SingaporeMotherhood | Baby & Toddler

March 2020

COVID-19: On Transmission in Kids, Pregnancy and Breastfeeding

Cases of COVID-19 continue to rise around the world. In Singapore, we’ve seen a spike in the number of cases over the last few days as well. And Case 160 is only five years old! Unsurprisingly, parents, as well as expectant mums, are extra concerned. After all, we’re responsible for the well-being of more than just ourselves. Dr Mohana D/O Rajakulendran, a paediatrician at Parkway East Hospital, answers a few more questions.

(See also: COVID-19: On Masks for Kids, Hand Sanitisers, School Holidays, and More)

1. We hear that kids are not as susceptible to COVID-19 virus as adults are. Does this mean that we don’t have to worry too much about our children getting it?

Babies and children diagnosed with COVID-19 so far are manifesting mild symptoms, and recover quickly and without complications. This is indeed reassuring. However, it is still important to continue encouraging our children to exercise good hygiene measures, and to take sensible precautions such as avoiding crowded areas where possible.

A look at the SARS and MERS coronavirus epidemics shows us that it is possible, though rare, for children to develop severe respiratory disease. Seek medical attention early if your child develops symptoms such as rapid breathing, lethargy, drowsiness or poor feeding.

preschool kids

2. The five-year-old who was confirmed to have COVID-19 attends the same school as my kids. Should I keep them at home even after it reopens?

The Orange Tree Preschool (Choa Chu Kang branch) will be closed temporarily till 20 March. Apart from the school being thoroughly disinfected during these 10 days, MOH would also do the appropriate contact tracing. This means they will notify you if there is a necessity to keep your child at home.

However, from a parent’s point of view, it is reasonable to keep your child home if they are in the same classroom environment as a child associated with an infection cluster. Since children could have very minimal or mild symptoms, even when infected with COVID-19, keeping your child home will allow you to monitor them more closely. I would stay vigilant for symptoms such as fever, cough, nasal congestion, runny nose, abdominal pain, nausea, vomiting and diarrhoea. Seek medical attention accordingly.

(See also: 6 Most Common Reasons Why Children in Singapore End up in the A&E)

3. The virus is said to spread through droplets when an infected person sneezes or coughs. Should I tell my child to avoid anyone who sneezes or coughs?

As much as this epidemic has taught us lessons on keeping ourselves and our children safe, it is also a great exercise in inculcating good habits and for us to strive together to be a cultured and gracious society. It’s difficult to avoid every single person who coughs and sneezes.

Instead, teach your child what is right. To cover their nose and mouth with a tissue or to cough or sneeze into their elbow. To wash their hands with soap and water thoroughly, and to avoid touching their face. They could then help gently reinforce these habits with their friends (or even adults) who are coughing or sneezing.

Extend your thoughtfulness to others, and help share a mask with others who are coughing and sneezing around your child. It will help protect your child and also help subtly educate people who are unwell, COVID-19 or otherwise.

normal flu or covid-19

4. Kids often come home from school/childcare with the common cold/flu. If my child has the sniffles or a slight cough, should I take her to the doctor immediately, just in case it’s COVID-19?

The symptoms of the COVID-19 virus in children are similar to that of many common childhood viral illnesses. MOH has advised those with mild symptoms to remain home for five days to prevent the potential spread of any viruses, including COVID-19. Routine testing for mild symptoms is not being performed unless there is a contact history with a case of COVID-19 or a recent travel history to a high-risk country.

Take your child to a doctor for assessment if they have symptoms of rapid breathing, poor feeding, drowsiness or lethargy, or if they are still unwell beyond five days.

(See also: How to Locate the Nearest Children’s Clinics in Singapore Open on Sundays, Public Holidays and 24 Hours)

5. I am pregnant. What extra precautions should I take?

Immunological changes during pregnancy may make pregnant women more susceptible to viral illnesses in general. If you are pregnant, avoid contact with persons who are unwell. Avoid spending long periods of time in crowded venues and practise frequent hand washing. Do consider postponing all non-essential travel where possible.

pregnant in the time of covid-19

6. Can a pregnant woman pass COVID-19 to her unborn child?

There is currently limited data of the effects of COVID-19 in pregnancy. In reports of a series of 18 women infected with COVID-19 during the third trimester, all babies tested negative for COVID-19. So far, breast milk samples and amniotic fluid samples from infected pregnant women have also tested negative for the virus. The single case reported of a 30-hour-old infant who tested positive was not conclusive, as transmission during delivery or post-delivery could not be excluded.

The experience from previous MERS and SARS epidemics also showed no evidence of in-utero transfer of the coronaviruses. Although an increased risk of pregnancy-related complications was seen in infected pregnant women.

(See also: Common Pregnancy Aches and Pains You Should Not Ignore)

7. Can a nursing mother pass COVID-19 to her infant through breastfeeding?

Based on experience with other respiratory viruses, the transmission of viruses via breast milk is likely to be less significant in comparison to the benefits of breastfeeding. Breast milk samples from six pregnant women with COVID-19 in China tested negative for the virus.

However, if you have been diagnosed with COVID-19, you should take extra precautions to prevent transmission of the virus to infants through respiratory droplets and contact. This includes wearing a face mask when breastfeeding, and taking strict hygiene measures when handling your baby. A safe option would be to give your infant expressed breast milk till you have cleared the virus. Take adequate hygiene precautions when handling expressed milk for your infant.

breast pump

8. Can breastfeeding keep my baby safe from the virus?

Going from our experience from influenza and other viral illnesses, a mother infected with COVID-19 would develop protective antibodies. These antibodies would then pass on to the baby during breastfeeding. However, there is insufficient evidence about the levels of coronavirus antibodies in breast milk, and if these levels are sufficient to protect a majority of breastfed babies from developing the illness.

(See also: Breastfeeding (in a Coma) Saved My Life)

Our little ones depend on us to not just keep them safe and healthy. They also look to us for guidance and stability. So rather than panic and overreact, let’s focus on practising social responsibility and good hygiene habits as Dr Mohana advises. After all, kids learn best by emulating their parents. So rather than just hoping for the epidemic to subside, let’s get proactive and help make it happen!

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covid-19 coronavirus

COVID-19: On Transmission in Kids, Pregnancy and Breastfeeding