CoVID-19 has been stressful for all parents, here at Carolina Kids Pediatrics, throughout Raleigh, NC, and throughout the country This may be especially true for mothers who are breastfeeding and concerned about transmitting infection to their infant. However, the CDC has published guidelines for breastfeeding moms during the pandemic, with some recommended precautions. To view these guidelines, check out:
Although none of the pediatricians at Carolina Kids Pediatrics have yet seen patients positive for CoVID-19 during the past 3 months, we know that CoVID-19 has been on the rise in Raleigh and throughout North Carolina in recent weeks. So can breastfeeding spread infection to babies if a mom is asymptomatic and does not know that she is infected? In general, respiratory viruses, including coronaviruses, are not expressed through breastmilk, and breastmilk would therefore not be a likely cause for spreading CoVID-19. However, a mother’s antibodies are secreted in breastmilk – including antibodies to CoVID-19 if a mother is infected, or has been infected in the past. Although we don’t have definitive evidence for CoVID-19 on this point yet, maternal antibodies are often the reason that breastfeeding infants are less likely to have severe respiratory infections when they get sick.
However, CoVID-19 is spread through close contact with respiratory droplets from those who are infected, whether symptomatic or asymptomatic. Therefore, it is possible for mothers to infect babies through the kind of close contact required for direct breastfeeding.
For this reason, the CDC recommends that moms who may be infected with CoVID-19 consider pumping and providing expressed breastmilk to their infants until they recover and are no longer contagious. If you have COVID-19 or are suspected of having COVID-19, staying in a different room from your baby is the safest way to keep your newborn healthy if this is at all possible. Washing hands thoroughly before touching bottles or pumping supplies is helpful. Cleaning your breasts before pumping and wearing a mask during the pumping process is also a good idea. If at all possible, a healthy caregiver can then feed breastmilk to your baby until you recover from infection.
It's also very important to clean your breast pump after each use. Remind all caregivers to wash hands thoroughly before touching bottles, or feeding or caring for your baby. If you decide to breastfeed directly, take all the recommended steps to prevent the potential spread of the virus, including using a mask and following careful breast and hand hygiene.
If you and your family decide to keep your baby in the same room as you while you are infected, keep a distance of at least 6 feet from your baby. When closer than 6 feet, wear a mask and make sure your hands are clean.
If you have COVID-19 (or suspect that you do), you can stop isolating yourself from your baby once you are fever-free without use of fever medicines (acetaminophen or ibuprofen) for at least 72 hours; when your other symptoms of COVID-19 are improving; and when at least 10 days have passed since your symptoms started.
If you have questions about breastfeeding as the pandemic evolves in the Raleigh, NC area, remember you can always give us a call at (919) 881-9009 to speak to our Carolina Kids Pediatrics lactation consultant, Jerrianne Webb.
We’ll post another general update about CoVID in the Raleigh, NC area within the coming week.
Christian Nechyba, MD
Carolina Kids Pediatrics
If you are planning to breastfeed, the first few weeks of your baby’s life can be the most challenging.
Even if this is your first child, you’ve probably heard stories from other moms discussing the trials, tribulations and triumphs of breastfeeding. At Carolina Kids Pediatrics in Raleigh, NC, our pediatricians and our lactation consultant are here for you every step of the way to make breastfeeding more successful for you and your baby.
Latching Takes Time
The chances of a successful latch increase if you are able to attempt nursing in the first hour or so after a baby is born. Babies tend to be alert and readier to breastfeed during this first hour – afterward, they (and their exhausted parents) often fall asleep for the better part of the next 8-12 hours. Although it’s still important to wake babies to breastfeed during this time, it tends to be more challenging than during that first hour.
Remember that your milk does not come in for about 3 to 4 days after your baby is born – so when they are breastfeeding, they are getting only small amounts of colostrum (early milk) for those first few days.
During this time, it’s less important how much a baby gets, and more important that they develop a deep latch – with the baby’s mouth wide open, their lips flanged apart, and the nipple in the back of their mouth – not between their gums. Support your baby’s head close to the breast – I often tell new moms that if you aren’t worried that the breast will suffocate your baby (no worries, it won’t!), then your baby probably is not close enough to your breast. If they back up, they will slip off and bite down on your nipple with their gums. Not only is this painful, it’s just not an effective way for your baby to express milk.
Breastfeeding Happens Around the Clock
Babies should be breastfeeding about every 2 to 2 ½ hours – or more often if they are asking for it – for the first few weeks. That time is measured from the beginning of one feeding to the beginning of the next – so, unfortunately, your break between feedings is usually even shorter than this.
At first, they may only nurse for 5 or 10 minutes. That’s fine on the first day, but your baby should start to feed longer on the second and third day. Eventually, they may latch for 20-30 minutes on the first side, and a few minutes on the second. Once your milk comes in, your breast should soften with the feeding – and it’s always a good idea to empty the first side before switching. The last part of the milk feeding (the hindmilk) is higher in fat and calories, so it’s important to empty the first breast before offering a baby the second side.
Babies can lose up to 7 to 10% of their birth weight before your milk comes in. Once your milk comes in, your baby should gain close to an ounce a day. They should also be more content after nursing; their stools should change from dark to light yellow and loose - sometimes 8 to 12 stools a day or more (you’ll never look at mustard the same way again!).
