Care for Breastfeeding Women

Considerations for well-child visits

Healthcare providers are encouraged to prioritize newborn care and vaccinations. Every effort should be made to conduct newborn follow-up visits in person. During in-person visits, healthcare providers 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 providers 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 providers 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 providers) 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 effectively support some breastfeeding dyads. 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 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 home 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. Discard disposable surgical masks between clients. 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 members of the household 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 providers 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 providers 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). There is evidence that SARS-CoV-2 may remain on surfaces for several hours to days. However, there is no evidence that precautions such as cleansing the breast (e.g., using soap and water) prior to breastfeeding or milk expression or disinfecting external surfaces of milk collection devices (e.g., bottles, milk bags) reduce transmission of SARS-CoV-2. 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 Further, there are also 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.

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