Updated 02 April 2020
The Unicef UK Baby Friendly Initiative has received a number of queries regarding best practice for infant feeding during the Covid-19 outbreak. We suggest that all practitioners follow latest updates from the UK governments and the World Health Organization (WHO) (see Clinical management of severe acute respiratory infection, currently page 13). Note: these documents could change as more information becomes available.
There is a wealth of evidence that breastfeeding reduces the risk of babies developing infectious diseases. There are numerous live constituents in human milk, including immunoglobulins, antiviral factors, cytokines and leucocytes that help to destroy harmful pathogens and boost the baby’s immune system. There is no evidence at this time that Covid-19 can be passed through breastmilk. Therefore, considering the protection that human milk and breastfeeding offers the baby and the minimal role it plays in the transmission of respiratory viruses, it seems sensible to do all we can to continue to promote, protect and support breastfeeding.
To facilitate breastfeeding, mothers and babies should be enabled to stay together as much as possible, to have skin-to-skin contact, to feed their baby responsively and to have access to ongoing support when this is needed.
When mothers are partially breastfeeding, they can be encouraged to maximise the amount of breastmilk they are able to give or, if they choose, to be supported to return to full breastfeeding. If mothers are considering stopping breastfeeding, it is worth having a sensitive conversation about the value of continuing during the Covid-19 outbreak.
Parents should be encouraged to continue adhering to current guidance on washing and sterilising equipment. Parents should be supported to bottle feed responsively, including pacing feeds and limiting the number of people who feed their baby.
Practical information for parents if they have Covid-19 and are caring for their baby
If parents/carers are infected, take precautions to limit the spread of Covid-19 to the baby by:
- Washing hands thoroughly before and after contact with the baby.
- Routinely cleaning and disinfecting any surfaces touched.
- Cleaning any infant feeding equipment, including breast pumps, bottles and teats thoroughly before and after use.
- Practicing respiratory hygiene, including during feeding, for example by avoiding coughing or sneezing on the baby and by wearing a face mask or suitable alternative if available.
- Parents should take care to avoid falling asleep with their baby, see Co-sleeping and SIDS, Safer sleep for babies.
- If a breastfeeding mother is feeling unwell, continuing breastfeeding rather than expressing may be easier and less stressful during this time. Alternatively, she may prefer for someone who is well to feed expressed breastmilk to the baby.
- If the mother is too unwell to breastfeed or express breastmilk, she may be supported to re-lactate once well enough. Consider using donor milk if available and applicable.
- If a baby is being bottle fed with infant formula or expressed milk, wash equipment in hot, soapy water and sterilise carefully before each use.
Accessing infant formula
There were reports of parents being unable to purchase infant formula, but at time of writing this seems to be improving. We have been informed that retailers do have stock and are limiting purchases of infant formula to 2-4 tins per customer. However, we are unsure if supplies are consistently available across all parts of the UK and whether the current situation will change as the Covid-19 outbreak progresses.
Currently, parents should be advised that stage 1 / first infant formula should be used for infants in the first year of life:
- If parents are unable to get their usual brand of first infant formula, they can use any first infant formula as all preparations have a similar nutritional composition to comply with legislation.
- Parents should be advised not to use stage 2 follow on formula for any baby under 6 months – only use first infant formula.
- If parents are using follow on formula for a baby older than 6 months and cannot access this, then they can use first infant formula.
- If parents are using other milks such as anti-reflux milk, comfort milk, etc. and can’t access these, they can use first infant formula.
- Advise parents to always make up infant formula as per manufacturer’s guidance and not be tempted to add more water to the feed to make it last longer, as diluting the milk could endanger the baby’s health.
There are reports that the number of families applying for universal credit has dramatically increased during the first weeks of the Covid-19 outbreak. Families in receipt of universal credit are entitled to Healthy Start vouchers. Supporting families to claim their vouchers will enable them to access infant formula.
Supporting close and loving relationships
Regardless of feeding method, it is essential that babies’ needs for emotional attachment with their parents / primary caregiver continues to be considered. Keeping babies close and responding to their need for food, love and comfort are all essential for babies’ health, wellbeing and development. In addition, this will enhance the mother’s mental wellbeing in the postnatal period.
A range of Baby Friendly resources on infant feeding and supporting close and loving relationships can be found at: Unicef UK Baby Friendly Initiative
Information on infant formula can be found at: First Steps Nutrition Trust