Update on Coronavirus and breastfeeding

The information about coronavirus and breastfeeding on this page is being checked regularly and will develop in response to guidelines and evidence.  This page was last updated on 1st April 2020.

Coronavirus 2019-nCoV or COVID-19 is a new respiratory illness that has not previously been seen in humans.  The first coronavirus cases have been confirmed in the UK and the rising death toll worldwide is causing alarm and concern.  This can be especially worrying for all parents with new babies and young children, including those who are worried about coronavirus and breastfeeding. 

Can I breastfeed if I have COVID-19?

Information on the COVID-19 is a rapidly changing but current evidence suggests that it is safe to breastfeed and continue to offer breastmilk. In fact, breastmilk is the best source of nutrition for infants and provides protection against many illnesses. If you have confirmed COVID-19 or have symptoms you should take all possible precautions to avoid spreading the virus to your baby, including washing your hands before touching your baby, sterilising any breast pump or bottles and washing your hands after changing their nappy.  

If available, wear a face mask while feeding your baby at the breast. If you are too unwell to breastfeed you may still be able to express milk for your baby. 

Pump equipment and bottles need to be sterilised according to manufacturers instructions. [Coronovirus (COVID-19) Infection in Pregnancy Information for healthcare professionals V1 09/03/2020 p22].

What are the symptoms?

Based on current evidence, the coronavirus presents with flu-like symptoms including a fever, a cough, or difficulty breathing.  Anyone who thinks they have symptoms should visit https://111.nhs.uk/covid-19 or in England, Wales and Northern Ireland should call NHS 111. In Scotland call your GP surgery or call 111 if your surgery is not open.  

You should stay at home and avoid close contact with other people. Do not go to a GP surgery, pharmacy or hospital.

How to avoid catching or spreading coronavirus

Do

  • wash your hands with soap and water often – do this for at least 20 seconds
  • always wash your hands when you get home or into work
  • use hand sanitiser gel if soap and water are not available
  • cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • put used tissues in the bin straight away and wash your hands afterwards
  • try to avoid close contact with people who are unwell

Don’t

  • touch your eyes, nose or mouth if your hands are not clean
I am feeling unwell and may have coronavirus

If you are feeling unwell, the general information provided by Public Health England applies.  This includes keeping yourself hydrated and taking painkillers such as paracetamol to help you feel more comfortable.

The link also includes details for phoning for medical help.

Whilst ibuprofen is compatible with breastfeeding there is some uncertainty as to whether it should be taken when there are symptoms of coronavirus. if you have been prescribed anti-inflammatory medication by your doctor for other reasons please do not stop treatment without discussion.

Links checked 19th March 2020

Information about looking after yourself here from the NHS which includes details for phoning for medical help.

Tweet from WHO explaining current position on ibuprofen. 18 March 2020: 10.46pm

There is information about breastfeeding with coronavirus about half way down this page.

Starting breastfeeding - the first few days.

Women tell us that days 3 or 4 can be a time of change and feelings of being overwhelmed together with tiredness can be common. You may also feel isolated during this time of public worry and restrictions on social contact. Staying connected with your baby as your body adapts to support your baby’s needs is important as is knowing where you may be able to get help if you need it. You may notice your breasts becoming warmer and tingly as they begin filling with milk and your baby may be more unsettled and feed in unpredictable patterns. Take each feed, one at a time, spending time with your baby as you both learn from each other. When possible keeping together in skin to skin will help to calm your baby.  Knowing what to look out for can help you see and feel how well your baby is feeding. Learning and recognising some simple signs can make all the difference.

How is feeding going?

Helping your baby attach well will allow them to make the most of your milk and avoid hurting your breasts.

You are looking for short sucks to begin, which can feel strong, followed by long rhythmic sucks and swallows.

When your baby finishes the feed, they should appear content and satisfied – though they may want more from the second breast before they finally settle.

Your nipples should look like they did before the feed, if sore, misshapen or have pressure lines, the attachment may have shifted during the feed – this is something to work on.

Keep in mind the phrase ‘CHINS’, trained peer supporters use this acronym when supporting mothers to help remember the ways of holding and attaching your baby:

Close, your baby needs to be close to you so that they can scoop enough breast into their mouth

Head free, so your baby can tilt their head back when attaching to your breast. This allows their chin to lead as he comes on to the breast

In Line, your baby’s head and body need to be in a straight line so they are comfortable and can swallow easily.

