Pan American Health Organization · 2020
Guidance for health workers on supporting breastfeeding mothers and feeding infants during the COVID-19 pandemic.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- Health workers caring for babies and mothers, including community health workers and breastfeeding support group members
- Evidence
- Based on WHO standard infant feeding guidelines and infection prevention principles
- Reviewed
- 19 Oct 2026 · GMJ
What this guideline says
GMJ summary
This guidance provides evidence-based recommendations for health workers caring for mothers and infants during the COVID-19 pandemic. It affirms that breastfeeding should continue according to standard guidelines even when mothers have suspected, probable or confirmed COVID-19 infection, as the benefits of breastfeeding outweigh potential risks of transmission.
The document emphasises that mothers with COVID-19 symptoms should practice respiratory hygiene (wearing a medical mask when near the baby), hand hygiene (washing hands before and after contact), and environmental cleaning, whilst continuing breastfeeding, skin-to-skin contact and rooming-in. When mothers are severely ill and unable to breastfeed, expression of breastmilk should be supported with appropriate infection prevention and control measures.
The guidance reinforces WHO standard infant feeding recommendations: initiation of breastfeeding within one hour of birth, exclusive breastfeeding until six months, and continued breastfeeding with appropriate complementary foods until two years or beyond. It prohibits promotion of breastmilk substitutes in maternity and newborn care facilities, in accordance with the International Code of Marketing of Breastmilk Substitutes.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Breastfeeding should be initiated within one hour of birth for all infants, including those born to mothers with suspected, probable or confirmed COVID-19
- Babies should be exclusively breastfed until six months old, with continued breastfeeding along with complementary foods until two years or beyond
- Mothers with COVID-19 symptoms should wear a medical mask when near the baby, practice hand hygiene before and after contact, and clean/disinfect surfaces
- Mothers and infants should remain together and practice skin-to-skin contact and rooming-in regardless of COVID-19 status
- When mothers are severely ill and unable to breastfeed, support expression of breastmilk with appropriate infection prevention and control measures
- Provide breastfeeding counselling, basic psychosocial support and practical feeding support to all pregnant women and mothers, whether they or their infants have suspected or confirmed COVID-19
- No promotion of breastmilk substitutes, feeding bottles, teats or pacifiers should occur in maternity or newborn care facilities or by health workers
From the guideline
Verbatim
“Infants born to mothers with suspected, probable or confirmed COVID-19 infection should be fed according to standard infant feeding guidelines, while applying necessary precautions for infection prevention and control.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively on maternal and child health programmes in Georgia, I recognise the critical importance of this guidance during the COVID-19 pandemic. The protective effect of breastfeeding against respiratory infections is well-established, and the document correctly prioritises continuation of breastfeeding even when mothers have COVID-19, provided simple infection prevention measures are implemented. For Georgian clinicians, I would emphasise the recommendation against separating mothers and infants, as unnecessary separation undermines both breastfeeding initiation and maternal-infant bonding. The main implementation challenge will be ensuring consistent availability of medical masks and hand hygiene supplies in all maternity facilities, particularly in rural areas, whilst simultaneously training staff to provide supportive rather than restrictive guidance to mothers concerned about transmitting infection to their newborns.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 19 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance is directly applicable to maternity facilities and primary care settings managing mothers and infants during COVID-19. National programmes should ensure that infection prevention and control supplies (medical masks, hand hygiene facilities) are available in all maternity and newborn care facilities, whilst simultaneously maintaining breastfeeding support services. Implementation requires training health workers and community health workers to deliver consistent messaging that balances infection control with protection of breastfeeding, avoiding unnecessary fear-driven separation of mothers and infants or inappropriate promotion of breastmilk substitutes during the pandemic.
Questions this guideline answers
Quick answers
Should mothers with COVID-19 breastfeed their babies?
Yes. Mothers with suspected, probable or confirmed COVID-19 should be supported to breastfeed according to standard infant feeding guidelines whilst applying infection prevention measures including wearing a medical mask when near the baby and practicing hand hygiene before and after contact.
When should breastfeeding be initiated for infants born to mothers with COVID-19?
Breastfeeding should be initiated within one hour of birth. If this is not possible (for example, due to caesarean section or medical instability), mothers should be supported to start breastfeeding as soon as they are able.
Should mothers and babies be separated if the mother has COVID-19?
No. Mothers and infants should be supported to remain together and practice skin-to-skin contact, kangaroo care and rooming-in whether or not they have suspected, probable or confirmed COVID-19 infection, whilst applying appropriate infection prevention measures.
What if a mother with COVID-19 is too severely ill to breastfeed?
When a mother is severely ill and unable to care for or breastfeed her infant, she should be encouraged and supported in expression of breastmilk if possible, and in feeding of her infant whilst applying appropriate infection prevention and control measures. Other options include donor breastmilk or breastmilk substitutes, and relactation should be supported when the mother is well enough.
Related on GMJ
Interconnected resources
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GMJ News coverage
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- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Scope
- Guidance for health workers on infant feeding practices when mothers have suspected, probable or confirmed COVID-19
- Audience
- Health workers caring for babies and mothers, including community health workers and breastfeeding support group members
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Based on WHO standard infant feeding guidelines and infection prevention principles
- Record history
- Created 19 Oct 2026 · updated 19 Oct 2026 · next check Apr 2027
Pan American Health Organization. Breastfeeding and COVID-19. Washington, D.C.: PAHO; 2020. (PAHO/NMH/RF/COVID-19/20-0018). Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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