Mother-Infant Contact During Maternal Viral Illness
Mothers with most viral infections should maintain close contact with their infants, including breastfeeding, while implementing appropriate infection control measures such as hand hygiene and wearing a mask during direct contact. 1
General Principle for Viral Infections
The American Academy of Pediatrics clearly states that most maternal infections are compatible with breastfeeding 1. The fundamental rationale is that breast milk provides antibodies and protection to the infant, with little to no direct evidence of viruses causing infections through milk itself 1. The primary risk of transmission comes from respiratory secretions during close contact, not from breastfeeding per se 1.
Infection Control Measures to Enable Contact
When a mother has a viral respiratory illness, she should:
- Practice meticulous hand hygiene before touching the infant or breastfeeding 1, 2
- Wear a mask covering nose and mouth during direct breastfeeding and close contact 1
- Continue direct breastfeeding with these precautions in place 1, 2
The American Academy of Pediatrics recommends that breastfeeding should be maintained throughout the illness, and if the mother is too ill to breastfeed directly, she should pump and feed expressed breast milk to the infant 2.
Evidence Supporting Continued Contact
The benefits of maintaining mother-infant contact and breastfeeding substantially outweigh transmission risks when proper precautions are used:
- Breastfeeding reduces infant mortality by 19-51% depending on duration 1
- Exclusive breastfeeding for 6 months reduces lower respiratory tract infections by 19% 1
- Breastfeeding reduces severe diarrhea by 30% 1
- Breastfeeding reduces SIDS risk by 40-64% depending on duration 1
Recent evidence from the COVID-19 pandemic demonstrates that with appropriate infection control measures (hand hygiene and masking), mothers can safely breastfeed without transmitting infection to their infants 3, 4.
When Separation IS Indicated
Complete mother-infant separation should only occur in exceptional circumstances:
- If the mother or infant requires ICU-level care 1
- If adequate facilities do not exist to safely accommodate both mother and infant together 5
- For specific contraindicated infections: HIV, HTLV-I/II, untreated brucellosis, or confirmed Ebola 1
For bacterial infections like Group A Streptococcus requiring isolation, mother and baby should not be separated unless one requires ICU admission, and breastfeeding should be supported where possible 1.
Common Pitfalls to Avoid
Never assume that separation is safer than contact with infection control measures. The evidence consistently shows that the immunologic and nutritional benefits of breastfeeding, combined with the psychological benefits of mother-infant bonding, outweigh theoretical transmission risks when basic precautions are implemented 1, 3, 4.
Never recommend formula feeding as a "safer" alternative during maternal viral illness. The protective antibodies in breast milk are specifically beneficial during maternal infection 1.
Never delay initiation of breastfeeding waiting for viral test results. Early breastfeeding initiation (within the first hour) reduces infant mortality by 25% in some populations 1.
Practical Implementation
For mothers with respiratory viral infections in the hospital setting:
- Provide surgical masks to mothers and replace daily 5
- Ensure hand hygiene facilities are readily available 1
- Keep mother and infant together in the same room 1, 5
- Support rooming-in arrangements throughout hospitalization 1, 5
The only time to consider temporary separation is if the mother is severely ill and unable to safely care for the infant, in which case expressed breast milk should still be provided to the baby 2, 3.