Nose to nipple, this should be at the top of the list – start the feed with your nipple level with your babies nose so that as they root and tilt their head you can bring them closer to you so they will be well attached.

Sustainable, comfortable for both of you through the feed.

Your baby’s wet and dirty nappies are a good indication of the amount of milk taken.

The first 48 hours

  • At the beginning, your baby will pass a black tar-like poo (called meconium)
  • In the first 48 hours, your baby is likely to have only 2 or 3 wet nappies.

Wet nappies should then start to become more frequent, with at least 6 every 24 hours from day 5 onwards.

You may notice an orange or red, brick-dust coloured stain in your baby’s nappy in the first couple of days after birth. This can look alarmingly like blood, but is urate crystals, which is normal at this time. As feeds increase the urine will become less concentrated and the staining will disappear. Let your midwife know if it is still there by day 3 or 4.

It is also common for baby girls to have a vaginal discharge in the first few days after birth. At times this may be slightly blood stained and is due to the presence of your hormones in your daughter’s body; this is entirely normal but if in doubt please check with your midwife.

https://www.cuh.nhs.uk/rosie-hospital/pregnancy-labour-and-birth/going-home/caring-for-your-baby/what%E2%80%99s-nappy

Days 3-4

  • By day 3, your baby’s poo becomes easier to clean as the meconium mixes with your milk and should be changing to a lighter, loose, greenish poo.
  • From day 4 and for the first 4 – 6 weeks your baby should pass at least 2 yellow poos every day, with poos at least the size of a £2 coin.

If on any day during the first week your baby has not had a poo, or you have any concerns,  call the National Breastfeeding Helpline. You can also speak to your midwife. They will help you check how well your baby is feeding and any difficulties you may be having. There will be many times when your baby is doing well with a gap in poo, yet it is better to be careful and to seek support to help guide you.  

To discuss this, or any question, ask your midwife or call the National Breastfeeding Helpline, 0300 100 0212, open 9.30am-9.30pm, every day of the year. It’s important to stay connected so call as often as you like.

Link to all the breastfeeding support available during COVID-19 https://www.breastfeedingnetwork.org.uk/breastfeeding-support-in-the-uk-during-the-coronavirus-covid-19-situation/

These links below can make it all seem easy when the reality may be harder. Talk it through with someone on the helpline as they are skilled at knowing how to help.

See colour changes of baby poo on p17 https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2010/11/otbs_leaflet.pdf

Beginning breastfeeding

https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-positioning-attachment/

Longer, ten minute, video showing more detail on attachment and how babies signal they are ready to feed through feeding cues https://globalhealthmedia.org/portfolio-items/attaching-your-baby-at-the-breast/

First feeds

https://web.bestbeginnings.org.uk/web/video/your-babys-first-feed-1041/videos

Feeding on day 2 – to show babies need to calm to feed. Too upset on first try https://www.breastfeedinginc.ca/baby-28-hours-old-assisted-latching

How can I increase the amount of breastfeeding and reduce the amount of formula?

If your baby is breastfeeding some of the time and also having formula, you can start reducing one of the formula feeds at a time that suits you both.

Early to mid-morning is often good, you will know what works for you.

Keep the rest of the formula feeds the same throughout the day.

Once you stop this feed, hold this pattern for a few days and then try reducing the amount of formula in another bottle, perhaps in the afternoon.

Going slowly like this means you know your baby is only missing out on a little formula at any time. If they are unsettled in between feeds try offering an extra breastfeed, this will help boost your milk supply.

A good sign that your baby is receiving enough milk is that they are producing at least 6 wet nappies (once they are 6 days and older) and at least 2 poos every 24 hrs. For older babies this pattern may vary so compare with their usual amount of wet and dirty nappies.

If you have difficulties with breastfeeding call the National Breastfeeding Helpline to talk this through.

Link checked 20 March 2020

https://abm.me.uk/breastfeeding-information/relactation/

I have stopped breastfeeding, can I restart?

Restarting breastfeeding is possible. It takes time, lots of patience and depends on how your baby reacts, some find it surprisingly easy to adjust and others take a while to become interested.

