Breastfeeding in case of COVID-19 positivity
Breastfeeding and COVID-19 positivity: the pandemic has dramatically changed our daily routines, but breastfeeding is one of the earliest stages of our lives in terms of physical and psychological development and it is important to protect it
Breastfeeding and covid-19: what to do if the mother is positive or hospitalised?
In Italy, the Ministry of Health has set up a Technical Table on Breastfeeding (TAS) and defined a document published on 4 June 2021 with precise indications for
The document states:
The Technical Table for Lactation (TAS) of the Ministry of Health, following the experience gained in relation to the COVID-19 pandemic, has decided to establish some basic public health concepts regarding infant feeding to provide some indications that may be useful in the event of a future pandemic, which can be summarised in a few points:
Role of breastfeeding and recommendations on infant feeding During a pandemic
Similar to other health and national emergencies (e.g. earthquakes, floods, people displacement), pregnant/lactating women and children in particular under one year of age have specific needs, which need to be adequately addressed (Davanzo 2004; IFE Core Group 2017; TAS 2018; ISS 2018).
Breast milk is the nutritional gold standard for infancy.
Exclusive breastfeeding fully meets the nutritional needs of the child and is recommended by the WHO and the Ministry of Health throughout the first six months of life.
In the period after the 6th month of life, breastfeeding continues to be recommended as part of complementary feeding, with the introduction of semi-solid and solid foods.
Long-term breastfeeding has documented benefits for both mother and child and should be encouraged, even up to and beyond the completion of the second year of life (Binns 2016).
Breastfeeding has a positive role on growth, development and health of the individual in the short term (reduction of infections, better response to vaccinations) but also in the long term (lower risk of obesity, cardiovascular and immune-mediated diseases). It is also advantageous in terms of convenience (breast milk is always ready for use), cost-effectiveness and environmental sustainability.
Breastfeeding and protection from infection
Breast milk is not a sterile biological liquid but has its own normal bacterial flora (microbiota); when a mother is ill her milk may contain pathogenic microorganisms (bacteria or viruses), which in the vast majority of cases are not capable of infecting the infant.
Transmission of infection from mother to child via milk is only documented with certainty for HIV and HTLV. In contrast, the possible transmission of viral infections, such as influenza and COVID-19, from mother to child is mainly via respiratory droplets or at most by contact inoculation through the mucous membranes (Giusti et al 2021).
The protection and support of breastfeeding in a health emergency situation such as a pandemic simplifies the child’s feeding and ensures maternal care, unless the mother is in a serious health condition (Davanzo et al. 2020).
In fact, breastfeeding is not recommended by the WHO in cases of maternal Ebola virus disease (EVD) (WHO 2020) because of the contagious nature of this highly lethal infection, provided that the mother and child can be managed separately and safely.
Stopping breastfeeding when maternal infection is diagnosed is untimely, as respiratory transmission from mother to child may have already occurred.
It is also a potentially harmful intervention, as it would deprive the baby not only of a nutritionally and biologically optimal food, but at the same time of the opportunity to receive antibodies against the specific feared infectious agent with the mother’s milk.
Nor should it be overlooked that stopping breastfeeding does not take into account the emotional and psychological needs of the mother (WHO 2020; TAS 2021)
In summary, maternal infections are very rarely a contraindication to breastfeeding, while a woman’s discomfort is an obstacle that can also be overcome by providing reassurance and practical help to continue breastfeeding, rather than by default recommending a switch to formula feeding.
The use of milk formulas is therefore only indicated for good medical reasons (WHO 2009; Davanzo et al. 2015; Davanzo 2018) or for the mother’s informed choice.
Moreover, breastfed children have less need for outpatient and inpatient care (Cattaneo 2006), the use of which in emergencies may be restricted, also because of the need to reorganise the care priorities of the population.
The hormones activated by lactation (in particular prolactin and oxytocin) released during breastfeeding and the mother-child bond help to manage anxiety, stress and any maternal depressive symptoms, especially in emergency/pandemic conditions.
Dietary management in the first six months of life
The milk requirement in the first six months of life is approximately 150 ml/kg/day, irrespective of whether the baby is breastfed or fed with type 1 formula.
The maximum volume of milk intake increases over the months, but usually does not exceed 800-1,000 ml/day for milk-only feeding.
Responsive breastfeeding, i.e. breastfeeding on demand, allows the healthy full-term baby to meet his or her own needs and develop the ability to regulate himself or herself.
This is easily guaranteed if the baby is breastfed because it takes variable feedings in number, volume and composition (during the feeding, for example, the final milk is richer in lipids).
Milk formula, on the other hand, has a constant composition and lends itself to pre-set feeding patterns in terms of the number, time and volume of individual feeds.
In most cases a baby fed exclusively with formula will have 8 feedings in 24 hours.
Based on the above discussion of breastfeeding and Covid-19, the TAS makes the following recommendations:
1. Women should never be separated from their babies, except in cases where the woman and/or child need intensive care.
2. Breastfeeding should be protected whenever possible, including during a pandemic.
3. Any indication for formula feeding should be made only after careful evaluation of the risk-benefit ratio of each feeding option and the general health status of the breastfeeding woman.
- Binns, C., Lee, M., & Low, W. Y. The Long-Term Public Health Benefits of Breastfeeding. Asia Pacific Journal of Public Health 2016 28(1), 7 14. doi:10.1177/1010539515624964
- Cattaneo A, Ronfani L, Burmaz T, Quintero-Romero S, Macaluso A, Di Mario S. Infant feeding and cost of health care: a cohort study. Acta Paediatr. 2006 May;95(5):540-6. doi: 10.1080/08035250500447936.
- Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. Breastfeeding and Coronavirus Disease-2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr. 2020 Apr 3:e13010. doi: 10.1111/mcn.13010. Riferito al documento ufficiale della SIN: ALLATTAMENTO e INFEZIONE da SARS-CoV-2 (Coronavirus Disease 2019 – COVID19) – Indicazioni ad interim della Società Italiana di Neonatologia (SIN), Versione 3, 10 maggio 2020. https://www.sin-neonatologia.it/wpcontent/uploads/2020/05/SIN.COVID19-10-maggio.V3-Indicazioni-1.pdf [Accesso: 29 Apr 2021].
- Davanzo R. Newborns in adverse conditions: issues, challenges, and interventions. J Midwifery Womens Health. 2004 Jul-Aug;49(4 Suppl 1):29- 35. doi: 10.1016/j.jmwh.2004.05.002. PMID: 15236701
- Davanzo R., Romagnoli C, Corsello G. Position Statement on Breastfeeding from the Italian Pediatric Societies. Italian Journal of Pediatrics 2015 (41) 80: 1-3. Riferito al document: Davanzo, R., Maffeis, C., Silano, M., Bertino, E., Agostoni, C., Cazzato, T., Tonetto, P., Staiano, A., Vitiello, R., Natale, F., et al. (2015). Allattamento al seno e uso del latte materno/umano – Position Statement 2015 di Società Italiana di Pediatria (SIP), Società Italiana di Neonatologia (SIN), Società Italiana delle Cure Primarie Pediatriche (SICuPP), Società Italiana di Gastroenterologia Epatologia e Nutrizione Pediatrica (SIGENP) e Società Italiana di Medicina Perinatale (SIMP)(Documento condiviso dal TAS istituito presso il Ministero della Salute nella riunione del 15 settembre 2015). http://www.salute.gov.it/imgs/C_17_pubblicazioni_2415_allegato.pdf . Accesso: 1 maggio 2021].
- Davanzo, R. (2018). Controversies in breastfeeding. Frontiers in Pediatrics 2018 Nov 1;6:278. doi: 10.3389/fped.2018.00278. PMID: 30443539; PMCID: PMC6221984.
- Giusti A, Zambri F, Marchetti F, Corsi E, Preziosi J, Sampaolo L, Pizzi E, Taruscio D, Salerno P, Chiantera A, Colacurci N, Davanzo R, Mosca F, Petrini F, Ramenghi L, Vicario M, Villani A, Viora E, Zanetto F, Chapin EM, Donati S. COVID-19 and pregnancy, childbirth, and breastfeeding: the interim guidance of the Italian National Institute of Health. Epidemiol Prev. 2021 Jan-Apr;45(1-2):14-16. English. doi: 10.19191/EP21.1-2.P014.030. PMID: 33884834. Corrispondente al documento: Istituto Superiore di Sanità ISS). Indicazioni ad interim per gravidanza, parto, allattamento e cura dei piccolissimi di 0-2 anni in risposta all’emergenza COVID-19. Aggiornamento del Rapporto ISS COVID-19 n. 45/2020, Versione del 5 febbraio 2021. https://www.iss.it/documents/20126/0/Rapporto+ISS+COVID-19+2_2021.pdf/73969e59-08d9-3257-5cbe649528d61788?t=1613387397571 (Accesso: 6 maggio 2021)
- Ife Core Group (2017). The Operational Guidance on Infant and Young Child Feeding in Emergencies, ENN Oxford, UK. Versione 3.0. Edizione Italiana: L’alimentazione dei lattanti e dei bambini piccoli nelle emergenze. Guida Operativa per il personale di primo soccorso e per i responsabili dei programmi nelle emergenze. http://www.epicentro.iss.it/allattamento/pdf/GO-AINE_v3.0.0.ITA.pdf (Accesso: 1 maggio 2021)
- Tavolo Tecnico Allattamento (TAS) del Ministero della Salute, Comitato Italiano per UNICEF, FNOMCeO, FIASO, ANMDO, SIP, SIN, ACP, SIMP, SIGO, SIMIT, FNOPO, FNOPI, FNOTSRM PSTRP, CNOP (2021) La continuità del rapporto madre-bambino e il mantenimento dell’allattamento in caso di ricovero ospedaliero. Indicazioni a cura del Gruppo di Lavoromulti-professionale 2020-2021.
- Tavolo Tecnico Allattamento (TAS)(2018). Allattamento nelle emergenze. Ministero della Salute, Roma; http://www.salute.gov.it/imgs/C_17_pubblicazioni_2830_allegato.pdf (Accesso: 1 maggio 2021)
- World Health Organization. Meeting women’s emotional, psychological and clinical needs during childbirth. (2020). Disponibile a: https://www.who.int/news/item/20-08-2020-meeting-women-s-emotional-psychological-and-clinical-needs-during-childbirth. [Accesso: 9 aprile 2021].
- World Health Organization, UNICEF (2009). Acceptable medical reasons for use of breast-milk substitutes.http://apps.who.int/iris/bitstream/handle/10665/69938/WHO_FCH_CAH_09.01_eng.pdf?ua=1
- World Health Organization (2020). Pregnancy and breastfeeding during an Ebola virus outbreak. https://www.who.int/news/item/10-02-2020- pregnancy-and-breastfeeding-during-an-ebola-virus-outbreak