# Presentation: 515029

## Infant Feeding in the Context 

- Infant Feeding in the Context
- of HIV Infection

## Module 4: Objectives

- Describe current global recommendations for infant feeding in the context of HIV/AIDS.
- Understand importance of optimal infant and young child feeding for child health, nutrition, growth and development.
- Define main options for infant feeding and advantages and disadvantages of each.
- Describe steps for counselling mothers infected with HIV about infant feeding.
- Understand importance of postnatal follow-up and support in infant feeding** **

## Infant Feeding in the Context of HIV Infection

**Session 1**
**Global Recommendations for Infant and Young Child Feeding**

## Introduction to Infant Feeding

- ARV treatment and prophylaxis administered to the mother and infant reduces MTCT.
- Up to 20% of infants breastfed by mothers who are HIV-positive are at risk of acquiring HIV.
- National and UN infant feeding recommendations and guidelines can reduce MTCT.

## Infant Feeding and Child Survival 

**World Health Report (2002)**
- Malnutrition is an underlying cause of 60% of deaths in children under 5 years.
- Being underweight was associated with 3.7 million deaths in 2000.
- Poor feeding practices are a major cause of death in children.

## Infant Feeding and Child Survival 

- Counselling and support of infant feeding
- Improves feeding practices
- Prevents malnutrition
- Prevents HIV transmission to infants
- Reduces the risk of death in children

## Infant Feeding: Mothers who are not HIV-Infected

- Exclusive breastfeeding for 6 months
- Continue breastfeeding for up to 2 years or beyond.
- Introduce nutritionally adequate and safe complementary foods after the infant reaches 6 months of age, while continuing to breastfeed for 2 years or beyond.

**  ****UN Recommendation****:**

## Exclusive Breastfeeding

**Definition**
- Giving an infant only breastmilk, with the exception of drops or syrups consisting of vitamins, mineral supplements, or drugs
- No food or drink other than breastmilk—not even water

## Infant Feeding: Mothers Infected with HIV

***UN Recommendation******: ***
**R****eplacement feeding** when
**Acceptable**
**Feasible**
**Affordable**
**Sustainable**
**Safe**
- Otherwise, exclusive breastfeeding for the first months of life

## Implementing UN Guidance in the Community

- Ensure all mothers who are HIV-positive receive infant feeding counselling.
- Identify the range of feeding options that are acceptable, feasible, affordable, sustainable and safe.
- Educate the public about MTCT.
- Train infant-feeding counsellors.
- Train peer counsellors.

## Session 2

Feeding Options 

- of HIV Infection

**Session 2**
**Feeding Options **

## Policy and Protocol

- Insert national HIV infant-feeding
- policy and protocol.

## Commercial Infant Formula

**Advantages**
- No risk of transmitting HIV
- Made especially for infants
- Includes most nutrients an infant needs
- Others can feed infant** **

**Disadvantages**
- Infant is more likely to get sick
- Need reliable formula supply
- Formula is expensive
- Requires clean water
- Must be made fresh each time
- Infant needs to drink from a cup
- Not  breastfeeding may raise questions about mother’s HIV status

## Home-Modified Animal Milk

**       ****Advantages**
- No risk of transmitting HIV
- Can be less costly than commercial formula
- Can be used when commercial infant formula is not available
- Others can feed infant

**       ****Disadvantages**
- Infant more likely to get sick
- Must be made fresh each time
- Difficult to digest
- Multivitamin supplements are needed
- Must add boiled water and sugar
- Mother must stop breastfeeding
- Does not contain antibodies
- Infant needs to drink from a cup
- Not breastfeeding may raise questions about mother’s HIV status

## Exclusive Breastfeeding

**      ****Advantages**
- Easily digestible
- Nutritious and complete
- Always available
- No special preparation needed
- Protects from diarrhoea, pneumonia, and other infections/diseases
- Promotes bonding

**      ****Disadvantages**
- Risk of passing HIV to baby
- Requires feeding on demand
- Mother requires additional calories to support breastfeeding

## Exclusive Breastfeeding with Early Cessation

**Advantages**
- Early cessation limits infant’s exposure to HIV

**Disadvantages**
- Breastmilk substitute is necessary
- Mother's breasts may become engorged
- Mother at risk of becoming pregnant if sexually active

##  Wet Nurses

**Advantages**
- Same benefits as breastmilk feeding
- No risk of HIV if wet nurse is not HIV-positive

**     ****Disadvantages**
- Wet nurse must be confirmed HIV-negative
- She must protect herself from HIV infection
- She must be available to breastfeed infant on demand

## Expressed Heat-Treated Breastmilk

- Steps for breastmilk preparation
- Wash all containers with soap and water
- Heat enough expressed milk for one feed
- Heat to boiling and cool
- Use within one hour

## Infant Feeding in the Context 

- of HIV Infection

**Session 3**** **
**Infant-Feeding Counselling ****and Support**

## Infant-Feeding Counselling and Support 

- Offer counselling, education and support by trained healthcare workers.
- Provide before birth and during first 2 years of life.
- Base on country or local guidelines.
- Base on a woman’s circumstances.
- Include information on infant-feeding options and advantages and disadvantages.
- Provide women with safer feeding skills.
- Encourage partner or family involvement.

## Infant-Feeding Counselling and Support 

**Counselling Visits**
- At least one during the antenatal period
- Immediately after birth
- Within 7 days of birth to monitor post-partum and infant-feeding progress
- Monthly follow-up sessions
- Additional sessions may be required during high-risk time periods

## Infant-Feeding Counselling and Support

**Infant-Feeding Counselling Steps**
**STEP 1:**** ****	**Explain risks of MTCT.
**STEP 2:**** ****	**Explain advantages and disadvantages of different feeding options, starting with mother’s initial preference.
**STEP 3:**** ****	**Explore mother’s home and family situation.

## Infant-Feeding Counselling and Support

**STEP 4:****    **Help mother choose appropriate option.
**STEP 5:    **Demonstrate how to practise chosen 		feeding option.
- Replacement feeding
- Exclusive breastfeeding
- Other breastmilk options
-  **STEP 6****:**   Provide follow-up counselling and support.

## Module 4: Key Points

- All women who are HIV-positive need infant feeding counselling and support.
- HIV transmission risk continues the entire time a mother who is HIV-positive breastfeeds her child.
- The mother has the right to choose how she wants to feed her infant; the healthcare worker's job is to support her choice.
- Mothers who are HIV-positive should avoid breastfeeding when replacement feeding is acceptable, feasible, affordable, sustainable, and safe.

## Module 4: Key Points 

- Exclusive breastfeeding with early cessation at or before 6 months is appropriate when breastfeeding is the chosen option.
- Counselling, education, and support are key to establishing and maintaining safer infant-feeding practices.
- Postnatal counselling and infant follow-up are required throughout the first 2 years of the infant's life.

## Module 4: Key Points 

- Prevent misuse of replacement feeding
- Promote exclusive breastfeeding for the general population
- Discourage use of replacement milk supplies by mothers whose infants don’t need them
- Respect International Code of Marketing of Breastmilk Substitutes