Encouraging your baby

The following steps can help, there is no exact, or simple way to do this. Watch your baby, follow their cues. Sometimes they need a few days of being with you, skin to skin, before they decide to take an interest in latching on.

Find a time where you can lie on your bed propped up on pillow or cushions, or lying on your side, whatever is comfortable for you both. If sitting up hold your baby between your breasts skin to skin. If on your side, lie with your baby close to your breast. Let your baby get used to being close again and explore your breasts. Just like at the beginning they often start by nuzzling and licking your nipple, and reaching out with their hands. You can encourage this by expressing a little milk, if you have some so they can taste it. This can be fiddly and distracting so concentrate on letting them explore until you think it would help.

Stimulating your breasts

Use a pump or hand express to stimulate your breasts for 10-15 minutes each side aiming for least eight times in 24 hours, including once at night. The pump should be comfortable, too high a setting is likely to make you sore without increasing your supply. The number of times you express is more important that keeping the expressing times evenly spaced out.

Increasing the amount of breastfeeds

It is easier to go slowly dropping one feed at a time as it means you know your baby is only missing out on a little formula at any time. If they are unsettled in between feeds try offering an extra breastfeed, this will help boost your milk supply. Mothers often saw they find the change from more predictable feeding times unsettling. It takes a while to settle to this new pattern. Some babies will want to go faster so this phase may feel quite intense. You may notice you are getting thirstier and more hungry as your milk supply increases. This is all expected and a good sign you are making more milk.

Another sign that your baby is receiving enough milk is that they are producing at least 6 wet nappies (once they are 6 days and older) and at least 2 poos every 24 hrs. For older babies this pattern may vary so compare with their usual amount of wet and dirty nappies. You may notice their poos change to become runnier and more yellow again.

If you have difficulties with breastfeeding call the National Breastfeeding Helpline to talk this through.

ABM have a leaflet explaining relactation in more detail:

https://abm.me.uk/wp-content/uploads/ABM-relactation-breastfeeding.pdf

Is sharing breastmilk safe during coronavirus?

Informal milk sharing is not recommended particularly while coronavirus – COVID-19 is such a concern. Although the virus has not been detected in breastmilk it can stay on the surface of containers and can also be passed on through close contact without the person being aware they have any of the symptoms.

http://www.ukamb.org/breastmilk-sharing/

Is donor breastmilk from a milk bank an option?

Pasteurised donor milk may be obtained from a milk bank. Priority is given to the sickest, most premature babies. Mothers with their own breastfeeding challenges may be able to get donor breastmilk if there are sufficient supplies.

http://heartsmilkbank.org/milk/

Breastfeeding support in the UK during the COVID-19 situation

Breastfeeding supporters in the UK – both voluntary and paid – are skilled and experienced in offering breastfeeding support over the phone and online. Several helplines are available, and many have increased capacity:

National Breastfeeding Helpline (run by the Association of Breastfeeding Mothers and the Breastfeeding Network) – 0300 100 0212 Open 9.30am-9.30pm, every day of the year. 

This line also includes an option for Welsh and Polish language support.

Breastfeeding Network Bengali/Sylheti Helpline 0300 456 2421

The National Breastfeeding Helpline also provides support via web chat at www.nationalbreastfeedinghelpline.org.uk and via Facebook messenger www.facebook.com/nationalbreastfeedinghelpline

The Breastfeeding Network’s Drugs in Breastmilk Information service offers evidence based info on the safety of medications and treatments during breastfeeding.

A series of fact sheets covering a wide range of issues and medications can be found at: www.breastfeedingnetwork.org.uk/drugs-factsheets

Or you can message the BfN Drugs in Breastmilk Information page on Facebook at www.facebook.com/BfNDrugsinBreastmilkinformation

Or email druginformation@breastfeedingnetwork.org.uk

La Leche League – 0345 120 2918 (8am-11pm) and visit https://www.laleche.org.uk/get-support/ for a range of online and telephone breastfeeding support options.

NCT – 0300 330 0700 Feeding line (8am-midnight) https://www.nct.org.uk/baby-toddler/feeding/early-days/breastfeeding-support-nct

You can also contact your local health visiting team or local infant feeding support team to see what other resources are available. An internet search using ‘breastfeeding’ and the name of your town or county will usually get you to the right teams. In many areas, there are increased levels of phone support and support available online and through video.

