A COVID-19 diagnosis while caring for an infant raises serious questions about the safety of holding, feeding, and interacting with a newborn. Current public health bodies, including the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), have developed practical guidance to navigate this challenging period safely. This advice focuses on minimizing the risk of viral spread while prioritizing the well-being of both parent and child.
Understanding Transmission Risk and Benefits of Contact
The primary concern for an infected parent is transmitting the SARS-CoV-2 virus, which spreads mainly through respiratory droplets. Postnatal infection through close contact with an infected caregiver is the most common route of transmission in newborns, though transmission during pregnancy or birth is unlikely. Fortunately, most neonates who contract COVID-19 experience mild or no symptoms, but the risk of severe illness must still be managed.
Despite the transmission risk, maintaining close physical contact is highly recommended due to its benefits for the infant’s development and the parent’s mental health. Skin-to-skin contact promotes bonding, aids in regulating the infant’s body temperature, and helps establish a secure attachment. Major health organizations support “rooming-in,” where the infant remains with the parent, provided strict infection prevention protocols are followed. This approach recognizes that the developmental and emotional advantages of a continuous parent-infant relationship often outweigh the risk when appropriate precautions are taken.
Essential Safety Protocols During Direct Interaction
Any direct interaction with the infant while infectious requires adherence to safety protocols to prevent droplet transmission. The most effective step is wearing a high-quality, well-fitting mask, such as an N95 or KN95, at all times when within six feet of the baby. The mask must cover both the nose and mouth completely and should not be removed during close contact, including holding or feeding.
Rigorous hand hygiene is equally important, as the virus can be transferred from contaminated hands to the infant or surrounding surfaces. Hands must be washed with soap and water for at least 20 seconds immediately before touching the baby, expressing milk, and after any contact. If soap and water are not available, use a hand sanitizer containing at least 60% alcohol. Maintaining good ventilation and routinely cleaning high-touch surfaces also helps reduce environmental contamination.
Feeding Guidelines for Mothers with COVID-19
Breast milk is encouraged, even for mothers diagnosed with COVID-19, because the virus itself has generally not been found to transmit through the milk. Breast milk contains antibodies and immunological factors that help protect the infant from infections, including potential SARS-CoV-2 antibodies produced by the mother.
If the mother chooses to breastfeed directly, she must wear a mask and practice hand hygiene immediately before and during each feeding session. If the mother is too unwell or needs to minimize direct contact, she should express her milk. A healthy caregiver should then feed the expressed milk to the infant using a clean bottle or cup. All breast pump parts must be thoroughly cleaned and sanitized after every use to prevent indirect transmission.
Criteria for Ending Isolation and Resuming Normal Contact
The intensive safety measures can be discontinued once the parent meets the criteria for ending isolation. For individuals who experienced symptoms, isolation can end a minimum of five days after symptoms first appeared, provided two conditions are met. These conditions are being fever-free for 24 hours without medication, and that other COVID-19 symptoms are improving overall.
After the initial isolation period ends, typically on day six, a high-quality mask should continue to be worn around the infant and others through day ten. If the parent never developed symptoms, isolation can end after five days from the date of the first positive test, with continued masking through day ten. Once the parent is past the ten-day period, precautions like constant masking and physical distancing can be stopped, allowing for a return to normal, unrestricted contact with the infant.