We’re approaching my daughter’s first birthday, and our pediatrician has passed on the common wisdom that I should start weaning. I thought I would be low-key ecstatic at the promise of waking up in the mornings without swollen breasts and perpetually damp sheets. Instead, I’m faced with the same conundrum many breastfeeding moms are dealing with in the pandemic: Should I continue breastfeeding if only to provide my child some antibody protection against the coronavirus?
That question is loaded, both emotionally and scientifically. Nearly 5.3 million kids have tested positive for the coronavirus since the onset of the pandemic, with 243,000 cases added in the past week, per the American Academy of Pediatrics — the second highest number of child cases in a week since the pandemic began. Pediatric covid-related hospitalizations are at an all-time high, though babies are the tail risk, accounting for a very small percentage of those hospitalized. It’s a bleak, anxiety-riddled time, and even more so because of the delta variant spreading across the country. The reality is my baby, along with millions of other infants under the age of 2, will be the last community group to be offered a coronavirus vaccine.
Pfizer and Moderna have been testing their vaccines on babies as young as six months, experimenting with lower doses for the youngest cohorts in trials; they’re not expected to publish preliminary results until later in the fall. In the meantime, the U.S. Food and Drug Administration put out a warning this month against parents seeking vaccines prematurely for their kids under the age of 12. Anthony S. Fauci, President Biden’s chief medical adviser, recently speculated that the earliest we could see shots for kids under 2 would be sometime next spring. For parents of little ones, that timeline feels like a lifetime away.
So, what to do while waiting for the scientists to crunch the data?
The answer, we are told, is to breastfeed.
For the past few months, parents of very young children have been offered tantalizing morsels of hope from drips of data that suggest infants may retain some protection from vaccinated moms through antibodies passed via breast milk. Our breasts may be the first — and for now only — line of defense for babies. We have seen a resurgence of headlines reinforcing the idea justly, albeit somewhat controversially, that breast milk is “liquid gold.” But women like me are fortunate to even get to wrestle with this conundrum. Not every person who wants to breastfeed can, and for a lot of lactating people, breastfeeding is not an easy journey.
Some, like me, who were looking forward to bittersweet celebrations after 12 months of clogged ducts and bitten nipples are having second thoughts. As one friend of mine — who has been juggling her paid, highly demanding executive job with her other highly demanding unpaid job nursing her infant — put it: “I’m breastfeeding my LO like she’s foie gras.”
But does the data really support this choice?
In the past month, the American Academy of Pediatrics cited a yet-to-be-published, peer-reviewed research paper from Spanish scientists that suggested women who are vaccinated for covid-19 and continue to breastfeed their children beyond 23 months see the highest antibody benefits. That translates to breastfeeding babies for two years. This would be a radical departure from the guidelines from the AAP and most pediatricians across the United States, who recommend starting to wean a baby off the breast at 12 months, when solids should more exclusively form their diets. And it would be a major shift for a lot of mothers; in the United States, most women drop off breastfeeding after six months, with a Centers for Disease Control and Prevention study showing that fewer than one-third of infants are being breastfed up to 12 months.
I asked Rebecca Powell, a human milk immunologist at New York’s Icahn School of Medicine at Mount Sinai, what she thought.
Powell has been looking at the antibody response in milk samples of people who were infected with covid-19 and recovered, as well as people who had been given the coronavirus vaccine. Babies develop a secretory antibody response from breast milk after they’re born — it’s known as passive immunization, as opposed to the active immunity a mom gets from having had a coronavirus vaccine and generating antibodies herself. Because of this, Powell explained, it seems sensible to conclude that an infant is protected insofar as they continue to ingest breast milk.
Well then — what’s the magic amount of milk?
That is the big question that Powell said she gets asked all the time. Antibodies bind to cells to a certain extent, but it is a temporary effect that gets washed away by other foods or drinks the baby consumes, she said. Because a baby typically breastfeeds many times a day, those antibodies are continually replenished. In other words, top-ups are needed — it’s just a question of how many.
Another complicated question is whether all vaccines pack the same punch. Powell, who has studied this, told me that mRNA vaccines such as Moderna and Pfizer not only offer more antibodies in the blood for the vaccinated individual, but they also show more antibodies in the milk given to breastfeeding babies. By contrast, the Johnson & Johnson vaccine elicited a far lower antibody response in breast milk, according to her research. Powell, who believes that everyone should get the vaccine, stressed this data is important because millions of Americans who aren’t vaccinated and are currently or soon to be nursing should know if they have an option, an mRNA vaccine may be their best bet. (The CDC encourages pregnant and lactating people to get whichever vaccine is available to them.)
It is also important to remember that — as with adults who are seeing breakthrough cases — the presence of antibodies doesn’t necessarily mean being able to fully neutralize the virus, and the research isn’t there yet on determining how effective the existing antibodies within babies are.
Josef Neu, a professor in the University of Florida College of Medicine department of pediatrics and division of neonatology, acknowledged the absence of data on this topic — but is nonetheless hopeful. He and his colleagues conducted a small study among lactating health-care workers that was published last month.
“Vaccination really increases the immunoglobulins that are specific for covid. This tells us that factors that specifically protect against covid infection by binding the virus is present in the milk of vaccinated moms,” Neu said. “One can assume that it is protective for babies, but solid scientific evidence from clinical trials is lacking.”
Neu added: “It seems that even without the more solid data, it is prudent to breastfeed.”
Easier said than done. Continuing to breastfeed takes up a considerable amount of time. (My breastfeeding tracker tells me I spent over 450 hours this past year feeding my baby.) Then there’s the question of how to maintain a strong supply when you’re pursuing paid employment, not to mention how to keep a uninterested baby nursing when, like many tots, she frequently seems more inclined toward whole blueberries than breast milk.
When in doubt, I turn to parenting and data guru Emily Oster, author of the bestseller “Expecting Better.” What, I asked, does she think of this quandary moms are in? Oster told me that even with these studies, we still don’t know much beyond the fact that “there are antibodies in breastmilk” and some vague suggestion that they might help. She isn’t hopeful that we will ever definitively know how much breast milk shields babies from covid.
“It’s impossible for us to know. The effect sizes — if they are there — are likely to be small and the disease risk in this group is really small also. So how would you know if this mattered? You’d need an enormous study,” Oster explained. “Forget about randomization; even to have the most basic results you’d need a huge number of people studied. So I think it’s a little hopeless.”
All this leaves parents of infants with yet another anxiety-riddled decision to make — and, as with so many aspects of parenting, little solid data to go on. It comes down to gut. So while I was gearing up to be mentally and emotionally done with breastfeeding, I’m going to continue a little longer.
Without any more concrete data, but the promise of even the potential that it might be helping protect my baby, what choice do I and other moms have?
Caroline Modarressy-Tehrani is an Emmy-nominated journalist, producer and writer living in New York City.