Breastfeeding and newborn care during cold, flu, and COVID-19 season

Taking care of a newborn baby is never “easy,” especially in the midst of a global pandemic! It doesn’t matter if you’ve recently had your first baby or your sixth – our nation’s COVID-19 situation, coupled with cold and flu season starting up, has added additional stress. Overall, parents have less help and support with newborn care and breastfeeding than in the past. Reasons for this include all of the following:

• As a result of the pandemic, many hospital systems have cut back on available support from lactation specialists.  In addition, due to visitation restrictions, doulas (who often help new moms with breastfeeding and newborn care) can no longer visit. 

• Families’ in-person “villages” have shrunk. Prior to COVID-19, it was not unusual for one’s own mom, mother-in-law, or other relative(s), to visit and help out for the first few postpartum weeks. These visits give new moms opportunities to bond with their newborn babies, rest, and recover. Unfortunately, due to “social distancing” and recommendations against traveling, families with new babies have significantly less help overall with newborn care and household chores. 

• Many families have taken on additional commitments during the pandemic, i.e. having older kids home 24/7 due to a switch to virtual schooling and/or having to work extra hours. These additional time commitments can make breastfeeding and taking care of a new baby much more challenging than in the past. 

• Parents have fears related to getting sick with COVID-19 and/or their newborn babies getting sick with the virus.  Common questions and concerns that new parents have about COVID-19 include:

• • “What would happen if I get sick with COVID-19 while breastfeeding?”
  • “Will my baby can get sick from my breastmilk?”
  • “Is it safe for me to get the new COVID-19 vaccine while breastfeeding?” 

Newborn babies and COVID-19

The good news is that we know from the American Academy of Pediatrics’ Perinatal COVID-19 registry (which includes data on over 5000 mother-baby dyads) that most women who have COVID-19 during late pregnancy, labor, and delivery, do not pass the virus to their babies. If the virus is passed from mother to baby around the time of birth, it seems that most newborns do not get seriously ill with the virus.  

The bad news is that newborns are susceptible to getting the virus after they are born, especially after going home from the hospital due to community spread. COVID-19 can cause symptoms in babies that are similar to symptoms of RSV and other fall/winter respiratory viruses, like influenza. These symptoms include fever, pneumonia (infection in the lungs), bronchiolitis (inflammation in the airways), lethargy and fatigue, vomiting, and poor feeding. 

Ways to protect you and your baby from getting sick with COVID-19 and other viruses this winter

The best ways to protect you and your newborn from all cold and flu viruses this winter, including COVID-19, are the following:

1. Limit visitors during the newborn period (especially visitors who have recently been sick and/or have current symptoms of an illness, such as cough or fever). 

2. Breastfeed, if possible. Your breastmilk is chock full of immune proteins and antibodies that can protect your baby against getting sick with viruses, including COVID-19. There has been recent research showing that IgA antibodies against SARS-CoV-2, the virus that causes COVID-19, are found in the breastmilk of moms who have, or have recently had, COVID-19. These antibodies pass to babies during feeding.  IgA antibodies in breastmilk protect newborn babies and infants against other viral illnesses, including influenza and common cold viruses, so it’s postulated that the same holds true for COVID-19.  

Please keep in mind that some breastmilk is better than no breastmilk. Even if you can only provide breastmilk for a few days or weeks, this will protect your baby much better than if he or she does not get any milk at all.

3. You can safely breastfeed if you have symptoms of COVID-19 and/or test positive for the virus. You just need to make sure to wash your hands before touching your baby and also wear a mask at all times around your baby until you are no longer infectious. There are fortunately not any documented cases of babies getting COVID-19 from their moms’ milk, so most pregnancy and pediatrics experts recommend that mothers with the virus continue to breastfeed.  

4. If you are pumping and bottle feeding your baby breastmilk, it’s very important to have meticulous hygiene right now. This includes washing your hands before and after every pumping session, washing and sanitizing pump parts after every pumping session, and making sure that your expressed breast milk is handled and stored properly and safely.

5. If someone outside of your household is going to be visiting and feeding your baby pumped milk or formula by bottle, make sure of all of the following are true:

• That they are not currently ill and/or have not had a recent exposure to someone with COVID-19.
• If they have recently had COVID-19 that they have fully recovered and been cleared by their local public health department to come off of quarantine.
• That they wash their hands and wear a face mask while feeding your baby. Wearing a  face mask is an easy thing to do and will provide an additional layer of protection for your baby to prevent him or her from getting sick. 

6. Be very cautious with informal milk sharing due to the possibility of COVID contamination of pumped milk and storage containers.

7. If you (or any other household member) has been exposed to the virus you will need to discuss what to do with your doctor, quarantine as directed, and monitor for symptoms of the virus per current Centers for Disease Control (CDC) and public health recommendations. Please make sure to get tested if it has been recommended!

8. If anyone in your household tests positive for COVID-19 and/or is symptomatic, they should mask and maintain distance from your baby (if possible). The same holds true if anyone has a cold or the flu – it’s best for any sick household members to maintain distance from newborns to prevent them from getting sick. If they cannot maintain distance and are over the age of two, they should wear a face mask at all times until they have fully recovered from their illness. 

COVID-19 vaccine considerations while breastfeeding

At the time this article was written , both the Pfizer and Moderna COVID-19 vaccines have received emergency FDA approval and certain high risk groups, such as frontline health care workers, are receiving their first doses of the vaccine.

We do know that all other vaccines, except those for smallpox and yellow fever, are safe to get while breastfeeding, and that the best way to provide protection to newborns from viruses, like influenza, is through IgA antibodies that pass from moms to babies through breast milk. Because of this, the American College of Obstetricians and Gynecologists (ACOG), the Academy of Breastfeeding Medicine (ABM), and the CDC all recommend that women who are breastfeeding can get the new COVID-19 vaccine. Per ACOG’s policy statement, “There is no need to avoid initiation or discontinue breastfeeding in patients who receive a COVID-19 vaccine,” and according to a recent statement by the ABM, “Antibodies and T-cells stimulated by the vaccine may passively transfer into milk. Following vaccination against other viruses, IgA antibodies are detectable in milk within 5 to 7 days. Antibodies transferred into milk may therefore protect the infant from infection with SARS-CoV-2.”

The most important things to remember about having a baby in the middle of a pandemic are that it’s okay to feel stressed AND that you need to make decisions that are best for you, your family, and your new baby. It might be hard to say “no” to friends and family who want to visit, miss out on family parties and gatherings, and deal with feelings of isolation due the pandemic. Please remember that all of this will soon end! Before you know it, you will be able to bring your baby outside of your home, gather with extended family and loved ones, and not have to worry as much about getting sick. Fortunately, your baby will not remember any of this!

Jessica Madden, MD is a board-certified pediatrician and neonatologist, soon-to-be International Board-Certified Lactation Consultant (IBCLC) and Medical Director of Aeroflow Breastpumps.