Remember that at Carolina Kids we have a lactation consultant, Jerrianne Webb, working in our office. She is happy to meet with patients for in-depth lactation consults – or just answer your questions by phone. If you are having trouble breastfeeding at any point don’t hesitate to talk to our pediatricians or our lactation consultant at Carolina Kids in Raleigh. Remember, successful breastfeeding takes all kinds of support - roadblocks can and do happen but we are here to help.
If you are looking for resources online, check out www.kellymom.com. You’ll find a wide range of information on breastfeeding, from the basics to more unique topics (like how to get through surgery or jury duty while breast feeding).
Do you have questions about breastfeeding? Whatever you need, Carolina Kids Pediatrics in Raleigh, NC, is here to help. Call us today at (919) 881-9009 to schedule an appointment or to address your breastfeeding concerns with us.
How Your Pediatricians in Raleigh, NC, Can Help You
At Carolina Kids Pediatrics, we do what we can to support families as they navigate all the challenges that come with infant feeding – breast, bottle, or both. The American Academy of Pediatrics policy on breastfeeding recommends:
“Exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.”
We fully support this recommendation, but we also recognize that for many families, it isn’t that easy. There are many challenges to successful breastfeeding, including difficulties with infant latching, flat/inverted nipples, infant tongue tie, breast infections, low milk supply, engorgement, and many other competing demands on a new mom.
Fortunately, it's not a path you have to navigate alone — your pediatricians and our lactation consultant here at Carolina Kids Pediatrics in Raleigh, NC are here to support you every step of the way. We recognize that while breastmilk provides ideal nutrition for babies, breastfeeding is not right for all families – and we are here to help your baby and your family thrive, whether you decide to breastfeed or formula fee. Our lactation consultant, Jerrianne Webb, is in our office weekly to provide extended lactation consultation appointments for families, and she is available to provide free telephone support at other times also.
For most families, I see three phases of learning to breastfeed which I call “learning to latch”, “learning to eat”, and “learning the routine.”
Learning to latch: Newborns are designed to require very little milk – breast or formula – in the first few days of life. In the first 24 hours of life, the focus should usually be on proper latch at the breast, not on how much milk a baby is getting. Your baby’s lips should be flanged wide apart, and the nipple of the breast should be in the back of their mouth, not between their lips. If it hurts or pinches through the feeding, the latch is probably wrong and needs to be corrected. Gently open your baby’s mouth wide and support their head in very close to the breast to achieve a proper latch. During this time, a brief 5 minute feed with a good latch is better than a 20 minute feed with a poor latch. Putting your baby to breast as early as possible after delivery, at least 10-12 times daily, and correcting a narrow, biting latch whenever possible can help increase your chance of success.
Learning to eat: Your milk comes in three or four days after delivery. Now, your breast feels full before the feeding, and hopefully softens after the feeding. Your baby will eat 15-30 minutes per side instead of the brief feedings of the first few days. If your baby has learned how to latch well in the first few days, she should be more content after the feeding, continue to eat every 2-3 hours on average, and start to have more frequent wet diapers and lighter yellow or brown stools. She should stop losing weight and start to gain 1/2 to 1 ounce daily.
Learning the routine: As your baby grows, you may choose to start introducing bottles of pumped breastmilk to get some breaks in your day and to allow family members to feed your baby. Ideally, your baby has learned to latch and nurse well first. A slow-flow bottle, like an Avent bottle, might be less confusing for your breastfeeding baby. Brief pumping after nursing several times daily will provide you the milk you need to supplement. You can freeze breastmilk for months, then thaw it in warm water – don’t microwave breastmilk to warm it.
The list of advantages from breastfeeding for your baby may include reduction in the risks of:
1. Infectious diseases such as ear infections, gastroenteritis, and pneumonia
2. Eczema and asthma
5. Sudden infant death syndrome
6. Overall infant mortality
Mothers who breastfeed their infants also receive health benefits, significantly reducing their own risk of developing:
1. Type 2 diabetes
2. High blood pressure
3. Ovarian cancer
4. Breast cancer
Questions? Give Us a Call
To learn more, call your pediatricians or lactation consultant at Carolina Kids Pediatrics in Raleigh, NC, at (919) 881-9009, or send us a message through the patient portal!
Should a mother continue to breastfeed if she has been exposed to influenza?
What if she has tested positive for the flu, or has other children that have it? Should she temporarily wean the baby to protect him?
These questions have been frequently asked by many mothers of breastfeeding newborns over the last few weeks. As the lactation consultant at Carolina Kids Pediatrics in Raleigh, NC, I have been asked these questions several times in the last few days alone.
Breastfeeding mothers SHOULD continue to breastfeed even if they have influenza, or have been exposed to it. Breastfeeding protects the newborn from infections, as antibodies from the mother’s body are passed to the newborn through the milk. The flu virus, as with any virus, has an incubation period. This is the time before the onset of symptoms. Since breastfeeding mothers and babies share the same environment, the mother and baby are likely exposed to the virus at the same time. During this incubation period, the mother’s body begins to produce these protective antibodies for the baby. Breastfeeding (and handwashing!) is the best protection for the newborn.
In the case where a mother is receiving anti-viral medications, such as Tamiflu, breastfeeding is still not contraindicated. The mother should continue to breastfeed as desired.
Please do not hesitate to contact your pediatrician in Raleigh, NC, to discuss any concerns you have about flu symptoms, or breastfeeding.
You may call Carolina Kids Pediatrics at (919) 881-9009 to schedule an appointment with me. I’ll be glad to help with any of your breastfeeding concerns.
Jerrianne Webb, RN, IBCLC
For more information: