Feeding Recommendations for Newborns of COVID-19 Positive Mothers
Breastfeeding should be encouraged and supported for newborns of COVID-19 positive mothers, with the mother wearing a mask and practicing hand hygiene, as the benefits of breastfeeding outweigh the minimal transmission risk. 1
Primary Recommendation: Direct Breastfeeding with Precautions
Direct breastfeeding is the preferred feeding method for infants born to COVID-19 positive mothers. 1 The evidence consistently demonstrates that:
- The benefits of breastfeeding currently outweigh the risks of passing infection from mother to infant 1
- SARS-CoV-2 is unlikely to be transmitted via human milk 2, 3
- Mothers with suspected or confirmed COVID-19 can safely breastfeed with appropriate infection control measures 2, 3
- Evidence does not support mother-neonate separation or formula feeding to prevent neonatal SARS-CoV-2 infection 1
Essential Infection Control Measures During Breastfeeding
When a COVID-19 positive mother is breastfeeding, the following precautions must be implemented:
- Mask wearing: The mother should wear a medical mask (N95 preferred) when in the presence of the infant during feeding 4, 2
- Hand hygiene: Clean and disinfect hands before touching the baby, before and after feeding 4, 2
- Respiratory hygiene: Avoid coughing or sneezing directly on the infant 2, 3
- Surface cleaning: Regularly clean and disinfect surfaces that may come into contact with the infant 4
Rooming-In Practice
Mothers who have tested positive for COVID-19 and healthy babies do not require separation. 1 The evidence shows:
- Neonates born to SARS-CoV-2 positive women who roomed-in had better outcomes overall 1
- Most mother-to-neonate transmissions occurred in utero, making separation after birth ineffective for prevention 1
- Mother-baby separation has negative health and emotional consequences for both 3
- Recent guidelines recommend keeping the mother and newborn in the same room when possible 5
Alternative Feeding Options (When Direct Breastfeeding Not Feasible)
If the mother is too ill to directly breastfeed or chooses not to, a structured approach should be followed:
Option B - Expressed Breast Milk: 2
- The infant receives mother's expressed milk fed by another caregiver
- Milk expression equipment should be cleaned thoroughly after each use
- The caregiver feeding the infant should follow standard hygiene precautions
Option C - Formula Feeding: 2
- Only considered when breast milk is not available or mother declines
- This should be a last resort given the protective antibodies in breast milk 3, 6
Evidence on Breast Milk Safety
The scientific evidence strongly supports breast milk safety:
- The majority of infants breastfed by infected mothers tested negative for SARS-CoV-2 6
- Breast milk samples from infected mothers mainly demonstrated negative results in viral tests 6
- Specific antibodies against SARS-CoV-2 have been found in breast milk, implying protective effects 6
- Only two publications have reported SARS-CoV-2 in human breast milk, and the role of breast milk as a vehicle of transmission remains unclear 3
- Breast milk may actually provide protective antibodies against SARS-CoV-2 infection even in infected neonates 3
Common Pitfalls to Avoid
Do not separate mother and baby based solely on maternal COVID-19 status. 1 Early in the pandemic, fear among healthcare workers and parents led to unnecessary separations that had negative consequences 7. The evidence does not support:
- Routine cesarean section for COVID-19 positive mothers 1
- Immediate mother-neonate separation 1
- Withholding breastfeeding or breast milk 3
- Early cord clamping (which was associated with lower breastfeeding rates) 1
Shared Decision-Making Framework
While direct breastfeeding with precautions is strongly recommended, the final decision should involve 2, 5:
- Discussion of current evidence on transmission risk
- Assessment of maternal illness severity
- Consideration of available resources and support
- Maternal preferences and comfort level
- Recognition that the decision can be flexible as the situation changes 2
When to Consider Temporary Separation
Separation may be warranted only in specific circumstances:
- Mother is critically ill and unable to care for the infant 1
- Severe maternal respiratory distress requiring intensive support 1
- Maternal health condition prevents safe infant care 2
Even in these cases, expressed breast milk should still be provided to the infant whenever possible 2.
Monitoring the Newborn
Regardless of feeding method chosen, all newborns of COVID-19 positive mothers require: