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Infant Feeding in the Context of HIV/AIDS

Infant Feeding in the First Six Months

Key principles:

• Only children born to HIV positive mothers can get HIV from their mother.
   
• It is recommended for all mothers to go for HIV Individual counselling and Testing to know their status during the time of pregnancy and during breastfeeding.
   
• Mothers that believe they are at risk from HIV infection should try to practice safer sex to remain negative during the time of pregnancy and during breastfeeding. Recent infection in the postnatal period may increase risks of mother-to-child HIV transmission through breastfeeding. Health workers should provide adequate information and support (e.g. condom distribution) for all mothers willing to practice safer sex (including HIV positive mothers).
   
• All women who do not know their status and all those who are negative should practice exclusive breastfeeding for the first six months. NO other foods or fluids should be given during this period, except for prescribed medicines. Introducing other feeds and fluid before 6 months puts the child at risk of developing infections like diarrhoea and respiratory infections.
   
• HIV positive mothers should be advised by health workers on all options available to reduce HIV transmission to the baby. Out of every 10 HIV positive mothers only 3 will transmit the virus to their children. 7 will not. The 3 children could get the virus during pregnancy, during delivery or during breastfeeding. And this is IF there is NO intervention to reduce transmission rates.
   
• Interventions that reduce HIV transmission rates during pregnancy and delivery include:
   
  • Safe delivery practices.
     
  • Drugs that are given to the HIV-positive mother during pregnancy, delivery and to the infant after birth. These are called antiretroviral drugs [ARVs]. When ARVs are given to prevent mother-to-child transmission of HIV, this is called ARV prophylaxis. In this case, the drugs are given to reduce the baby's chances of HIV infection. However, these drugs do not treat the woman's own HIV infection.
     
• There are two options of feeding children born to HIV positive mothers and they cannot be used together. It is either exclusive breastfeeding OR exclusive replacement feeding through Breast Milk Substitute (BMS).
   
• Generic or commercial Infant Formula is the recommended Breast Milk Substitute (BMS) by WHO. Home-modified animal milks should not be recommended as Breast Milk Substitutes in the first six months because of difficulties in obtaining adequate nutrition, particularly regarding micronutrients. It should be used in non-breastfed infants below 6 months only as a last resort when there is really no other feasible alternative option, such as generic or commercial infant formula.
   
• HIV positive mothers should be enabled by trained health or nutrition workers to make an informed decision about the best infant feeding option in their own situation based on what is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS). Check the AFASS Principles and Table of AFASS criteria.
   
• The aim of infant feeding counselling in the context of HIV/AIDS is to avoid mixed feeding - both breastfeeding and use of replacement feeding. Introducing other feeds and fluid before 6 months puts the child at risk of developing gut irritation, diarrhoea and respiratory infections that may increase the risk of HIV transmission.
   
• Exclusive breastfeeding for the first six months is recommended unless exclusive replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe before that time (Consensus Statement IATT on Prevention of HIV Infections).
   
• HIV positive mothers that opt for exclusive breastfeeding for the first six months should be assisted to initiate breastfeeding within one hour (Breast Crawl) and to practice correct position and attachment to prevent common breast problems like cracked nipples, sore nipples and mastitis. These mothers should be taught how to check the infant's mouth for sores. If any of the above conditions is present, they should be able to get timely assistance from a trained health or nutrition worker.
   
• HIV positive mothers that meet all AFASS conditions and opt for exclusive replacement feeding should be assisted to initiate the feeding option at delivery. Careful attention must be taken to protect against spillover effects by ensuring privacy in the maternity ward. These mothers should be counselled during pregnancy by trained health or nutrition workers on how to safely prepare and use the infant formula through one-to-one demonstrations. The mother should follow the instructions on the tin for mixing the formula and ensure that the formula is neither too concentrated nor too diluted. Over concentrated infant formula overloads the infant with salt and waste amino acid which can be dangerous for the kidney. Over diluted infant formula exposes the children to malnutrition. Follow-ups should be made to prevent mixed-feeding. It is recommended to avoid bottle-feeding and use open cup-feeding instead.
   
• HIV positive mothers that have to shift from exclusive breastfeeding to replacement feeding (because of their own or their baby's medical conditions) should be assisted to sustain the weaning process and minimize the mixed feeding period as much as possible. In the event that infant formula is provided, as determined by assessment from a trained health or nutrition worker, supply should be continued for as long as the infant concerned needs it. Careful attention must be taken to protect against spillover effects by using separate and discrete distribution channels directly linked to one-to-one demonstrations and follow-ups by skilled personnel.
   
• Non-breastfed infants are at increased risk of acute respiratory infections, diarrhoea disease and severe dehydration. Mothers should, therefore, be vigilant about providing ORS when the baby has diarrhoea and should be timely assisted by trained health or nutrition workers if any complication arises.

02 January, 2009