Monkeypox continues to spread throughout the world, and although it has not yet been declared a pandemic, the numbers are beginning to be worrying : in Spain we have exceeded 3,000 cases and we are the country that has registered the most infections in the world (which adds 15,379 cases as of July 20 according to the Center for Disease Control and Prevention CDC).
Given this scenario, we must bear in mind that it is a disease that, according to the WHO, can be serious in children and pregnant women, so it is important to inform ourselves about its pathology and management.
One of the questions that is beginning to arise is what happens when we feed our babies through breastfeeding : will we infect the baby? Can we provide antibodies through milk? should we interrupt it?
Is it safe for a mother infected with monkeypox to breastfeed her baby?
We have turned to the main authorities on the matter to find out their recommendations, and although we have not found a consensus, they maintain that in order to make a decision it is essential to confirm if only the mother is infected. Additionally , they all mention that it is essential to take into account the consequences that separating a baby from its mother can have , and not only in areas where breastfeeding is the only source of food for the little ones.
According to the WHO, infant feeding practices should be evaluated, including the possibility that a mother infected with monkeypox should stop breastfeeding her baby, because although it is not known whether milk transmits the virus, there is a high risk of contagion by having close contact with the skin during breastfeeding.
They emphasize that it is essential to evaluate case by case, considering the general physical condition of the mother and the severity of the disease. If you have been exposed to the virus but show no signs of infection, you should not be separated from your baby. And adds:
Infected mothers should take general protective measures when handling and feeding their infants, for example, wash hands before and after each feeding, wear a mask (if possible), and cover any lesions on the areola or areas that have direct contact with the baby.
Alternatively, if only one breast has lesions, mothers can express milk from the breast with lesions on the areola and discard the milk and feed from the unaffected breast. In all cases, close monitoring of the partner, mother, and baby is necessary for the development of signs and symptoms.
If the mother of an infant or young child has been exposed to the virus and has no symptoms suggestive of infection, the infant or child should not be separated and should continue to breastfeed while monitored for signs and symptoms.
According to a publication by the Royal College of Obstetricians and Gynecologists RCOG on the management of the disease during pregnancy and later, it agrees with the WHO regarding the precautions that should be taken when the mother has been infected.
He further stresses that the risk of infection must be weighed against the potential harm and distress caused by the interruption of breastfeeding and close contact between parents and children:
If it is possible for you to continue to breastfeed and have close contact, it is advisable to reduce the risk by taking measures such as covering injuries and wearing a mask to reduce the risk of transmitting the virus. The risk of infection will need to be carefully balanced against the potential harm and distress caused by interrupted breastfeeding and close contact between parent and child. It is not yet known whether the monkeypox virus can be passed from parent to child through breast milk; this is an area that needs further study.
From the CDC Center for Disease Control and Prevention they emphasize that the transmission of the virus occurs by close contact and in the ignorance of the possibilities of transmitting the disease through breast milk, for which they recommend separating the infant from his mother until it is completely healthy (contrary to what was said at the time with Covid-19).
Breast milk is the best source of nutrition for most newborns and provides protection against many diseases. However, because monkeypox virus is transmitted by close contact and neonatal infection can be severe, nursing should be delayed until the criteria for discontinuation of isolation are met (i.e., all lesions have resolved). , the scabs have fallen off and a new layer of intact skin has formed).
Some nursing mothers may need the additional support of a breast pump to start and maintain their milk supply and prevent a breast infection while monkeypox lesions heal. It is unknown if the virus is present in breast milk. Expressed breast milk from a symptomatic or isolated patient should be discarded while lactation is delayed. To avoid inadvertently exposing a baby to the monkeypox virus, a healthy caregiver can feed the baby pasteurized donor human milk or infant formula. People who are breastfeeding should talk to their doctor to determine if their lesions have healed and can resume direct breastfeeding or express-feeding breast milk.
From e-lactancia.org, specialized in analyzing the risks for breastfeeding of more than 28 thousand terms, they indicate that the risk is high for breastfeeding, so it is essential to take into account that if the mother is infected and the baby no, you have to isolate the baby and not breastfeed .
Although the Spanish Association of Pediatrics has published a document on monkeypox, it has not yet ruled on the recommendations to take into account in the case of a nursing mother who has been exposed to the virus or is already infected.
What precautionary measures must be taken?
Mothers who are infected, suspect they might be, or have symptoms, but are well enough to breastfeed their baby and decide to continue doing so, should, according to guidelines agreed upon by authorities:
- Wear a mask when breastfeeding the baby (or whenever you are near the baby).
- Cover the injuries so that they do not come into direct contact with the baby. In case of having them in any of the nipples, it is recommended to express the milk to avoid mastitis and discard it.
- Wash your hands before and after nursing the baby (or having contact with the baby).
- Avoid contact with clothing, bedding, towels, kitchen utensils, etc., of people who are sick.
Of course, this is in addition to taking the recommended prevention measures for the entire population, such as immediately isolating yourself if you test positive for the disease, wearing a mask indoors, washing your hands frequently and disinfecting surfaces.
