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IYCF-E and Covid 19: questions from the field

This question was posted the COVID-19 and nutrition programming forum area and has 4 replies.

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Alex

Global IYCF-E Adviser

Normal user

23 Mar 2020, 18:30

Dear all,

in support to the initial exercise supported by Mija, Save the Children is engaging country offices to  understand what are the questions and concerns around IYCF-E and Covid 19.

The countries that responded for now (the questions are open and will be open for COs to keep asking) are the following:

Bangladesh, Bolivia, Ethiopia, Indonesia, Mauritania, oPt, Somalia, South Sudan, Spain, Uganda, USA, Zimbabwe, UK, Global

A total of 37 respondents of which 34 working on health and nutrition programmes, 3 working in other sectors

The questions asked are across BF/NBF, CF and other nutrition priorities

We will continue this as we expect more countries to respond. 

The questions are:

Breastfeeding Questions

1. Can women affected by Covid 19 still breastfeed?

2. Can an infected Mother get in contact with her uninfected child if she wants to breastfeed the baby?

3. Is breastfeeding safe after coronavirus infection? 

4. Can mothers breastfeed their babies if they test positive for COVID19? If yes, what is the recommendation? Position? Attachment? How to protect the baby?

5. What are the processes to support a Covid-19 confirmed mother breastfeeding? 

6. Can the mother still breastfeed if infected by Covid 19? If yes, how?

7. What measures do we need to consider for a breastfeeding/infant formula feeding mother that has symptoms?

8. What is the relationship between breastfeeding and covid 19?

9. What are the recommendations for breastfeeding mothers concerning the "no contact" reccomendation during this Covid19 outbreak period?

10. How can group counselling sessions on breastfeeding be conducted given the fact that group setups are abolished?

11. As we know, in this situation we need to improve the optimal breastfeeding and reach each mother in order to encourage mothers to prevent overcrowding and also to counsel if they are feeling signs and symptoms of COVID 19, so we need to know how to do this.

12. We would like to know if the virus may be passed through breast milk?

13. We work reaching groups of mothers to promote breastfeeding. How can we do that with the no gathering/no contact/no grouping policies?

14. During this virus outbreak if an affected mother has a child under 6 months what is the solution?

16. BF programming for covid-19 response: what are the suggested actions

17. We need guidance on the risk of transmitting covid-19 while breastfeeding (not just through the breastmilk but during the action)

18. Can the mother with COVID-19 continue breastfeeding

19. Please confirm. Has there been any evidence that breastfeeding puts the woman at higher risk of Covid 19, or other complications?

20. What community approach (without gathering) should I take to continue services in MBA or IYCF-E corners as the mothers may need these services more than ever in the face of panic/fear of infection?

Complementary Feeding:

1. How is the food preparation done for a child in a Covid 19 outbreak?

2. How can we prevent Coronavirus when the mother is feeding the child? Cuddling? Spoon feeding/hand feeding (using her hands)?

3. What are the appropriate food groups that are required for infected children? what food should be avoided? 

4. Any different recommendation for complementary feeding as in COVID19 oubreak in high malnutrition setups?

5. Which is the best complementary food during Covid 19 outbreak?

6. Are there any type of foods that we could promore for infants and young children during Covid 19?

7. How do we ensure breastfeeding is safe for both the mother and child to avoid the spread of the virus?

8. How to distribute complementary feeding when mass gatherings are forbidden?

9. if the child is 8 or 9 months or 9 to 12 months  and affected by the virus Covid 19, tell me the best food for that child

10. what is the CF programming for covid-19 response?

11. Are there certain foods that should be encouraged or avoided?

12. Most adults share plates and spoons with their children 6-23 months for complementary feeding. If the caretaker has Covid19, should s/he stop to take care of the child, or is the risk negligable (low incidence of severe Covid in small children)?

Mustafa

Nutrition specialist

Normal user

24 Mar 2020, 09:47

Dear; all

Guidance for breastfeeding women with confirmed or suspected COVID-19
It is not known whether mothers with COVID-19 can transmit the virus via breast milk.
In limited studies reported to date, on women with COVID-19 and another coronavirus infection,
Severe Acute Respiratory Syndrome (SARS-CoV), the virus has not been detected in breast milk,
However, antibodies against SARS-CoV were detected in at least one sample.

• All mothers in affected and at-risk areas who have symptoms of fever, cough or difficulty
breathing, should seek medical care early.
• Whether and how a mother, with confirmed or suspected COVID-19, should start or continue
providing breastmilk should be determined by the mother in coordination with her family and
healthcare providers in line with the national Ministry of Health guidance. The consultation
should consider the latest evidence on COVID-19 transmission and the risks associated with
use of a breastmilk substitute within the context.
• All confirmed (and suspected) COVID-19 mothers should take all possible precautions to avoid
spreading the virus to her child, including washing her hands before and after touching the
infant and wearing a protective face mask, if possible, while feeding at the breast -as well as
and regularly cleaning/disinfecting surfaces.
• If the mother is expressing breast milk with a manual or electric breast pump, she should
wash her hands before touching any pump or bottle parts and ensure proper pump cleaning
after each use. The expressed breastmilk should be fed to the child using a clean cup and/or
spoon, preferably by a person who has no signs or symptoms of illness.
Sources of information

Centres for Disease Control: https://www.cdc.gov/coronavirus/2019-ncov/specific-
groups/pregnancy-guidance-breastfeeding.html

World Health Organization: https://www.who.int/health-topics/coronavirus
Further information:
Understanding COVID-19 training course: https://openwho.org/courses/introduction-to-ncov

Alex

Global IYCF-E Adviser

Normal user

25 Mar 2020, 18:28

Dear All,

in the collective effort to contribute to the on going discussion around Nutrition and Covid 19, its effects and implications, Save the Children has engaged country and regional offices as well as members to gather their concerns, questions, and ideas on IYCF-E implications of the on going Covid 19 pandemic, I am sending a second update on the questions we received

As of March 24, we received questions and considerations from 17 offices, for a total of 43 respondents across the world. 

