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UPDATE
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Care for Breastfeeding People

Care for Breastfeeding People

Interim Guidance on Breastfeeding and Breast Milk Feeds in the Context of COVID-19

Updated June 17, 2021

Summary of Recent Changes

As of June 17, 2021

  • Updated considerations for breastfeeding and lactation services to incorporate vaccination status.

View Previous Updates

Key Points:

  • People without suspected or confirmed COVID-19 and who have not been in close contact with someone who has COVID-19, or who have received the COVID-19 vaccine do not need to take special precautions when feeding at the breast or expressing milk.
  • A breastfeeding person who is not fully vaccinated against COVID-19 should take precautions to protect themselves and the breastfed child when either member of the dyad has suspected or confirmed COVID-19.

This information is intended for healthcare professionals and lactation specialists who care for breastfeeding people as well as infants and children (hereafter referred to as child or children) who receive breast milk feeds during the COVID-19 pandemic. These considerations are based on what is currently known about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, and the evidence available to date about transmission of SARS-CoV-2 through breast milk. CDC will update these considerations as additional information becomes available. For related information, refer to Considerations for Inpatient Obstetric Healthcare Settings, Evaluation and Management Considerations for Neonates at Risk for COVID-19, and Information for Pediatric Healthcare Professionals.

Current evidence suggests that breast milk is not a likely source of transmission of SARS-C0V-2.1

Considerations for breastfeeding

Breast milk is the best source of nutrition for most infants, and it provides protection against many illnesses. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended.

People without suspected or confirmed COVID-19 and who have not been in close contact with someone who has COVID-19, or who have been fully vaccinated for COVID-19 do not need to take special precautions when feeding at the breast or expressing milk. All breastfeeding people regardless of COVID-19 status who are using breast pumps should be educated about CDC information on how to properly clean and sanitize their breast pump.

How to Protect the Breastfed Child

The following information can be used to counsel breastfeeding persons on precautions to take while feeding at the breast, expressing milk, or feeding from a bottle when the breastfeeding person

  • has suspected or confirmed COVID-19 or
  • has been in close contact with someone who has COVID-19 and is not fully vaccinated.

During the COVID-19 pandemic, consider providing additional information on isolation and quarantine when counseling people with specific living situations, such as those living in close quarters or living in shared housing.

Isolation and quarantine

  • The breastfeeding person should follow information on quarantine or isolation.
  • A child being breastfed by someone with suspected or confirmed COVID-19 should be considered as a close contact of a person with COVID-19, and should be quarantined for the duration of the lactating parent’s recommended period of isolation and during their own quarantine thereafter.

Precautions while feeding at the breast, expressing milk, or feeding from a bottle

  • Breastfeeding people should follow these precautions during their recommended period of isolation:
    • Wash their hands using soap and water before touching their child or expressing breast milk either by hand expression or with a breast pump. If soap and water are not available, use hand sanitizer with at least 60% alcohol.
    • Wear a mask when they are less than 6 feet from the child (including when feeding at the breast or feeding from a bottle) and when expressing breast milk
    • Clean and sanitize breast pumps and all infant feeding items.
  • Any healthy caregiver, preferably one who is fully vaccinated against COVID-19 and not at increased risk for severe illness from COVID-19, may feed expressed breast milk to the child. If this person is not vaccinated and is living in the same house or has been in contact with the breastfeeding person, they should wear a mask while feeding the child for the duration of the lactating parent’s recommended period of isolation and during their own quarantine thereafter.
  • See more information on breastfeeding neonates in the hospital setting when the lactating parent has suspected or confirmed COVID-19.

Other considerations

  • Some people with suspected or confirmed COVID-19 may desire to breastfeed their child, but they may be unable to or choose not to during their COVID-19 illness. One reason may be that they are unable to access appropriate support. Healthcare professionals may refer patients to professional lactation support as needed. Reestablishment of lactation (or relactation) may be possible for some.
  • Breastfeeding people should be counseled to inform their child’s healthcare professional that their child has had close contact with a person suspected or confirmed to have COVID-19 prior to any in-person healthcare visits or if the child develops symptoms of COVID-19.

How to Protect the Breastfeeding Person

The following information can be used to counsel breastfeeding dyads on precautions to take while feeding at the breast, expressing milk, or feeding from a bottle when the breastfed child

  • has suspected or confirmed COVID-19 or
  • has been in close contact with someone who has COVID-19 and the breastfeeding person is not fully vaccinated.

During the COVID-19 pandemic, consider providing additional information on isolation and quarantine when counseling people with specific living situations, such as those living in close quarters or living in shared housing.

CDC recommends that everyone 12 years of age and older should get a COVID-19 vaccination to help protect against COVID-19. More information about COVID-19 vaccines for breastfeeding/lactating persons can be found here https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html

Isolation and quarantine

  • The breastfed child with suspected or confirmed COVID-19 should follow information on quarantine or isolation.
  • People who are breastfeeding a child with suspected or confirmed COVID-19 should be considered as a close contact of a person with COVID-19, and should be quarantined for the duration of the breastfeeding child’s recommended period of isolation and during their own quarantine thereafter.

