Q1. What are the Recomended feeding options for a mother who is HIV positive?
There are essentially two feeding options;
Exclusive breastfeeding- This means giving the baby only breast milk for the first six months of life, and no other liquids or solids, not even water unless medically indicated.
Exclusive breastfeeding is recommended for HIV infected women for the first six months of life unless replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS) for them and their infants before that time. The transition from breastfeeding should be within 2-3 days to three weeks. Abrupt weaning is NOT recommended.
The other feeding option is exclusive replacement. This 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 foods. Infant formula is recommended for exclusive replacement feeding when AFASS is met.
Q2. Should mothers who are HIV positive and have decided not to breastfeed have skin-to-skin contact with their baby immediately after delivery?
Skin-to-skin contact immediately after birth is important for creating a bond between an infant and mother. Bonding promotes psychological development of an infant. It is also important for HIV positive mothers to have skin-to-skin contact with their infants. However, precaution should be taken to prevent infants from breastfeeding. This is because mixed feeding is not a recommended practice for HIV infected women.
Q3. Why is cow’s milk not encouraged as a suitable replacement feed for infants whose mothers decide not to breastfeed?
Cow’s milk is not encouraged as a suitable replacement feed for infants 0 up to 6 months of age as it does not contain the vitamins and minerals required to support adequate growth and development. Secondly, cow’s milk contains high levels of protein that an infant may not be able to digest well, resulting into diarrhoea or constipation. The cow’s milk contains more protein than human milk. It is difficult for a baby's immature kidneys to excrete the extra waste from the protein in cow’s milks.
There is also a possibility of contamination during preparation which may result into an infection such as diarrhea.
Q4. How safe is wet nursing?
Wet nursing is the provision of breast milk to the infant by another person who is not the biological mother. Wet-nursing is safe for the infant if the wet-nurse has no HIV infection. Otherwise, the infant remains at risk of being HIV infected if the wet-nurse is infected. Wet nursing is safe if the infant is not HIV infected. If the infant is infected, precautions should be taken in certain conditions such as cracked nipples to reduce cross-transmission of the infection if the infant has mouth sores. Remember that this feeding option is not a routine recommendation. It should only be considered in special situations for example when an infant is orphaned and the family cannot afford to feed the child on any other milk substitute. In other words the family is unable to meet Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS) criteria for any other replacement feeding options apart from wet nursing.
Q5. Why is it important to offer individual counseling to HIV positive women on Infant feeding options?
Targeted individual counseling to HIV infected women on infant feeding options is important for a number of reasons: first, to prevent the spill-over effect to the mothers who are HIV negative and to those of unknown status and do not need to feed their infants on a replacement feed. Second, individual counseling is also important to prevent mixed feeding which is not a good feeding practice in the context of HIV and AIDS.
Q6. Why is bottle feeding not a recommended practice?
Bottle feeding regardless of what is in the bottle is not a recommended practice due to the following reasons: if the infant breastfeeds and is started on bottle-feeds, bottle feeding interferes with suckling due to nipple confusion effect thereby hindering successful breastfeeding. A bottle is difficult to clean and therefore, a bottle fed infant risks being infected with bacteria that may cause diarrhoea, upper respiratory infection (cough).
Q7. Why is mixed feeding in the first six months not a recommended practice in the context of HIV?
For infants less than 6 months, the gastro-intestine lining is not fully developed. Therefore, mixed feeding may injure the lining and facilitate transmission of the HIV infection. A mother should not mix feed as the risk of transmitting HIV to the baby will be high.
There are essentially two feeding options;
Exclusive breastfeeding- This means giving the baby only breast milk for the first six months of life, and no other liquids or solids, not even water unless medically indicated.
Exclusive breastfeeding is recommended for HIV infected women for the first six months of life unless replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS) for them and their infants before that time. The transition from breastfeeding should be within 2-3 days to three weeks. Abrupt weaning is NOT recommended.
The other feeding option is exclusive replacement. This 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 foods. Infant formula is recommended for exclusive replacement feeding when AFASS is met.
Q2. Should mothers who are HIV positive and have decided not to breastfeed have skin-to-skin contact with their baby immediately after delivery?
Skin-to-skin contact immediately after birth is important for creating a bond between an infant and mother. Bonding promotes psychological development of an infant. It is also important for HIV positive mothers to have skin-to-skin contact with their infants. However, precaution should be taken to prevent infants from breastfeeding. This is because mixed feeding is not a recommended practice for HIV infected women.
Q3. Why is cow’s milk not encouraged as a suitable replacement feed for infants whose mothers decide not to breastfeed?
Cow’s milk is not encouraged as a suitable replacement feed for infants 0 up to 6 months of age as it does not contain the vitamins and minerals required to support adequate growth and development. Secondly, cow’s milk contains high levels of protein that an infant may not be able to digest well, resulting into diarrhoea or constipation. The cow’s milk contains more protein than human milk. It is difficult for a baby's immature kidneys to excrete the extra waste from the protein in cow’s milks.
There is also a possibility of contamination during preparation which may result into an infection such as diarrhea.
Q4. How safe is wet nursing?
Wet nursing is the provision of breast milk to the infant by another person who is not the biological mother. Wet-nursing is safe for the infant if the wet-nurse has no HIV infection. Otherwise, the infant remains at risk of being HIV infected if the wet-nurse is infected. Wet nursing is safe if the infant is not HIV infected. If the infant is infected, precautions should be taken in certain conditions such as cracked nipples to reduce cross-transmission of the infection if the infant has mouth sores. Remember that this feeding option is not a routine recommendation. It should only be considered in special situations for example when an infant is orphaned and the family cannot afford to feed the child on any other milk substitute. In other words the family is unable to meet Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS) criteria for any other replacement feeding options apart from wet nursing.
Q5. Why is it important to offer individual counseling to HIV positive women on Infant feeding options?
Targeted individual counseling to HIV infected women on infant feeding options is important for a number of reasons: first, to prevent the spill-over effect to the mothers who are HIV negative and to those of unknown status and do not need to feed their infants on a replacement feed. Second, individual counseling is also important to prevent mixed feeding which is not a good feeding practice in the context of HIV and AIDS.
Q6. Why is bottle feeding not a recommended practice?
Bottle feeding regardless of what is in the bottle is not a recommended practice due to the following reasons: if the infant breastfeeds and is started on bottle-feeds, bottle feeding interferes with suckling due to nipple confusion effect thereby hindering successful breastfeeding. A bottle is difficult to clean and therefore, a bottle fed infant risks being infected with bacteria that may cause diarrhoea, upper respiratory infection (cough).
Q7. Why is mixed feeding in the first six months not a recommended practice in the context of HIV?
For infants less than 6 months, the gastro-intestine lining is not fully developed. Therefore, mixed feeding may injure the lining and facilitate transmission of the HIV infection. A mother should not mix feed as the risk of transmitting HIV to the baby will be high.