The countries that responded for now (the questions are open and will be open for Cos to keep asking) are the following:

Bangladesh, Bolivia,, Colombia, Ethiopia, Indonesia, Mauritania, Norway, oPt, Somalia, South Sudan, Spain, Rwanda,Uganda, USA, Zimbabwe, UK, Global

A total of 45 respondents of which 41 working on health and nutrition programmes, 4 working in other sectors

The questions I asked are across BF/NBF, CF and other nutrition priorities

after an initual consolidation we have grouped the questions into 

1 Breastfeeding

2. Complementary Feeding

BREASTFEEDING

EVIDENCE:

1. Can women affected by Covid 19 still breastfeed

2. Can an infected Mother get in contact with her uninfected child if she wants to breastfeed the baby?

3. Is breastfeeding safe after corona infection 

4. Do the mother can breastfeed their baby if they are positive COVID19? If yes, what is the recommendation? Position? Attachment? How to protect the baby?

5. We would like to know if the virus may be passed through breast milk?

6. I would assume that a woman who is breastfeeding should continue to do so, even if she has confirmed Covid19 infection. Please confirm. Has there been any evidence that breastfeeding puts the woman and or the baby  at higher risk of Covid 19, or other complications?

7. What measures do we need to consider for a breastfeeding/infant formula feeding mother that has symptoms

8. What is relationship between breastfeeding and covid 19 ?

9 what are the recommendations on breastfeeding mothers concerning the "no contact" recommendations during this Covid19 outbreak period

10. What precaution should we take for immediate breast feeding for a new-born whose mother is COVID19 positive?

PROGRAMMING

10. How can group counselling sessions on breastfeeding be conducted given the fact that group setups are abolished?

11. We know in this situation we need to improve the optimal breast feeding practices and try to reach all women in order to encourage them to a) prevent infection and at the same time b)  provide IYCF and breastfeeding counselling

12. We work reaching group of mothers to promote breastfeeding. How can we do that with the no gathering/no contact/no grouping policies?

13. how about if this virus outbreak and mother affected if the child its under 6 months what is the solution, if the mother is ill? What are the recommendations in this case? Can we promote wet nursing? Or shall we give Infant formula

16. What community approaches (without gathering) continue? How can I continue the  services in the MBA or IYCF-E corners as the mothers may need these services more than ever in the face of panic/fear of infection?

17. What is the recommendation for individual counselling during the covid-19 pandemic for example the distance between the mother and counsellor, what are the prevention actions that should be taken during counselling for both the mother and counsellor?

18. If young children < 24 months (breasted and non-breasted) are covid 19 positive, what are the recommendations on use of additional fluids such as ORS?

19. Can we use phone counselling and how effective?

COMPLEMENTARY FEEDING

1. What are the recommendations for food preparation for a child in a Covid 19 outbreak

2.how can we prevent Corona when the mother is feeding the child? Cuddling? Spoon feeding/hand feeding (using her hands)

3. what are the appropriate food groups that are required for infected children? what food should be avoided? 

4.Any different recommendation for complementary feeding as in COVID19 outbreak in high malnutrition setups?

5. Are there any type of foods that we could promote for infants and young children during Covid 19

6. How distribute complementary feeding when mass gathering is forbidden?

7. What is the CF programming for covid-19 response

8. In our context, most adults share plates and spoons with their children 6-23 months for complementary feeding. If the caretaker has Covid19, should s/he stop to take care of the child, or is the risk negligible (low incidence of severe Covid in small children)?

9. Is there any risk of infection through the meal preparation?

as discussed, we will keep updating teh collective and feeding into the larger conversation. 

Best 

Alex

Lindsey Pexton

Senior Nutrition Adviser, Mercy Corps

Normal user

25 Mar 2020, 19:19

Hi Alex,

Thanks so much to everyone working on this! It's a great, comprehensive list of practical questions that will be of huge help to our field teams. I don't want to be rude and I know that everyone is working flat out in these strange times, but I'm just wondering what the timeline is for answers? I know there is some initial guidance out there already but this Q&A would definitely add value.

Take care and thanks again, 

Lindsey 

Alex

Global IYCF-E Adviser

Normal user

26 Mar 2020, 07:01

Dear Lindsey

thanks a lot for your question, Really important

Now, some of the questions can be answered by the current WHO Guidance

see link https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected

also, GNC and GTAM with the support of UNICEF informed us that this friday a 2 pager briefs will be released for IYCF-E and Nutrition programming, and will be regularly updated (every ten days)..very important and we need to appreciate the commitment and the effort

from our side, we are preparing the initial answwers to these questions...based on the above and also bsed on our programmatic guidance, and will share to all, as it is important at this tiem to join forces and resources to help out country offices be prepared and continue ensure nutrition services are provided to the best possible quality 

thanks 

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