Precautions while feeding at the breast, expressing milk, or feeding from a bottle

  • Because of the danger of suffocation, masks should NOT be put on children younger than 2 years.
  • To minimize possible exposure, breastfeeding people may choose to take precautions as recommended above for those with suspected or confirmed COVID-19 while feeding at the breast, expressing milk, or feeding from a bottle. This includes wearing a mask during any close contact (i.e., less than 6 feet) with the child and cleaning their hands frequently (i.e., before and after touching their child).
  • Recently pregnant people (for at least 42 days following end of pregnancy) are at increased risk for severe COVID-19 illness. Healthcare professionals may counsel the breastfeeding person on risks and benefits of continuing to feed at the breast during the child’s COVID-19 illness.

How to Protect Others

The following information can be used to counsel breastfeeding dyads on precautions to take while feeding at the breast, expressing milk, or feeding from a bottle when both the breastfeeding person and breastfed child have suspected or confirmed COVID-19 or have been in close contact with someone who has COVID-19 and the breastfeeding person is not fully vaccinated.

During the COVID-19 pandemic, consider providing additional information on isolation and quarantine when counseling people with specific living situations, such as those living in close quarters or living in shared housing.

Isolation and quarantine

  • Both the breastfeeding person and breastfed child should follow information on isolation.

Precautions while feeding at the breast, expressing milk, or feeding from a bottle

No special precautions (e.g., wearing a mask) are recommended for breastfeeding, expressing milk, or feeding from a bottle during the period of isolation when both members of the dyad have suspected or confirmed COVID-19.

Considerations for well-child visits

Healthcare professionals are encouraged to prioritize newborn care and recommend infant and childhood vaccinations. Every effort should be made to conduct newborn follow-up visits in person. During in-person visits, healthcare professionals should evaluate feeding and weight gain (particularly given potential breastfeeding disruptions due to COVID-19 illness), assess for dehydration and jaundice, assess caregiver stressors and coping, and provide appropriate supports.

Prior to any in-person healthcare visits, parents and caregivers should be counseled to inform their child’s healthcare provider if either they or their child has had close contact with a person suspected or confirmed to have COVID-19 or develops symptoms of COVID-19. The same approach should be taken with respect to a child who has any other ongoing, close contact with another person who has suspected or confirmed COVID-19.

Healthcare professionals should consider how to minimize exposure to COVID-19 for patients, caregivers, and staff in the context of their local COVID-19 epidemiology and practice environment. Information is available for pediatric healthcare professionals as well as on the delivery of non-COVID-19 clinical care and infection prevention and control in healthcare settings.

Considerations for lactation services

Lack of access to professional lactation support (e.g., lactation consultants, pediatric or obstetric healthcare professionals) is a barrier to breastfeeding. During the COVID-19 pandemic, it is critical to ensure that people who are breastfeeding or who desire to breastfeed continue to have access to this support. Breastfeeding problems are often urgent and require immediate assistance. Further, breastfeeding consults typically require very close contact between the lactation specialist and the lactating caregiver-child dyad; therefore, the use of appropriate personal protective equipment (PPE) is essential.

During the COVID-19 pandemic, lactation specialists who are not vaccinated should use alternative approaches, such as telemedicineexternal icon, to provide lactation support services whenever possible, particularly when providing support to breastfeeding dyads with suspected or confirmed COVID-19.

In-person support may be necessary to support some breastfeeding dyads effectively. Further, not all families may have access to telemedicine. Lactation support is delivered in a variety of settings including outpatient clinics or offices or in the breastfeeding person’s home. The following considerations address infection prevention and control measures including the use of PPE in outpatient and home settings.

In-person lactation visits in the healthcare setting (e.g., hospital, clinic, doctor’s office)

Lactation specialists working in healthcare settings should follow recommended infection prevention and control measures for those settings.

In-person lactation visits in a breastfeeding person’s home

Lactation specialists conducting home visits, breastfeeding people receiving in-home lactation services (hereafter, clients), and any other household members should consider getting the COVID-19 vaccine or screen themselves for COVID-19 as instructed below before entering the home as well as take necessary infection prevention and control measures detailed below.

