Infant Feeding

In Relation to HIV

Mayom Mabuong Marek

PMTCT Inspector
Ministry of Health,
Juba

1
 INFANT AND YOUNG CHILD FEEDING
The transmission of HIV from mother to child
through breast milk is a very complex issue given
the many challenges and considerations involved
in making an informed infant feeding decision.

Providing appropriate information, and

counseling, based on the mothers personal
situation, is critical for reducing transmission
rates.
2
 Objectives:
Define key infant feeding Terms
Discuss national recommendations for infant
feeding in the context of HIV
Describe conditions needed for safe exclusive
replacement feeding
Explain the steps in infant feeding counseling

3
 Key Infant-Feeding Terms
Exclusive Breast Feeding (EBF) is the process
of feeding the baby on breast milk for 6
months of life without feeding any type of
food, drinks even water, except medicines like
vitamin and minerals.

4
 Replacement Feeding: is the process of
feeding a child who is not breastfeeding with a
diet that provides all the nutrients the child
needs until the child is fully fed on family food

Replacement Feeding Option

Commercial Infant Formula
Home prepared formula
5
Requirement for Replacement Feeding

Replacement feeding should be

(AFASS)
Acceptable,
Feasible,
Affordable,
Sustainable and
Safe

6
 Infant Feeding Cont
Mixed Feeding (MF)feeding both breast milk
and other liquids (such as water, tea, infant
formula, animal milk or food such as porridge
or rice)
Complementary Feeding (CF) any food
whether manufactured or locally prepared,
that is added to a childs diet when the child
reach 6 months of age

7
 Nutrition Assessment
Caretakers should be asked about childs feeding
and nutrition
It is crucial to ensure adequate nutrition for HIV
exposed infants and HIV infected children
An assessment of nutrition is essential at each
visit:
Mode of feeding
Frequency, duration
Adequacy of supply
Bowel habits
Reported problems

8
 Infant Feeding for HIV Exposed
Infants
All providers should counsel HIV-infected women
on infant feeding
HIV infection can be passed through breast milk,
however this risk is substantially reduced if the
mother is on ART and adherent
Ensure mother is taking her ART and adherent
Encourage exclusive breastfeeding for the first 6
months
Thereafter introduction of complimentary feeds
in addition to breastfeeding from 6 months to 12
months
9
 Recommendations on Infant feeding
and HIV
ART lowers the risk of HIV transmission through
breast milk.
For women with HIV, the risks associated with not
breastfeeding (i.e., diarrhea, pneumonia and
malnutrition) are much greater than the risks
associated with breastfeeding (i.e., risk of HIV
transmission from mother to baby).
Infants who are HIV infected will benefit from
extended breastfeeding and should continue
breastfeeding for as long as feasible and desired,
24 months or longer.

10
 Why is infant and young child Breast
feeding is important
Provides food security for the infant without
dependence on supplies
Reduces maternal bleeding after delivery by
helping the uterus to contract
Protects against pregnancy (birth spacing)
Makes caring for baby easier
Places less burden on the healthcare system
Empowers mothers
Reduces the risk of some cancers
Gives long-term health benefits to the child
Promotes bonding between mother and baby

11
 Artificial feeding is always
risky
it is not sterile, it increases food insecurity and
dependency, it is costly in time, resources and
care, and bottle feeding increases risk further
due to difficulties in cleaning, adding a source
of infection.

12
 National recommendations for infant
feeding in the contact of HIV
There are two main options that a mother can
choose
Breastfeeding
Replacement Feeding with commercial infant
formula

13
 Mothers known to be infected with HIV (and
whose infants are HIV uninfected or of
unknown HIV status) should exclusively
breastfeed their infants for the first 6 months
of life, introducing appropriate
complementary foods thereafter, and
continue breastfeeding for the first 12 months
of life. Breastfeeding should then only stop
once a nutritionally adequate and safe diet
without breast-milk can be provided
14
 First, WHO recommends that: National health authorities
should decide which feeding practices will be adopted
nationally for HIV-positive mothers and their babies, that is
whether:
To adopt breastfeeding with ART to reduce transmission OR
To avoid breastfeeding completely.
In the case of South Sudan, the choice is to adopt
breastfeeding with ART to reduce transmission.
Secondly, WHO also recommends breastfeeding for 12
months because the maximum benefit of breastfeeding in
preventing mortality from diarrhoea, pneumonia and
malnutrition is in the first 12 months of life

15
 How to make a decision to stop
breastfeeding after 12 months
Correct positioning of children to avoid sore
nipples and having them treated when they
develop.
How to provide optimal complementary food
using the locally available ingredients
Essential behaviours for exclusive breastfeeding
Essential behaviours for complementary feeding.
Counselling of mothers without enough breast
milk

16
 Initiates breastfeeding within one hour of birth.
Feeds the colostrums to the baby.
Positions and attaches the infant correctly at the
breast.
Breastfeeds on demand.
Breastfeeds frequently during the day.
Breastfeeds during the night.
Offers second breast after infant empties the
first.

17
 Gives only breast milk; gives no water or teas or
any other liquids or foods.
Continues breastfeeding when she is sick.
Increases breastfeeding frequency during and
after infants illness, including diarrhoea.
Seeks help from a trained health worker or
counsellor if she has problems with
breastfeeding.
Eats sufficient nutritious foods herself and takes
supplements as recommended by the health
provider
18
Breastfeeding women living with HIV

Woman not on ART

If a breastfeeding woman is not ART, probably
because she has just tested or tested before but
never started, then she should start on ART after
receiving the pre-ART package. The HIV-exposed
infants should be examined clinically for HIV, and
at that point get a DBS taken off. Infants without
clinical features of HIV should receive NVP
prophylaxis for 6 weeks

19
 Woman is on ART
If the breastfeeding woman is already on ART,
she should continue with the regimen she is
on and receive the package of care for PLHIV
on ART

20
 PMTCT services for breastfeeding
mothers
PMTCT services for breastfeeding mothers
Traditionally the postnatal period is up to 6 weeks after
birth. Women should be encouraged to return with their
babies for routine postnatal follow-up visits on the 3rd day
and at 6 weeks. Women need to understand the
advantages of continued care. Women, who give birth at
home, should be encouraged to go/return to the health
facility as soon as possible after childbirth.

PMTCT services for breastfeeding women include postnatal

services recommended for all postnatal women, PLUS
special interventions for breastfeeding women living with
HIV.

21
 The END!

THANKS FOR YOUR ATTENTION

22