Health-and-Nutrition/C2/Breastfeeding-during-COVID-19/English



Visual Cue	Narration
Slide Number 1 Title Slide	Welcome to the spoken tutorial on breastfeeding during COVID-19.
Image: COVID-19 = Infection caused by coronavirus Image: Collage of guidelines for breastfeeding during COVID-19	In this tutorial, we will learn: What is COVID-19? Guidelines for breastfeeding during COVID-19.
Image: COVID-19 = Infection caused by coronavirus	Let us first understand what is COVID-19?
Image: COVID-19 is an infectious disease caused by coronavirus Image: coronavirus present in the world	COVID-19 is an infectious disease caused by a virus called coronavirus. This virus has spread throughout the world.
Image: Infected person sneezes and generates droplets Image: Infected person coughs and generates droplets Image: Healthy person inhales the infected droplets	When infected people sneeze or cough, they generate droplets. These droplets contain the coronavirus. The infection spreads when other people inhale these infected droplets.
Image: Infected droplets travel for 1 to 2 m and settle on surfaces Image: Infected droplets remain alive on the door knob for hours or days Image: Healthy person touches the surface which has the infected droplets Image: Healthy person touches their eyes without washing hands and gets infected Image: Healthy person touches their nose without washing hands and gets infected Image: Healthy person touches their mouth without washing hands and gets infected	These droplets can also travel for 1 to 2 metres and settle on surfaces. There they remain alive for hours or days. Other people touch such infected surfaces with their hands. Then, they touch their eyes, nose or mouth without washing their hands. This is another way in which the infection spreads.
Image: Infected person is looking healthy but is spreading the virus on surfaces Image: The virus does not travel from the pregnant woman to the baby in her uterus Image: Breastmilk of infected mothers does not contain coronavirus Image: coronavirus is not transmitted to the baby through breastfeeding	Infected people can spread the virus even before the onset of symptoms. There is no clear evidence of intrauterine transmission of this virus to date. This virus has not yet been detected in the breastmilk of infected mothers. There is no evidence so far that it is transmitted through breastfeeding.
Image: Collage of symptoms of coronavirus Image: fever Image: Cough Image: Breathlessness Image: fatigue Image: Headache Image: Sore throat Image: Vomiting Image: Diarrhoea Image: Sneezing Image: Conjunctivitis Image: Infected person looks healthy and doesn’t show any symptoms.	The clinical symptoms of the coronavirus infection are various. Fever, cough, breathlessness, fatigue, headache, sore throat are common. Vomiting, diarrhoea, sneezing and conjunctivitis are uncommon. Infected people can also show no symptoms.
Image: Newborn baby and 6-month-old baby are not affected by the coronavirus Image: Very few young children have coronavirus infection Image: Infected babies have mild or no symptoms	Newborns and infants are at low risk of COVID-19. There are only a few cases of confirmed COVID-19 in young children. Most of the infected babies have experienced only mild or no symptoms.
Image: Collage of guidelines for breastfeeding during COVID-19 Image: Breastfeeding and hand expression of breastmilk Image: coronavirus infected mother’s baby Image: coronavirus infected baby Image: Collage of standard infant feeding guidelines	Now, let’s discuss the guidelines for breastfeeding during COVID-19. Breast milk is essential for all babies. This includes babies born to mothers with suspected or confirmed COVID-19. This also includes babies with suspected or confirmed COVID-19. All babies should be fed according to the standard infant feeding guidelines.
Image: Breastfeeding is starting within 1 hour after birth Image: Exclusive breastfeeding for 6 months Image: Mother’s expressed milk is fed to an infant Image: Complementary feeding is started at 6 months Image: Breastfeeding or hand expressed milk is given until 2 years of age. Image: Breastfeeding Image: Expressing milk Image: Complementary feeding	Breastfeeding should be initiated within 1 hour of birth. Exclusive breastfeeding should continue for 6 months. If needed, the mother’s expressed breast milk can be given. Complementary feeding must be started at 6 months of age. Breast milk must be fed at least up to 2 years of age. Breastfeeding, expressing milk and complementary feeding are essential skills. They are discussed in other tutorials. Please watch the prerequisite health and nutrition series on our website.
Image: Collage of hygiene guidelines for feeding the baby during COVID-19 Image: Mother washes hands before and after touching the baby. Image: Mother washes hands before and after breastfeeding Image: Mother washes hands before and after expressing milk Image: Alcohol-based hand rub	During COVID-19, special care must be taken to feed the baby hygienically. Mother should wash her hands for 20 seconds before and after touching the baby. She should also wash hands before and after breastfeeding or expressing milk. An alcohol-based hand rub can also be used to clean hands.
Image: Mother is a suspected or confirmed case of COVID-19 Image: Medical masks Image: Mother wears a medical mask during breastfeeding and expressing milk Image: Mask becomes damp while she is wearing it. Image: Mother wears a new medical mask Image: The damp mask is thrown in the dustbin Image: Wrong - Mother is washing and reusing the old damp mask Image: Wrong - Mother is touching the front part of the mask while wearing it Image: Right - Mother is removing the mask from behind without touching the front part.	If she is a suspected or confirmed case of COVID-19, medical masks are needed. She should wear a mask during breastfeeding and expressing milk. The mask must be replaced as soon as it becomes damp. The used mask should be disposed of immediately. It should not be re-used. Mother should not touch the front surface of the mask. She should remove it from behind.