  • Lactation specialists should stay home if they are sick with COVID-19, think they might have COVID-19, or have been in close contact with someone who has COVID-19 while not fully vaccinated. Refer all clients to another lactation specialist until the criteria for healthcare workers returning to work after SARS-CoV-2 infection have been met.
  • Screen clients by telephone for COVID-19 symptoms and recent exposure to people diagnosed with COVID-19 and to determine their vaccination status prior to conducting home visit. Keep in mind that screening for symptoms will not identify people who are asymptomatic or pre-symptomatic with COVID-19. If any person in the household has suspected or confirmed COVID-19 and the lactation specialist is not fully vaccinated, it is recommended that lactation services be provided via telemedicine for the recommended period of isolation plus any additional recommended quarantine period for other household members.
    • If the client or any other household member has COVID-19 and in-home support is deemed necessary and critical, use all recommended personal protective equipment as described in Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19) for caring for a patient with suspected or confirmed COVID-19.
    • If neither the client nor any of the household members is known to have suspected or confirmed COVID-19, wear a surgical mask while inside the client’s home. Wash hands with soap and water for at least 20 seconds when entering and leaving the home and when adjusting or putting on or taking off masks. Discard disposable surgical masks between clients. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Surgical masks offer both source control (i.e., blocking the spread of respiratory secretions from the wearer) and protection for the wearer against exposure to splashes and sprays of infectious material from others. Additionally, in communities with moderate to substantial community transmission, consider wearing eye protection in addition to a surgical mask to ensure that the eyes, nose, and mouth are all protected from exposure to respiratory secretions while providing breastfeeding support.
  • For all home visits where any household members are not vaccinated, or the household’s COVID-19 vaccination status is unknown:
    • Require the client as well as any other household members aged 2 and older to wear a mask. Because of the danger of suffocation, do NOT put masks on babies or children younger than 2 years. Masks should also not be worn by anyone who has trouble breathing, is unconscious, cannot move, or is otherwise unable to remove the mask without assistance. Information on how to wear a mask is available.
    • When not providing hands-on support or close observation, stay at least 6 feet away from the client and others in the home. Masks should be worn at all times and are even more important when less than 6 feet apart.
    • Wear disposable gloves when touching the client or the child. Wash hands with soap and water for at least 20 seconds when entering and leaving the home, when adjusting or putting on or off masks, and before putting on and after taking off disposable gloves. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Learn more about proper handwashing. Safely dispose of gloves after use.
    • Clean and disinfect surfaces and equipment such as infant scales.

Breastfeeding and expressing milk in workplaces

When counseling breastfeeding people on precautions to take prior to breastfeeding or expressing milk in workplaces, healthcare professionals should discuss a person’s individual circumstances (e.g., level of exposure to people with suspected or confirmed COVID-19, availability and proper use of personal protective equipment). All people breastfeeding or expressing milk in workplaces should be counseled to clean their hands, as instructed above, before touching any pump or bottle parts. They should also follow CDC information on how to properly clean and sanitize breast pumps. If possible, a single-user pump should be used. CDC information on how to properly clean and sanitize breast pumps should be followed for disinfecting before and after use.

For breastfeeding people who work in settings with higher risk of potential exposure to SARS-CoV-2, such as healthcare professionals and first responders, they should wear a mask while breastfeeding or expressing milk in the workplace. Additional information for healthcare personnel, including those who are pregnant or have underlying medical conditions from COVID-19, is available.

Employers should provide breastfeeding employees with a private, non-bathroom space for milk expression. Information is available on providing lactation break time and space in all industriesexternal icon. If a workplace has a multi-user lactation room, efforts should be made to implement engineering and administrative controls to enable physical distancing (e.g., spacing lactation stations at least 6 feet apart, installing physical shields between lactation stations, staggering lactation schedules, encouraging telework).Based on what we know right now, the risk of getting infected with SARS-CoV-2 from contaminated surfaces is low. However, both cleaning (use of soap or detergent) and disinfection (use of a product or process designed to inactivate SARS-CoV-2) of milk collection devices (e.g., bottles, milk bag, breast pump) can reduce the risk of transmission from contaminated surfaces and is generally recommended to prevent bacteria from contaminating the breast milk. Breastfeeding people may consider additional steps such as these to minimize potential routes of exposure. Additional information on disinfecting facilities, such as workplace lactation rooms, is available.

Pasteurized donor human milk

Pasteurized donor human milk is important in the care of preterm infants when a lactating caregiver’s milk is not available. Current evidence suggests that breast milk is not a likely source of SARS-CoV-2 infection.1 Also, there are data suggesting that pasteurization inactivates SARS-CoV-2 in donor human milk; therefore, pasteurized donor human milk is very unlikely to be a source of SARS-CoV-2 infection. Disruptions in human milk donations may be seen during the COVID-19 pandemic. If hospitals have difficulty acquiring donor human milk, available supplies should be prioritized for preterm infants who will benefit most from human milk feeds.

  • December 2020:
    • Updated recommendations on length of quarantine
    • Updated title of page from “Care for Breastfeeding Women” to “Care for Breastfeeding People”
  • October 2020
    • Update title and language to be inclusive of all persons breastfeeding, chestfeeding, and feeding human milk.
    • Reflect new evidence suggesting that breast milk is not a likely source of SARS-CoV-2 transmission.
    • Reflect new evidence that SARS-CoV-2 experimentally added to breast milk is inactivated via pasteurization.
    • Add considerations for infection prevention and control measures for lactation services.
References
  1. Walker KF, O’Donoghue K, Grace N, Dorling J, Comeau JL, Li W, Thornton Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. BJOG 2020; https://doi.org/10.1111/1471-0528.16362external icon.