By Dr Rosemary Marsh, GP Specialist Trainee, MRCPCH
On 11th March 2020, the WHO classified the outbreak of Coronavirus disease (COVID-19) as a pandemic. Information on COVID-19 is rapidly changing as research and understanding progresses. There is broad support for commencing or continuing breastfeeding in cases of COVID-19 in the mother or infant/child (correct at review 2/1/2021). Clinicians should check relevant Public Health England (PHE), Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Paediatrics and Child Health (RCPCH) guidance as there is potential for advice to change over time. Current PHE guidance regarding “staying at home” when you have COVID-19 symptoms includes a paragraph on breastfeeding.
During this period of social distancing, it is likely to be more difficult than usual for mothers to access face to face breastfeeding support. Some breastfeeding charities have increased their provision of online, telephone and virtual support to cover this gap. GPs can signpost families to these resources and explain that remote support may be available.
GPIFN Letter to GPs: In June 2020, GPIFN wrote to GPs with a links to organisations and resources available during the COVID-19 pandemic.
Postnatal and Newborn and Infant Physical Examination
The Royal College of General Practitioners (RCGP) has advised ongoing provision of post-natal checks and childhood immunisations at 8 weeks (see RCGP Guidance on workload prioritisation during COVID-19 linked from this page) which means GPs will still have an opportunity to meet new mothers and infants and discuss any feeding concerns. NHS England have recommended that provision of Newborn and Infant Physical Examination (NIPE) in line with national guidance should continue (from Newborn and infant physical examination screening programmes technical guidance during the coronavirus COVID-19) pandemic). RCPCH have issued guidance that performing visualisation of the soft palate is not an aerosol generating procedure (see section ‘AGPs in Neonates’).
Postnatal Maternal and Infant Care during the COVID-19 Pandemic – A guide for General Practice (Version 3 November 2020) is available from the RCGP COVID-19 Resource Hub, in the ‘Specific patient groups and settings’ section (under both the ‘Pregnancy and sexual health’ and ‘Paediatrics and child health’ tabs).
Start4Life: Coronavirus (COVID19)- Advice for parents NHS/PHE information for parents on infant care and feeding.
RCOG: Coronavirus Infection and Pregnancy Information for pregnant women and their families regarding the impact of COVID-19 on maternity care. This includes a Q&A section on postnatal care, including infant feeding.
Unicef UK Baby Friendly Initiative: Coronavirus (COVID-19) – Resources and Guidance to Support You Information regarding breastfeeding, maximising breastmilk and supporting relactation, expressing breastmilk and formula feeding aimed at the UK population.
GPIFN: Prescribing Information Information on prescribing in lactation and contact details for specific case advice.
Breastfeeding women and breastfed babies require Vitamin D supplementation.
Compiled by Dr Louise Santhanam, GP
On 30th December 2020 the UK Medicines & Healthcare products Regulatory Agency (MHRA) announced that both the Pfizer-BioNtech and Astra Zeneca COVID-19 vaccinations can be used during pregnancy and lactation, after considering the individual risks and benefits involved and with more caveats associated with use in pregnancy than in lactation.
The Green Book now states: ‘There is no known risk associated with giving non-live vaccines whilst breastfeeding. JCVI advises that breastfeeding women may be offered vaccination with the Pfizer-BioNTech or AstraZeneca COVID-19 vaccines.
The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for immunisation against COVID-19, and the woman should be informed about the absence of safety data for the vaccine in breastfeeding women.’
This Factsheet on the COVID-19 vaccinations was developed with The Hospital Infant Feeding Network (HIFN) and details vaccine delivery issues relating to breastfeeding and pregnancy (updated 21st January 2021). You can download the factsheet as a pdf here.
Vaccine Safety Research: GPIFN, HIFN and Breastfeeding For Doctors called for access to the COVID-19 vaccine for those breastfeeding and further breastmilk research to clarify vaccine safety- writing to the MHRA, JCVI, PHE and Vaccine developers in December 2020.
DHE/PHE Green Book Chapter 14a: COVID-19 – SARS-CoV-2 (Updated 31.12.2020) See pages 12-13 for information on breastfeeding.
NHS Health Education England e-Learning for Healthcare: Covid-19 Vaccination Includes up to date e-learning for healthcare professionals regarding COVID-19 vaccinations available in the UK.