Exclusive Breast Feeding In Special

Cases…“Doc… Should I or Shouldn't I?”

“Madam, You Should or you Should not!”

We Will Look Into Following Cases In

Brief:PLHA Mother

Mother with Active Pulmonary Tuberculosis

Mother who fails to quit Smoking or/& Alcohol

Mother on Anti cancerous Chemotherapy

Infant with Diarrhea

Infant with ARI

Multiple pregnancies

Any other condition you want to think of?

Mother: “Doc, should I breastfeed my baby, I am HIV+”?

So… Weigh before you say!

Without

ARVs, HIV-

infected

mothers

have 10 to

15% chance

of passing

HIV

through

breast milk,

and still

lower if on

ARV

Non breast feeders are at high risk of:Malnutrition, ARI, Diarrhea-

All leading causes of deaths!

Baby may survive, only to suffer later

in life from DM, Allergies, Auto- immune

diseases

Without ARVs

<5% with ARV& guidelines

<2% with ARV& guidelines

Breastfeeding protects Especially the youngest infants

WHO Collaborative Study Team. Effects of breastfeeding on infant and child mortality due to infectious disease in less developed countries: a pooled analysis. The Lancet 2000;355:451-5

IFE 1/4

Risk of death if breastfed is equivalent to one.

Tim

es m

ore

likel

y to

die

if n

ot b

reas

tfed

Age in months

Studies Quote infant mortality even up to 21% among normal population, who are not breastfed!

Risks of not breastfeeding

Particular high risk of:

Diarrhoea and ARTI

Malnutrition

Can lead to:

- Ill health

- Poor development

- Affect can last for life

- DEATH Aceh

Mother: “Doc, should I breastfeed my baby, I am HIV+”?

Doc: “Madam, AFASS”

For Person Living with HIV/AIDS

Work it out according to AFASS

Advise Exclusive Breast feed, just as for a HIV-ve mother

If Baby is HIV+ due to Prenatal Transmission

If Baby is HIV-ve or

Baby’s status is not known

Acceptable Feasibility Affordable Sustainabl

e

Safe

So to summarize:Ask for:

HIV status of the child

Viral load in the mother- higher the maternal plasma HIV load (>3.7 log 10 copies/mL), higher the risk!

CD4 Count< 200/ ml

Breast health

ARV therapy

Motivation& SE Status of the mother& family to Assess AFASS

Whatever you advise the mother to do, do it exclusively

You, as doc decide according to (AFASS):Breastfeed with ARV

intervention or,Avoid All breastfeeding,

Continue ARV for mother, compulsorily

Start prophylactic ARV for infant: Daily NVP un till 1 week after Stopping Breast feed, compulsorily

For non breast feeders, Start prophylactic ARV for infant: Daily NVP till 4- 6 weeks of age, compulsorily

Moral of the Story:HIV+ Mothers 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.

Mothers known to be HIV-infected who decide to stop breastfeeding at any time should stop gradually within one month.

Infants should continue prophylaxis for one week after breastfeeding is fully stopped.

Alternatives to breastfeeding include:

For infants less than six months of age:

Commercial infant formula milk as long as AFASS is met,

Expressed, heat-treated breast milk

NO to Home-modified animal milk in the first six months of life.

All children need complementary foods from six months of age.

There’s always a tug of war… In a Doc’s mind!

5% minus 2% & 21%

Between

Break a MythMixed feed is bad, so Is Abrupt Cessation of breast feeding good for the baby of a HIV+ mother?...

Break a MythMixed feed is bad, so Is Abrupt Cessation of breast feeding good for the baby of a

HIV+ mother?... NO

Baby of a Mother with Active Pulmonary Tuberculosis

Continue exclusive breast feeding till 6 months of age,& thereafter as in normal population.

Start ATT for mother immediately… Mother will be non infective within 2 months of regular ATT

Preventive Chemotherapy for baby- INH 5mg/kg/day* 6 months

Use face mask while around the baby, till 2 months after starting ATT

BCG Vaccine at birth… Something is better than Nothing!

Re- immunize with BCG after stopping Preventive Chemotherapy

Remember, its not only mother, Anybody (with TB) around can

infect the baby with Tuberculosis!

Break a MythIs ATT drug concentration in breast milk sufficient for the baby?...

Break a MythIs ATT drug concentration in breast milk

sufficient for the baby?... NO

Baby of a Mother who fails to quit smoking/

alcohol!!QUIT SMOKING & ALCOHOL!

It is better to exclusively breast feed the baby than to top feed her even if her mother smokes!

Breast milk does pass nicotine to the baby, but more harm happens due to passive smoking& the smoke dust which invisibly “clings” to your body, hands, clothes, hair& even beddings!

Remember, Anybody smoking in the house would leave the smoke dust to harm the baby

Baby of a Mother who fails to quit smoking/

alcohol!!Alcohol passes freely into mother's milk & peaks

about 30 to 60 minutes after consumption, 60 to 90 minutes when taken with food.

Avoid breast-feeding until alcohol has completely cleared breast milk. This typically takes 2-3 hrs, depending on your body weight.

So, If you plan to drink alcohol, consider having a drink just after breast-feeding so that the alcohol begins to clear your breast milk during the natural interval between breast-feeding sessions.

Remember, infant’s hepatic system is immature till 2- 3 months age, even small amounts of alcohol can be detrimental!

Break a MythDoes Pumping and dumping breast milk speed the elimination of alcohol from your body…

Break a MythDoes Pumping and dumping breast milk speed the elimination of alcohol from

your body... NO

Breast feeding multiple pregnancies

Do Not put off breastfeeding because you're

having multiple babies.

It's possible to breastfeed twins and even

triplets. Many are breastfed until they are

weaned.

Multiple babies are more likely to be born

prematurely, so there are even more benefits

to breastfeeding.

Breast milk is better for premature babies as

their gut is immature and it's easier for them

to tolerate and digest breast milk

Break a MythWill there be a “lack of milk”, if there are multiple babies born?...

Break a MythWill there be a “lack of milk”, if there

multiple babies are born?... NO

Thank you!