we use to ensure continuity of nutrition service as a priority?
6. What precaution should be taken while using tools such as Weight scales, MUAC tape, Height/Length board in context of COVID-19? how can anthropometric measurements be taken given the Global recommendations on physical distancing
7. Do we have a special guiding note that helps to advise and treatment malnourished child in case he/she is infected with COVID-19? (co-morbidity management)
8. What do we do when we do not have sufficient PPE soap/ handwashing facilities for all existing OTP sites... how do we balance the risk of COVID-19 versus the risk of children not receiving treatment for severe wasting?

1. Breastfeeding

1. Can COVID-19 be transmitted through breastmilk – what is the current evidence
2. Can an infected Mother get in contact with her uninfected child if she wants to breastfeed the baby?
3. Is breastfeeding safe after COVID-19 infection? 
4. Can mothers breastfeed their babies if they test positive for COVID-19?
5. What are the recommendations on the use of RUIF in the context of COVID -19?
6. What are the key recommendations to support a COVID-19 confirmed mother who is breastfeeding? 
7. How can group counselling sessions on breastfeeding be conducted given the fact that group setups are abolished?
8. How can we integrate MPHSS in IYCF-E?

1. Complementary Feeding:

1. What is the current guidance on complementary feeding in the context of COVID-19?
2. How can we prevent COVID-19 when the mother is feeding the child? Cuddling? Spoon feeding/hand feeding
3. Are there certain foods that should be encouraged or avoided in the context of COVID-19?

1. Continuity of service

1. What is the scientific evidence to guide on the nutrition critical services?
2. How we can respond to nutrition crisis in the context of COVID -19 that limits access to adequate and quality food?
    

1. Food assistance

1. What is the guidance of food assistance in the contest of COVID-19?  
2. Any advice on how to sustain WIFAS services started prior in school if the school closure going to be for long period?
3. How can we manage donations of food commodities during COVID -19 outbreaks?
    

1. Nutrition surveillance

1. How do we undertake Supervision and Monitoring of Nutrition programmes in the context of COVID-19? Especially for countries with poor electronic monitoring systems in place?
2. What examples do we have of effective monitoring and surveillance systems including innovations related data collections during COVID-19 outbreak e.g. use of mobile apps etc.
3. How will we monitor the effects of COVID-19 on prevalence of acute malnutrition?

Dear all,

WHO has released a new resource to respond to questions around breastfeeding and COVID-19. Please find it here: https://www.who.int/docs/default-source/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_1

A short web article from WHO on breastfeeding and COVID-19 is also available here https://www.who.int/news-room/detail/28-04-2020-new-faqs-address-healthcare-workers-questions-on-breastfeeding-and-covid-19

And the Frequently Asked Questions (FAQs) themselves here: https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-and-breastfeeding

The FAQ/Decision tree will be translated into Arabic, Chinese, French, Russian and Spanish - hopefully completed by the end of next week. 

Hi, I have read  a lot of information in this forum but nothing helped for me, but buy friend recommend me to try natural supplement I order Lactation Max in Amazon, I add it every morning to the warm tea! And girls it really works very good! 

https://www.amazon.com/dp/B0871NWZPD/?tag=wte-community-20

This is what I order, maybe you will find something more effective, please reply me!!