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AAP issues guidance on breastfeeding during COVID-19 pandemic :

April 23, 2020

Editor's note: This guidance was updated Feb. 11, 2021. Please visit https://bit.ly/2JL3U0A.For the latest news on coronavirus disease 2019, visit   https://www.aappublications.org/news/2020/01/28/coronavirus.

New AAP guidance on breastfeeding during the coronavirus disease 2019 (COVID-19) pandemic can help pediatricians advise and support mothers and family members after newborns leave the hospital.

“Breastfeeding Guidance Post Hospital Discharge for Mothers or Infants with Suspected or Confirmed SARS-CoV-2 Infection” addresses the following questions about breastfeeding:

Q: Why is it important to continue to promote and support breastfeeding in a family with suspected or confirmed COVID-19?

A: While studies have not found SARS-CoV-2 in breast milk, COVID-19 can be transmitted by respiratory droplets. Breastfeeding can help protect infants from infection, and breastfed infants are less likely to have severe respiratory symptoms, according to the guidance.

Among other maternal and infant health benefits, breastfeeding can be important during a time of potential shortages of formula, bottles and other supplies. Because a mother’s milk is established in the first weeks postpartum, this is a critical time to support milk production. Families should be reassured that mothers’ milk is safe and important for the baby, the AAP noted.

Q: If a mother and/or infant has COVID-19, how can I support breastfeeding?

A: The advice addresses how to counsel mothers who wish to express their milk, those who prefer to breastfeed directly or mothers who choose not to breastfeed during the first weeks after birth.

Infants born to mothers who are COVID-19 positive ideally should be discharged to the care of healthy caregiver, which aligns with the AAP “Initial Guidance: Management of Infants Born to Mothers with COVID-19.” Mothers who are in the same household as their babies should maintain at least a 6-foot distance whenever possible and, when closer to the baby, wear a mask and use hand hygiene for newborn care until she has been afebrile for 72 hours without use of antipyretics and at least seven days have passed since symptoms first appeared.

Q: What are important considerations for clinical management of breastfeeding,including telemedicine, during this pandemic?

A: An in-person visit within 24-48 hours is preferred, especially for infants discharged early from the hospital. The gold standard for breastfeeding support during this office visit within a day or two after discharge includes infant exam, weight check and direct observation of latch and feeding. Connecting virtually with a lactation specialist is best and requires pre-planning. When additional support is necessary, consider telemedicine or telephone consultation.

Telehealth visits for lactation support may cover breastfeeding latch assessment, milk transfer observation, baby weight check (if parents have a scale), assessment of the baby’s diaper output and stool color, engorgement, sore nipples and advice about maternal medications. Use of a baby doll or breast model or diagram during telehealth visits can be helpful. If there are concerns, the baby should be referred for urgent in-person evaluation.

For in-person visits, avoid use of waiting rooms, and implement strategies such as seeing newborns first thing in the morning, using separate entrances for well and sick patients, offering rooming upon arrival or waiting in the car until appointment time.

The guidance also includes numerous links to breastfeeding resources for families and pediatricians.

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