Infant feeding and PMTCT

Session Objective and content

• Objective: At the end of the session the participant should be able

• Discuss issues related to infant feeding and PMTCT• Discuss National guidelines with regard to HIV and infant

feeding

• Content• Benefits of breastfeeding• Breast milk transmission of HIV – risk and risk factors• Infant feeding options• National guidelines on infant feeding

MTCT and Breastfeeding

• ARV treatment and prophylaxis can reduce MTCT of HIV by at least 50%.

• ARV prophylaxis does not providelong-term protection for breastfed infant.

• Without interventions (ARV prophylaxis or therapy)– 5–15% of infants born to mothers infected with HIV

can become HIV-infected during breastfeeding.

Outcomes of Infants Born to Women with HIV Infection

100 infants born to women who are HIV infected, without any interventions

60–75 infants will not be HIV-infected

25–40 infants will be HIV-infected

5–10infants

infectedduring

pregnancy

About 15infants

infectedduringlabour

and delivery

5–15 infantsinfectedduring

breastfeeding

Infant Feeding Options

• Breast milk feeding options– Option 1: Exclusive breastfeeding– Option 2: Exclusive breastfeeding with early

cessation– Option 3: Wet nursing– Option 4: Expressing and heat-treating breastmilk

• Replacement feeding options– Commercial infant formula– Home prepared formula

Infant Feeding Counselling

Step 3Step 3Explore with the mother her home and family situation. Offer to discuss with her partner before she decides and acknowledge her right to change her decision.

Step 4Step 4Help the mother choose an appropriate feeding option.

Step 5Step 5Demonstrate how to practise the chosen feeding option. Provide take-home flyer.

How to practise exclusive breastfeeding How to practise other

breastmilk optionsHow to practise replacement feeding

Step 6Step 6Provide follow-up counselling and support.Repeat Steps 3-5 if the mother changes her original choice.

Explain when and how to stop breastfeeding early.

Postnatal VisitsPostnatal VisitsMonitor growth.Check feeding practices and whether any change is desirable.Check for signs of illness.

Discuss feeding 6 to 24 months.

Step 2Step 2Explain the advantages and disadvantages of different feeding options

starting with the mother's initial preference.

Step 1Step 1Explain the risks of MTCT.

Exclusive Breastfeeding

• Mother gives her infant only breastmilk -----not even water, except for drops or syrups consisting of vitamins, mineral supplements, or medicines (when indicated).

Exclusive Breastfeeding• Advantages

– Easily digestible– Nutritious, complete– Always available– No special preparation

needed– Reduces mother’s risk of

breast cancer– Increases birth spacing – Protects from diarrhoea,

pneumonia, other infections/diseases

– Compared to mixed feeding, lowers risk of HIV

– Promotes bonding

• Disadvantages– Risk of passing HIV to baby– Increased risk if mother has

breast infection– ?Increases risk of death in

immunosuppressed women– Mother requires additional

calories to support breastfeeding

– Requires feeding on demand

Management of Early Cessation

• Express enough breastmilk to prevent engorgement and reduce discomfort.

• Encourage early practice of cup or cup and spoon feeding with expressed breast milk.

• Enlist family members to assist with feeding and comforting of the infant.

• Alternate warm/cold compresses to reduce breast discomfort and swelling.

• Provide assurance that challenges are time-limited.

Management of Mastitis

• Mastitis – a sudden, painful inflammation of the breast tissue surrounding the milk ducts.

• CARESS model of management:– C compresses (hot and cold)– A antibiotics (if necessary)– R rest– E effective removal of breastmilk– S stress identification and management– S support and follow-up

Replacement Feeding

• Commercial infant formula• Home-modified formula with micronutrient

supplements• Cup feeding is recommended over

bottle feeding

Replacement Feeding

• Commercial infant formula• Home-modified animal milk formula

Consider– Cost and sustained availability– Reliable sources of animal milk products and multi-

nutrient supplements– Education in safe preparation and storage

Replacement feeding

• Advantages– No risk of transmitting HIV to the infant– Contains most nutrients needed by infant– Other family members can help feed the infant

• Disadvantages– Expensive– Contains no antibodies to protect infant– Can increase risk of diarrhoea– May not contain all the nutrient requirements for the infant– Can be more difficult to digest– Must be carefully prepared and stored

Kenya infant feeding Policy

• Right of parents of HIV-exposed infants to choose how and what to feed infants following counselling.

• Exclusive breastfeeding for first 6 months for mothers who are HIV-negative and mothers of unknown HIV status.

• Replacement feeding where – A--Acceptable– A--Affordable– F--Feasible– S--Sustainable– S--Safe