This guidance is for maternity, neonatal and child and family health services and is focussed on the feeding of infants when the mother has suspected or confirmed COVID-19 in the acute healthcare setting or at home.
This guideline is based on available evidence to date on COVID-19. The guideline focuses on specific considerations for infant feeding relevant to the COVID-19 environment. The guidance supplements, but does not replace, existing NSW Health guidance on infant feeding:
This guideline should be used in conjunction with the following NSW Health documents which focus on special considerations for care in the COVID-19 environment:
When mothers, babies/families are separated/ isolated for any reason maternity, neonatal and child and family health services should acknowledge that this may be a trigger for anxiety for mothers. This may be an especially difficult time for Aboriginal families and refugees. Health workers will need to identify mothers and families who may require additional support at referral or early in their care. Health workers will need to engage with appropriate local support for example Aboriginal liaison officers, Aboriginal health workers, multicultural health staff, and/or social work services to enhance care for these families.
Maternity, neonatal and child and family health services should monitor the
ACI COVID-19 risk level and respond according to the Clinical Excellence Commission (CEC) COVID-19 Response and Escalation Framework (Chapter 3) found in the
CEC Covid-19 Infection Prevention and Control Manual. Authorisation for an escalation of risk should be based on direction from the NSW Public Health Emergency Operations Centre (PHEOC) and the CEC.
The correct infection prevention and control (IPC) precautions must be followed for all aspects of clinical care, such as assisting a mother who is suspected or confirmed to have COVID-19 to breastfeed or to express breastmilk.
For information on IPC practices and Health Worker Safety see the CEC website
COVID-19 Infection Prevention and Control
At present the
World Health Organisation states that data are not sufficient to conclude vertical transmission of COVID-19 through breastfeeding. Breastmilk protects babies against infection and chronic disease and therefore is extremely important for all babies, particularly in the current environment. Given these factors, the known lifelong health and development benefits of breastfeeding to both mothers and babies currently substantially outweighs the potential risks of transmission of COVID-19.
Breastfeeding, or expressing breastmilk when mother and baby are separated, should therefore be strongly encouraged and supported, irrespective of COVID-19 status of the mother or the baby. The mother’s decision to breastfeed will be influenced by her state of health, and whether she is well enough to start or continue to breastfeed or express breastmilk. Health workers should discuss each mother’s individual situation with her and support her in her infant feeding choices.
If the mother is suspected or confirmed to have COVID-19 and
co-located with her baby in hospital or at home, the baby is at risk of transmission via the mother’s respiratory secretions. The mother should take special precautions when feeding the baby, expressing breastmilk, practising skin to skin contact, or undertaking care where she is closer than 1.5 metres from the baby.
These special precautions include:
These precautions must continue until the mother is no longer considered infectious and can be
released from isolation.
The principles of protecting the baby from COVID-19 transmission by maintaining strict respiratory and hand hygiene practices (Section 2.2) apply equally to breastfeeding, feeding expressed breast milk (EBM) or feeding formula when the mother, partner or carer is suspected or confirmed to have COVID-19.
When the mother and baby are separated because mother and/or baby are unwell with COVID-19, or while the baby remains an identified close contact of a confirmed case of COVID-19, the baby is effectively in isolation to protect others. The number of carers should be limited where possible to reduce the risk of transmission. The carer who feeds the baby should take appropriate precautions to prevent any risk of transmission to themselves, while being aware that close interaction with a primary caregiver is essential for the baby’s emotional wellbeing. These precautions are the same as those documented in 2.2 Protecting the Baby from COVID-19 Transmission.
A health worker feeding EBM to a baby with COVID-19 or the baby of a mother who is suspected or confirmed to have COVID-19, , should use transmission-based precautions and follow the usual process of ensuring the safe management of breastmilk as directed by
Maternity – Breast Milk: Safe Management PD2010_019
Mothers should be informed of the benefits of breastfeeding and the importance of breastmilk’s protective factors in the context of Covid-19.
Where the mother is COVID-19 positive in the third trimester and wishes to breastfeed an
individualised care plan should be prepared so the mother can initiate breastfeeding as soon as possible after the birth.
A comprehensive breastfeeding history should be taken with appropriate referral/s for any identified issues. Mothers should plan for her partner/family member/friend to assist if her or her baby’s clinical condition change.
Parents should be advised of online breastfeeding information and education resources.
If the mother contracts COVID-19 while she is breastfeeding an infant of any age, she should be supported to continue breastfeeding unless she no longer wishes to breastfeed or is too unwell to do so.
special precautions while breastfeeding
Expressing breastmilk may be an option for a mother who requires hospital admission and separation from her baby is necessary.
If the mother is too unwell to breastfeed or express breastmilk for some time she may be supported to re-lactate once she is well enough. Support is available from
Child and Family Health,
the Australian Breastfeeding Association and the
Lactation Consultants of Australia and New Zealand
The mother should maintain strict hand and respiratory hygiene - (see
Protecting the baby from COVID-19 transmission) before and while expressing breastmilk or touching any pump or bottle parts
Hospital breast pump components should be cleaned and sterilised between patients. Refer to
CEC Infection Prevention and Control Practice Handbook.
When at home all feeding equipment, including pumps, should be washed and disinfected according to the manufacturer’s instructions. The
CDC website - How to keep your breast pump kit clean provides general advice for parents/carers.
Containers of EBM should be labelled in the usual way, wiped with detergent solution and bagged for transporting.
Mothers expressing breastmilk at home for their baby on the neonatal unit should be provided with enough EBM containers, labels and enough bags for transporting. Health workers assisting a Covid-19 positive mother with expressing milk should use
Contact, Droplet and Airborne Precautions.
Transportation of the breastmilk to the neonatal unit from home should be by a person who is not in self-isolation for any reason. The process must be carefully described and planned for each mother and family on an individual basis.
A mother’s decision to formula feed should be an informed choice after providing information on the protective effects of breastmilk in the context of the COVID-19 pandemic.
Obtaining the usual brand of infant formula may be difficult when families are self-isolating or when baby formula stocks are low during the pandemic. If parents are unable to get their usual brand of infant formula they can use any formula that is age-appropriate, as all formulas have a similar nutritional composition. Parents need to be made aware that the preparation instructions may vary from formula to formula.
Any specialised formula use will need to be discussed on an individual basis.
Poor feeding and lethargy are often signs of illness in a baby, and should be investigated promptly, especially where a baby is co-located with a mother or other family members who are suspected or confirmed to have COVID-19.
Districts and networks should develop clear local guidance to ensure rapid referral, assessment and
readmission for babies where necessary. Health workers should ensure that mothers and their families are aware and informed of the signs and symptoms of an unwell baby and provided with details of how and who to contact should they have concerns.
The Australian Breastfeeding Association has prepared an information video called assessing newborn intake in the context of Covid-19. This
video may assist health workers to assess infant feeding via telehealth.
Women who are breastfeeding are encouraged to be vaccinated against COVID-19 and do not need to stop breastfeeding before or after the vaccination. Further information can be found in the Australian Government's
COVID-19 vaccination shared decision making guide for women who are pregnant, breastfeeding or planning pregnancy
For general information on COVID-19 vaccines go to
NSW Health COVID-19 vaccination: information for the NSW community.
Special precautions for management of expressed breast milk (EBM) of mothers who are COVID-19 positive (flow chart)
The following additional resources may be useful for health workers:
Health and Social Policy Branch (HSPB)
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning
Clinical Leads, Maternity, Neonatal and Child and Family Health, Clinical Excellence Commission
Maternity, neonatal and child and family health services.