The entire team at Baby-Friendly USA sends our deepest gratitude to all healthcare providers, staff and first responders for the heroic work you are doing to provide incredible care to your patients. To say you are working under extraordinarily difficult circumstances is a gross understatement. Our respect for each and every one of you has never been higher. While we must remain physically separated from one another, you are in our constant thoughts and sealed in our hearts. Thank you for all you are doing.

A Good Time to Remember: Breast Milk is Remarkable!

Many families are grappling with how to keep their newborn infants healthy and safe in this COVID-19 environment. It can be very empowering for them to fully understand the powerful immunological properties of breastfeeding and how it works to protect infants. As they are also likely very overwhelmed, we encourage calm and gentle conversations with families about the importance of exclusive breast and/or breast milk feeding.

Helping families achieve breastfeeding success is still one of your most critical roles, which is why the practices embodied in the Ten Steps remain important even during this public health emergency. If a mother is not symptomatic (PUI) for coronavirus, we strongly encourage you to keep these practices in place. Most especially:

  • Immediate and uninterrupted skin-to-skin contact which promotes the early initiation of breastfeeding. Talk with your patients about the importance of colostrum with its protective antibodies.
  • Rooming-in which allows a mother to practice responsive feeding and assists in the establishment of breastfeeding. Note: Rooming-in can also limit exposures from staff and other patients.
  • Assessment and individualized care to mothers that are breastfeeding.
  • Supplement with formula when medically necessary. If formula supplementation is necessary, the goal should be to return to exclusive breastfeeding, whenever possible.

For those mothers that may be temporarily separated from their infants, it is important for them to understand the value of expressing their breast milk and that this milk will be fed to their babies by a healthy caregiver (Centers for Disease Control and Prevention, 2020).

Programmatic Adjustments

We have been asked about potential adjustments to the BFHI programmatic requirements. We are now rescheduling all on-site assessments originally scheduled through the end of May. We understand your current priorities and, yes, of course we are extending due dates related to all other aspects of our program; 4-D Pathway, Annual Quality Improvement (AQI) and Re-Designations. Since the full national impacts of COVID-19 are still unknown, we will continue to monitor the situation and offer firm plans later. Please be assured that we will diligently set reasonable strategies and timelines for how we can all get back on track once this global health crisis is over.

Infant Formula Use and Distribution at Hospitals

Many of you have written to us for guidance on supporting formula feeding mothers during this time. To be clear, every mother and baby is special. We believe it is imperative that, in emergencies, services be coordinated for infants who are not breastfed to ensure that their nutritional needs are also met.

We are aware of several factors impacting the supply of infant formula in some areas of the country, including formula shortages in stores and limited WIC services.

Given the overwhelming healthcare responsibilities hospitals are facing, it is not reasonable to also take on the role of an emergency food provider. However, some assistance to families may be warranted. During this time, we will suspend the outright prohibition of giving a small amount of formula to formula feeding families at discharge. When necessary, Baby-Friendly designated hospitals and those working toward designation should follow the guidance of the Interagency Working Group on Infant and Young Child Feeding in Emergencies (2017):

  • 5.17 Determine infant formula need through individual-level assessment by a qualified health or nutrition worker trained in breastfeeding and infant feeding issues. Provide individual-level education, one-to-one demonstrations and practical training on safe preparation to the caregiver. Ensure follow-up (at least twice a month) and trace defaulters.
  • Definition of individual-level assessment: A process to evaluate a caregiver-baby pair, establish infant feeding practice and needs, and decide what type of support may be necessary. There are two levels of assessment: simple rapid assessment and full assessment.

We close by reminding facilities of the other key aspects of our program that are helpful to families post discharge:

  • Guideline 10.1 states, “prior to discharge, a responsible staff member explores with each mother and a family member or support person (when available) the plans for infant feeding after discharge.”
  • Criterion 10.1.1: Mothers are given information on where they can find support if they need help with feeding their infants after returning home.
  • Criterion 10.1.2: Facility coordinates with community services that provide infant feeding support to mothers.
  • Criterion 11.1.7: There should be no promotion of infant formula at the point of distribution, including displays of products.
These are as important now as ever before.

Please stay healthy and safe — and thank you for your important work!