First six months exclusive breastfeeding prevents malnutrition in children

While the causes of malnutrition are complex, it is proven that exclusive breastfeeding till the age of six months is a key factor to prevent malnutrition and ensuring young children get a good start in life.

This emerged at the World BreastFeeding Press Briefing held on Monday, 18 July 2022 at the UNICEF Zimbabwe Offices in Harare.

Research has shown that nearly one child out of four Zimbabwean children is suffering from chronic undernutrition and does not grow and develop to its full potential. At the same time, overweight is increasing in Zimbabwe, which is also impacting seriously the health and well-being of children.

“While the causes of malnutrition are complex, it is proven exclusive breastfeeding till the age of six months is a key factor to prevent malnutrition and ensuring young children get a good start in life. Breastmilk is the only food that a baby needs for the first six months of its life. It ensures adequate physical growth and cognitive development of the child; helps prevent malnutrition; provides immunity and protects young children against infections and childhood illnesses; and is readily available, safe, and does not cost anything. It forms a unique biological and emotional basis for the health of both mother and child,” said Kudzai Mukudoka-Mudukuti of UNICEF Zimbabwe.

Addressing journalists, Zvanaka Sithole, the Family, and Reproductive Health Technical Officer and COVID-19 Infection Prevention and Control Focal point person with World Health Organization (WHO) Zimbabwe quoted The Lancet child survival Series, 2003 report and said it is possible to prevent 26% of deaths of children under 5 years of age by scaling up key nutrition interventions mainly during infancy and early childhood.

“Breastfeeding is the cornerstone of infant and young child survival, nutrition and development, and maternal health. The World Health Organization recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond.

“Early and uninterrupted skin to skin contact, rooming-in, and kangaroo mother care, also significantly improve neonatal survival and reduce morbidity and are recommended by WHO. However, concerns have been raised about whether mothers with COVID-19 can transmit the SARS-CoV-2 virus to their infant or young child through breastfeeding. Recommendations on mother-infant contact and breastfeeding must be based on a full consideration of not only the potential risks of COVID-19 infection of the infant but also the risks of morbidity and mortality associated with not breastfeeding, the inappropriate use of infant formula milk, as well as the protective effects of skin-to-skin contact,” Sithole said.

The health expert alluded to a number of benefits of breastfeeding. She said breastmilk is the ideal food for infants. It is safe, clean, and contains antibodies that help protect against many common childhood illnesses.

“Children who are not breastfed are at higher risk from infectious diseases as well as lifelong ill-health from some non-communicable diseases. Breastfed children perform better on intelligence tests, are less likely to be overweight or obese, and are less prone to diabetes later in life. Women who breastfeed also have a reduced risk of breast and ovarian cancers.”

Turning to newborn and infant risk of COVID-19, the health expert said they are at low risk of COVID-19 severe illness and death.

“Of the few young children with COVID-19, most have had a mild illness or a positive test with no symptoms (asymptomatic). The virus SARS-CoV-2 has not been detected in the breastmilk of mothers with confirmed or suspected COVID-19 and there is no evidence of virus transmission through breastmilk.

“If you are too unwell to breastfeed your baby due to COVID-19 or other complications, you should be supported to safely provide your baby with breast milk in a way possible, available, and acceptable to you,” Sithole added.

The Health expert attended to frequently asked questions and provided answers as shared below:

Can COVID-19 be passed through breastfeeding?

Transmission of active COVID-19 (the virus that can cause infection) through breast milk and breastfeeding has not been detected to date. There is no reason to avoid or stop breastfeeding.

In communities where COVID-19 is prevalent, should mothers Breast feed?

Yes. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also improves the health of mothers.

If I am confirmed or suspected to have COVID-19 and am too unwell to breastfeed my baby directly, what should I do?

• If you are too unwell to breastfeed your baby due to COVID-19 or other complications, you should be supported to safely provide your baby with breast milk in a way possible, available, and acceptable to you. This could include:
• Expressing milk;
• Donor human milk. – if available from a human milk bank

ØPrioritize limited supplies for preterm and low birth weight newborn

• If expressing breast milk or donor human milk are not feasible then consider
• Wet nursing (another woman breastfeeds the child) or
• Infant formula milk (as last resort) with measures to ensure that it is feasible, correctly prepared, safe, and sustainable.

Can women with confirmed or suspected COVID-19 breastfeed?

• Yes. Women with confirmed or suspected COVID-19 can breastfeed if they wish to do so. They should
• Perform hand hygiene: Wash hands frequently with soap and water or use alcohol-based hand rub and especially before touching the baby;
• Wear a medical mask during any contact with the baby, including while feeding;
• Sneeze or cough into a tissue. Then dispose of it immediately and wash hands again; (A breastfeeding mother should be helped to clean her chest with soap and water if she has been coughing and not unable to practice respiratory hygiene)
• Routinely clean and disinfect surfaces that mothers have touched.
• It is important to replace medical masks as soon as they become damp and dispose of them immediately. Masks should not be reused or touched in the front.
• NB: There should be no promotion of breastmilk substitutes, feeding bottles and teats, pacifiers or dummies in any part of facilities providing maternity or newborn services, or by any of the staff

If a mother with confirmed or suspected COVID-19 does not have a medical mask, should she still breastfeed with no mask?

• Yes. Breastfeeding unquestionably reduces mortality in newborns and infants and provides numerous lifelong health and brain development advantages to the child.
• Mothers with symptoms of COVID-19 are advised to wear a medical mask, but even if this is not possible, breastfeeding should be continued.
• Mothers should follow other infection prevention measures, such as washing hands, cleaning surfaces, sneezing, or coughing into a tissue.

What should happen if breastfeeding is interrupted? I had confirmed or suspected COVID-19 and was unable to breastfeed, When can I start to breastfeed again?

• You can start to breastfeed when you feel well enough to do so. There is no fixed time interval to wait after confirmed or suspected COVID-19.
• There is no evidence that breastfeeding changes the clinical course of COVID-19 in a mother.
• Health workers or breastfeeding counsellors should support you to relactate.

NB: When severe illness prevents a mother from breastfeeding or caring for her infant, she should be supported to express breastmilk and provide it safely, while applying appropriate measures to prevent infections

I have confirmed or suspected COVID-19, is it safer to give my baby infant formula milk?

• No. There are always risks associated with giving infant formula milk to newborns and infants in all settings. The risks associated with giving infant formula milk are increased whenever home and community conditions are compromised, such as reduced access to health services if a baby becomes unwell, reduced access to clean water and/or access to supplies of infant formula milk are difficult or not guaranteed, affordable and sustainable.
• The numerous benefits of breastfeeding substantially outweigh the potential risks of transmission and illness associated with the COVID-19 virus.

Can a breastfeeding woman get vaccinated against COVID-19?

• Yes. WHO recommends the use of COVID-19 vaccines in lactating women as in other adults. Therefore, healthy individuals currently breastfeeding or expressing milk CAN receive the vaccines
• Breastfeeding is vital to the health of infants and their mothers. Research on COVID-19 vaccines did not include breastfeeding women or consider the effects of mRNA or non-replicating vaccines on them or on the breastfed child. However, the absence of data does not mean that the vaccine is not safe for lactating women or their children. WHO recommends that mothers who are vaccinated continue breastfeeding after vaccination.