You can also visit lcgb.org to find a local lactation consultant: https://www.lcgb.org/find-an-ibclc/. Many are offering additional remote support options.

There are several reliable sources of online information about breastfeeding, talking about what’s normal and how to deal with problems, including:

https://www.laleche.org.uk/

www.breastfeedingnetwork.org.uk

www.abm.me.uk        

https://www.nct.org.uk/baby-toddler/feeding

https://breastfeeding.support/

https://globalhealthmedia.org/videos/breastfeeding/

The national charity Best Beginnings has created Baby Buddy, the free NHS approved app for pregnant women and new parents includes supportive daily information about breastfeeding, maternal mental health and more. Also, within the app you can watch over 30 films about breastfeeding including practical films on positioning and attachment.

For anyone wanting to see the breastfeeding films via a website, you can click here: https://web.bestbeginnings.org.uk/web/videos/breastfeeding

For joint expert information from midwives and doctors on breastfeeding and caring for a baby during a COVID-19 infection or suspected infection, please visit this site and scroll down to find the later questions: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

UNICEF Baby Friendly also has some useful resources here: https://www.unicef.org.uk/babyfriendly/COVID-19/

This information was prepared jointly by the breastfeeding support organisations.

If you are finding it hard to find your baby’s usual brand of infant formula

For all babies a first infant formula should be used throughout the first year.

If you are unable to get your usual brand of first infant formula, use another brand of first milk as all preparations have a similar nutritional composition to comply with legislation. There may be liquid ready to feed milk if no infant formula is available.

Do not use a follow-on milk in the first 6 months.

For babies 6 months or older and you cannot find your usual type of formula then use first infant formula. Your baby can stay on this formula throughout the first year.

If you usually use another milk such as anti-reflux milk, or comfort milk and can’t find these, then use first infant formula.

Always make up infant formula as stated on the tin – do not add more water to make it last longer as diluting the milk could endanger your baby’s health.

If the main supermarkets have no infant formula, try local stores, pharmacies and corner shops. Many pharmacies will order products for their customers if asked. They are very busy just now.

Links checked 22 March 2020

Adapted from: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2020/03/Unicef-UK-Baby-Friendly-Initiative-statement-on-infant-feeding-during-the-Covid-19-outbreak-2.pdf

More information on bottle feeding here: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf

And: https://www.firststepsnutrition.org/infant-milks-overview

Protecting your mental health during anxious times

Feeling anxious is a very normal emotion. We are all anxious just now. You may be isolated from your family, or finding the usual support is not available. That’s without the extra worry of coronavirus. 

These feelings are normal yet may feel overwhelming at times. Coronavirus, or COVID-19 feels threatening, both to ourselves and the people we care about.  Recognising this threat can help you work out how best to keep yourself safe.  Think about what is helping you and what is making you feel worse and then try to protect yourself from the negative things – including restricting time on social media.

It is only necessary to seek help if you find your feelings spiralling out of control.   Tell your loved ones how you feel, this may be an opportunity to express your frustration and worries, which may be all that you need for just now.   

You can call the National Breastfeeding Helpline to talk about your concerns related to breastfeeding, if you can feel more confident about how you feed your baby it can take a lot of weight off your mind.

Sources of help:

Here are some of the latest guidelines:-

La Leche League – coronavirus

UNICEF Baby Friendly Initiative – Infant Feeding during the Covid-19 outbreak 

Guidance from the World Health Organisation – the link includes information on the effects of the coronavirus on children, information for pregnant women and breastfeeding mothers.

The Royal College of Obstetricians and Gynaecologists have produced a report for healthcare professionals caring for pregnant women and new mums. Coronavirus and breastfeeding is covered in point 4.8.2.

Other Information and further support

Every day more information is published on official government sites.  For accurate and up to date information please visit the Government Public Health website.  The Department of Health and Social Care will be publishing updated data on the following page every day until further notice NHS website Coronavirus (2019-nCoV).

NHS Scotland – coronavirus

NHS UK – coronavirus

Useful information for staying at home

Updated 01/04/2020