• If breastfeeding is continued between a suspected or confirmed mother with mpox and a non-infected infant, IPC measures must be established including limited contact between mother and infant except during breastfeeding and coverage of active lesions on other parts of the body whilst breastfeeding.
• The presence of areolar lesions should prompt careful consideration and mothers should not use that breast to breastfeed the infant. In the case of unilateral lesions, until lesions are healed per WHO criteria (lesions are crusted, the scab of lesions have fallen off and a fresh layer of intact skin has formed underneath), breastfeeding may take place from the unaffected breast whilst covering all active lesions.
• Health and care workers should inform the mother about the risk of infection to infants whilst breastfeeding and availability of appropriate alternatives.
• Context will drive the feasibility, availability and safety of alternatives to breast feeding. Whenever it is safe and feasible, expressed breastmilk or milk substitutes and no direct contact, may be pursued to reduce transmission.

Practical info Additional guidance on breastfeeding can be found in WHO Recommendations on postnatal care of the mother and newborn and can be accessed here: https://www.who.int/publications/i/item/9789241506649.[161] General protective IPC measures should be taken by mothers with mpox when handling and feeding their infants, e.g. washing hands before and after each feeding, wearing a medical mask and covering any lesions on the areola or on areas which have direct contact with the infant. Alternatively, if only one breast has lesions, mothers can express/pump from the breast with lesions on the areola and discard the milk and feed from the non-affected breast. In all cases, monitor the mother-infant pair closely for development of signs and symptoms of mpox and treat accordingly. Infants of mothers with mpox should be closely monitored for signs and symptoms with the main goal of early supportive care to prevent the development of severe disease and poor outcomes. In the event of replacement feeding with breastmilk substitute, it is essential to track the infant’s growth, development and other illnesses as well as for signs and symptoms of mpox.