Image: Medical mask is not available Image: Tissues Image: Clean cloth Image: Handkerchief Image: Mother sneezes and coughs into a tissue/ clean cloth/ handkerchief Image: Used tissue/ handkerchief/ cloth Image: Used tissue/ handkerchief/cloth is thrown in the dustbin Image: Mother washes hands after throwing the tissue Image: Mother changes the soiled tissue/ cloth/ handkerchief as often as needed Image: cloth masks Image: Mother wearing a cloth mask while breastfeeding	Sometimes, medical masks may not be available. In such cases, mother should use a tissue or a clean cloth or a handkerchief. She should always sneeze or cough into it. She must immediately throw it in the dustbin and wash her hands. A soiled tissue or cloth or handkerchief should be changed as often as needed. Cloth masks can also be used if medical masks are not available.
Image: Mother is washing her breasts before every feeding Image: Mother bends her head, coughs on her chest and then washes it Image: Mother uses soap and warm water to gently wash the breasts for 20 seconds	The mother need not wash her breasts before every feeding. She should wash them if she has been coughing on her chest. She should use soap and warm water to wash them gently for at least 20 seconds.
Image: Caretaker of the baby washes hands before and after touching the baby Image: Surfaces in the room are routinely cleaned and disinfected	Baby’s caretakers must wash their hands before and after touching the baby. All the surfaces in the room must be routinely cleaned and disinfected.
Image: infected mother is too unwell to breastfeed Image: Baby is fed mother’s expressed milk by another person Image: Nurse Image: Family member Image: Family member has not been in contact with infected people. Image: Family member washes hands and wears a mask before touching the baby	Some infected mothers may be too unwell to breastfeed. In such cases, the baby should be fed expressed breast milk of the mother. A nurse or family member can feed this milk to the baby. The feeder should not have been in contact with infected people. Before touching the baby or the milk they must wash their hands for 20 seconds. After washing their hands they must also wear a mask.
Image: Expressed breastmilk does not need pasteurization before feeding it to the baby Image: Expression of breastmilk Image: Breastmilk filled container is being transported from the mother to the baby carefully Image: Breastfeeding is started when the mother recovers	Expressed milk can be fed to the baby without pasteurization. The collection and transport of expressed milk should be done very carefully. Breastfeeding should be started again when the mother recovers.
Image: coronavirus infected mother is too unwell to express milk Image: Collage of alternative options Image: Human milk from a donor milk bank Image: Donor milk is fed to the baby	Some infected mothers may be too unwell to express milk. In such cases, try other options to nourish the baby. Check if human milk is available from a donor human milk bank. Feed donor human milk to the baby until the mother recovers.
Image: Donor human milk is not available. Image: Wet-nursing is done till the mother recovers Image: A woman, who isn’t the mother, feeds the baby. Image: wet-nurse is not available Image: Animal milk is given to the baby Image: Mother asks the healthcare provider for their opinion	If donor human milk is not available, try wet-nursing until the mother recovers. Wet-nursing means to let a woman, who isn’t the mother, breastfeed the baby. If wet-nursing is not possible, feed animal milk to the baby. Always boil the animal milk before feeding it to the baby. Please ask your healthcare provider for their opinion on these options.
Image: Formula milk Image: Feeding bottle Image: Plastic nipples Image: Rubber nipples Image: Silicone nipples Image: Health worker helps the mother in relactation	Don’t use formula milk, feeding bottles and plastic, rubber or silicone nipples. Help the mother to start breastfeeding again when she recovers.
Image: Skin-to-skin contact between the mother and the baby Image: STS is done immediately after birth even when the mother is infected with COVID-19 Image: Breastfeeding starts after birth Image: KMC is performed throughout day and night	Another important practice is skin-to-skin contact between the mother and baby. It must start immediately after birth even if the mother has COVID-19. This will help in initiating breastfeeding. Kangaroo mother care should be performed throughout the day and night.
Image: Breastfeeding Image: Skin-to-skin contact Image: The risk of death in babies is reduced Image: Collage of the benefits of breastfeeding and skin-to-skin contact. Image: Breastfeeding reduces the risk of breast and ovarian cancer for mothers. Image: More benefits as compared to the risk of infection.	Breastfeeding and skin-to-skin contact reduces the risk of death in babies. They provide immediate and lifelong health and development advantages. Breastfeeding also reduces the risk of breast and ovarian cancer for mothers. These benefits are substantially greater than the risk of getting infected.
Image: Mother and family members are counselled regarding the danger signs by a doctor Image: Mother looks for danger signs in the baby Image: Mother takes the baby to the doctor	Lastly, mother and family members must be counselled regarding the warning signs. They must be trained to look for the warning signs in the baby. If they see any signs, they should report back to the doctor.
Image: Collage of guidelines in the tutorial. Image: Evidence Image: Collage of guidelines in the tutorial	The guidelines in this tutorial are based on limited evidence as available now. As new evidence accumulates, some of the recommendations may change. Please use these guidelines in accordance with the latest government regulations.
Slide Number 2 Acknowledgement	This brings us to the end of this tutorial. Thank you for joining.

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