Module 4: Infant Feeding in the
Context of HIV infection
Unit objectives
After completing the unit, the participants will be
able to:
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 counselling
Key Infant-Feeding Terms
Exclusive Breastfeeding (EBF)
Feeding infant ONLY breast milk and no other
liquids or solids, with the exception of drops or
syrups consisting of vitamins, mineral
supplements or medicines prescribed by a HCW
Key Infant-Feeding Terms cont
Replacement Feeding (RF)
Feeding infant something OTHER THAN breast
milk which meet all the infants nutrition
requirement. During the first 6 months of life,
the only replacement feed that meets an
infants nutritional requirements is
commercial infant formula
Key Infant-Feeding Terms cont
Complementary Feeding (CF)
Any foods whether manufactured or locally
prepared, that is added to a childs diet when
the child reaches 6 months of age.
Complementary foods are needed because
breast milk or replacement foods alone do not
satisfy the childs nutritional requirements
after 6 months.
Key Infant-Feeding Terms cont
Mix Feeding (MF)
Feeding both breast milk and other liquids (such as
water, tea, formula, animal milk) or foods (such
as porridge or rice).
National recommendations for
infant feeding in the context of HIV
There are 2 main infant-feeding options that a
mother can choose: Breastfeeding or
replacement feeding with commercial infant
formula
Breastfeeding
Breastfeeding exclusively for the first 6 months of
life dramatically reduces risk of MTCT.
Women who opt to breastfeed should do so
exclusively for the first six months of life and then
introduce complementary foods while continuing
breastfeeding with prophylaxis to 12 months of
age. At 12 months:
Breastfeeding
If the child tested HIV-negative by PCR or is of
unknown HIV status- breastfeeding should
stop gradually (over a period of one month) if
a nutritionally adequate diet without breast
milk can be provided.
Breastfeeding cont
If the child is known to be HIV-infected- mothers
are strongly encouraged to continue breastfeeding
as per the recommendations for the general
population, that is up to 24 months or beyond.
Breastfeeding cont
Whether the child is HIV-infected or uninfected,
breastfeeding should only stop once a
nutritionally adequate and safe diet without
breast milk can be provided
Breastfeeding cont
A women who wishes to stop breastfeeding
before it is recommended should be
encouraged and supported to continue
breastfeeding for the first 12 months.
Replacement feeding
Replacement feeding means providing infants
with milk feeds that are not breast milk but
which meet an infants nutritional
requirements. These include commercial
infant formula milk;
Replacement feeding cont
However, during the first six months of life, the
only replacement feed that meets an infants
nutritional requirements is commercial infant
formula milk. If being replaced fed, an infant
should not receive any other food or liquid
besides replacement milks until 6 months of age
Discussion questions
If a client of yours wanted to stop
breastfeeding her baby at 7 months, how
would you advise her?
Answer
You should encourage and support her to
continue to breastfeed- while providing
complementary feeds-until the baby is 12
months old. If she still wants to stop
breastfeed her baby e.g, maybe she needs to
return to work, then you should support her
to do so safely.
Practice point
During the first six months of life, the only
replacement feed that meets an infants
nutritional requirements is commercial infant
formula milk.
Practice point cont
An infant fed on commercial infant formula milk
should neither breastfeed nor be given any
other food, water or other types of liquids
except for multivitamins or medicines when
indicated.
Practice point cont
Replacement feeding should not be
recommended unless the mother meets all the
conditions for safe exclusive replacement
feeding
Home modified animal milk should
considered as an option only when both
breast milk and commercial formula is not
available or affordable
Conditions needed for Safe Exclusive
Replacement Feeding
Mother known to be HIV-infected should only give
commercial infant formula milk as a replacement
feed to their exposed infants when specific
conditions are met:
Conditions needed for Safe Exclusive
Replacement Feeding cont
Safe water and sanitation are assured at the
household level and in the community; and
The mother, or caregiver can reliably provide
sufficient infant formula milk to support
normal growth and development of the
infants, and
Conditions needed for Safe Exclusive
Replacement Feeding cont
The mother or caregiver can prepare it cleanly
and frequently enough so that it is safer and
carries a low risk of diarrhoea and malnutrition;
and
Conditions needed for Safe Exclusive
Replacement Feeding cont
The mother or caregiver can, in the first six
months, exclusively give infant formula milk,
and
The family is supportive of this practice; and
The mother or caregiver can access health
care that offers comprehensive child health
services
Women who wish to stop
breastfeeding early
It is recommended that they should be encouraged
and supported to continue breastfeeding for the
first 12 months. Breastfeeding until at least 1 year
of age avoids many complexities associated with
early cessation and the challenge of providing a
safe and adequate diet without breast milk.
Commercial Infant Formula Milk
Women living with HIV for whom condition for
safe exclusive replacement feed with
commercial infant formula are met may prefer
to exclusively replaced feed with commercial
infant formula milk, for the first 6 months of
life and then introduce complementary foods
while continuing to formula milk feed to 12
months of age.
Home-modified Animal Milk in
Emergency Situations
In the event that a mother runs out of infant
formula for some unforeseeable reason
instruct her to temporarily feed her infant
home-modified animal milk. She attempt to
NOT re-use/dilute any remaining infant
formula, nor should she attempt to breastfeed
7 Steps in infant feeding counselling for
women with HIV Cont
Step 1: Explain the risk of MTCT and how to
reduce risks
Step 2: Discuss advantages and disadvantages of
infant feeding options starting with the mothers
preference
7 Steps in infant feeding counselling
for women with HIV Cont
Step 3: Explore with the mother her home and
family situation, discuss conditions needed for
replacement
7 Steps in infant feeding
counselling for women with HIV
Step 4: Recommend exclusive breastfeeding for 6
months and continued breastfeeding for up to 1
year
Step 5: Demonstrate to the mother how she
should breastfeed
7 Steps in infant feeding
counselling for women with HIV
Step 6: Explain when and how to stop
breastfeeding
Step 7: Provide follow-up counselling and
support
Key Points
Breastfeeding exclusively for the first 6 months
of life dramatically reduces risk of MTCT.
Women who breastfeed should do so
exclusively for the first six months of life and
then introduce complementary foods while
continuing breastfeeding with prophylaxis to 12
months of age. At 12 months:
Key points Cont..
If the child tested HIV-negative by PCR or is of
unknown HIV status breastfeeding should stop
gradually (over a period of one month) if a
nutritionally adequate and safe diet without breast
milk can be provided.
If the child is known to be HIV-infected- mothers are
strongly encouraged to continue breastfeeding as
per the recommendations for the general
population, that is, up to 24 months or beyond
Key points Cont
Whether the child is HIV-infected or uninfected,
breastfeeding should only stop once a
nutritionally adequate and safe diet without
breast milk can be provided
A woman who wishes to stop breastfeeding
before it is recommended should be encourage
and supported to continue breastfeeding for the
first 12 months
Key points Cont
During the first six months of life, the only
replacement feed that meets an infants
nutritional requirements is commrcial infant
formula milk.
An infant fed on commercial formula milk should
neither breastfeed nor be given any other food,
water or other types of liquids except for
mulitivamins or medicines when indicated
Key points Cont
Replacement feeding should not be
recommended unless the conditions for safe
exclusive replacement feeding are met
Home-modified milk and commercial formula
is not available or affordable.
END OF SLIDES
