Caring for Our Childen (CFOC)

Chapter 4: Nutrition and Food Service

4.3 Requirements for Special Groups or Ages of Children

4.3.1 Nutrition for Infants

4.3.1.4: Feeding Human Milk to Another Mother’s Child

Content in the STANDARD was modified on 8/24/2017 and 06/10/2020.

 


Parents/guardians may express concern about the likelihood of disease transmission to their child if their child has been mistakenly fed another child’s bottle of expressed human milk. This issue is addressed in detail to reassure parents/guardians that the risk of transmission of infectious diseases via human milk is small.

If a child has been mistakenly fed another child’s bottle of expressed human milk, steps should be taken to minimize fear and manage the situation in a timely manner. When a milk mix-up occurs, any decisions about medical management and diagnostic testing of the child who received another mother’s milk should be based on the details of the individual situation and determined collaboratively between the child’s primary care provider and parents/guardians.1

The early care and education program should

  1. Inform the mother who expressed the human milk about the mistake and when the bottle switch occurred, and ask her the following questions1:
    • When was the human milk expressed and how was it handled prior to being delivered to the early care and education program?
    • Would she be willing to share information about her current medication use, recent infectious disease history, and presence of cracked or bleeding nipples during milk expression with the other family or the child’s primary care provider?
  2. Discuss the event with the parents/guardians of the child who was given another mother’s milk.1
    • Inform them that their child was given another mother’s expressed human milk.
    • Inform them that the risk of transmission of infectious diseases is small.
    • If possible, provide the family with information on when the milk was expressed and how the milk was handled prior to its being delivered to the early care and education program.
    • Encourage them to notify the child’s primary care provider of the situation and share any specific details known.
  3. Assess why the wrong milk was given and develop policies and procedures to prevent future mistakes related to labeling, storing, preparing, and feeding human milk in the early care and education program. Share these policies and procedures with parents/guardians as well as the early care and education staff.

Few illnesses are transmitted via human milk, and in fact, the unique properties of human milk help protect children from colds and other typical childhood viruses. Nonetheless, both families need to be notified when there is a milk mix-up, and they should be informed that the risk of transmission of infectious diseases via human milk is small.1

RATIONALE

Despite significant efforts to prevent mix-ups, expressed human milk is occasionally given to a child in error.1 Common concerns about human milk mistakenly fed to an child include transmission of HIV and hepatitis B and C, as well as medication exposure.

The risk of HIV transmission from expressed human milk consumed by another child is believed to be low because1

  • Transmission of HIV from a single human milk exposure has never been documented.
  • In the United States, women who know they are HIV positive are advised not to breastfeed their children. Thus, it is unlikely that a mother living with HIV would be providing expressed milk for her own child at an early care and education program center.

Hepatitis B and C cannot be spread from a woman to a child through breastfeeding unless there is exposure to blood.2–4

The risk of hepatitis B and C transmission from expressed human milk consumed by another child is believed to be low because2

  • Infants born to mothers with hepatitis B receive the hepatitis B vaccine at birth.
  • While mothers with hepatitis B and C can breastfeed,4,5 hepatitis B and C are spread by infected blood. If the nipples and/or surrounding areola of the mother with hepatitis B or C are cracked and bleeding, she should be advised to stop nursing or providing expressed milk to her child temporarily (until she is healed).2

Although many medications pass into human milk, most have little or no effect on a child’s well-being. Few medications are contraindicated while breastfeeding, and risk of adverse effects from a single exposure to a medication through human milk is very low.1

TYPE OF FACILITY
Center, Early Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
4.3.1.3 Preparing, Feeding, and Storing Human Milk
REFERENCES
  1. Centers for Disease Control and Prevention. What to do if an infant or child is mistakenly fed another woman’s expressed breast milk. http://www.cdc.gov/breastfeeding/recommendations/other_mothers_milk.htm. Reviewed January 24, 2018. Accessed October 24, 2019

  2. Centers for Disease Control and Prevention. Hepatitis B or C infections. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/hepatitis.html.Reviewed January 24, 2018. Accessed October 24, 2019

  3. Centers for Disease Control and Prevention. Hepatitis B questions and answers for the public. https://www.cdc.gov/hepatitis/hbv/bfaq.htm#bFAQ13. Reviewed September 10, 2019. Accessed October 24, 2019

  4. Centers for Disease Control and Prevention. Hepatitis C questions and answers for the public. https://www.cdc.gov/hepatitis/hcv/cfaq.htm#cFAQ37. Reviewed September 10, 2019. Accessed October 24, 2019

  5. American Academy of Pediatrics. Human milk. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018–2021 Report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics; 2018:113–122

NOTES

Content in the STANDARD was modified on 8/24/2017 and 06/10/2020.