Replacement Feedings in the First Six Months for HIV+

Adapted from IYCF: An Integrated Counseling Course 2005

Replacement feeding
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 food.

Adequate replacement feeding

is needed
throughout the time the child is at greatest risk of malnutrition - until the child is at least two years old. if an infant is not getting breast milk,

up to two years of age or more , milk should be part of the diet

 Replacement feeding must be: acceptable, feasible, affordable, sustainable and safe. AFASS

The mother will also need : a source of milk, water, soap, fuel and utensils to prepare the replacement feeds, need extra time.

ADVANTAGES AND DISADVANTAGES OF COMMERCIAL INFANT FORMULA

I. ADVANTAGES

Giving only formula carries no risk of transmitting HIV to the baby

Most of the nutrients a baby needs have already been added to the formula.
Other responsible family members can help feed the baby.

2. DISADVANTAGES

Formula does not contain antibodies that protect a baby from infections.

A formula-fed baby is more likely to get seriously sick from diarrhoea, chest infections and malnutrition, especially if the formula is not prepared correctly.

DISADVANTAGES OF COMMERCIAL FORMULA

A mother should stop breastfeeding completely or the risk of transmitting HIV will continue.

People may wonder why a mother is using formula instead of breastfeeding, and this could cause them to suspect she is HIV- positive.

DISADVANTAGES OF COMMERCIAL FORMULA

Mother needs fuel, clean water, utensils, soap etc. Time consuming Expensive Have to teach baby to drink from cup Mom may get pregnant soon

ADVANTAGES AND DISADVANTAGES OF HOME-MODIFIED ANIMAL MILK

1. ADVANTAGES There is no risk of transmitting HIV Home-modified animal milk may be cheaper than commercial infant formula, (if a mother has milkproducing animals) Other responsible family members can help feed the baby.

DISADVANTAGES OF HOME-MODIFIED ANIMAL MILK

2. DISADVANTAGES
Animal milk is hard for babies to digest does not contain all the nutrients that babies need. need to be mixed with water and sugar in exactly the right amounts. need to have a micronutrient supplement.
A baby is more likely to get sick from diarrhoea, chest infections, and malnutrition if he is fed home-modified animal milk especially if it is not prepared correctly.

DISADVANTAGES OF HOME-MODIFIED ANIMAL MILK

A mother should stop breastfeeding completely. People may ask why time to prepare

Must be made fresh each feeding time (unless she has a refrigerator) Needs utensils , fuel etc
May get pregnant soon

DISADVANTAGES OF HOME-MODIFIED ANIMAL MILK

A baby needs about 15 litres of milk per month for the first 6 months needs to buy sugar and micronutrient supplement, which will cost approximately P 50.00.
The baby will need to drink from a cup.

Locally available milks

There are different kinds of milk available. There are possible and unsuitable to use for replacement feeding.

Locally available milks

fresh liquid milks (low fat cows milk; full fat cows milk; semi skimmed milk; sterilized milk) commercial formulas other powdered milks (coffee creamers; powdered milks for older children and adults) other tinned milks (evaporated milk; condensed milk) miscellaneous products (juices, tea, sugary drinks).

Group 1

Fresh liquid milk

whole cows milk buffalo or goats milk. available in cartons or bottles or people may collect it in their own containers.
This milk needs to be modified for an infant, but it can be in the POSSIBLE group.

Fresh liquid milk

fresh milk

diluted

cream removed.

Skimmed milk has the fat (cream) removed the energy level is low. most of the vitamins A and D are also removed because they are in the milk fat (UNSUITABLE).

Fresh liquid milk

Semi-skimmed milk, contains 2% fat, Milk normally contains about 3.5-4%. A baby may need additional energy if semi-skimmed milk is used it is UNSUITABLE.

Group 2

Tinned liquid milks

Evaporated milk
is sterilized, has some of the water removed, is sealed in cans. sometimes the fat content is altered. processing destroys vitamin C and folate but extra vitamins may be added. diluted with water, it has a similar composition to fresh milk (POSSIBLE )

Tinned liquid milks

Condensed milk
has some of the water removed but a lot of sugar has been addedmakes bacteria grow more slowly when the tin is opened. the fat level may be reduced. This balance of fat and sugar in condensed milk make it very different from evaporated milk (UNSUITABLE )

Group 3

Powdered Milk

Full cream powdered milk is whole cows milk that is dried to a powder much vitamin C and some B vitamins are lost but the protein, fat, minerals and most of the vitamins A and D remain
It can be made up with water to the strength of whole fresh milk (POSSIBLE).

Powdered Milk

Dried skimmed milk has the fat and fat

soluble vitamins removed. (UNSUITABLE). Most modified powdered milks, such as creamers used for whitening tea or coffee or various filled milks, may have the animal fat removed replaced with vegetable fat. sugar may also be added and ingredients to make it dissolve easily (UNSUITABLE).

Group 4 Commercial infant formula

Commercial infant formula usually made from cows milk the fat removed dried to a powder. another form of fat (often vegetable fat), sugar and micronutrients are added. needs only water added before use.

Group 5

Miscellaneous

Other foods and drinks are sometimes used to feed infants under six months of age- for example, juices, tea, sugary drinks.

These fill a childs stomach and may reduce his appetite for nutritious foods.
They are not suitable as an alternative to food for any young child.

How milks can be modified to make replacement feeds

Possible milks for infants are : full cream milks
fresh liquid milk powdered milk or tinned evaporated milk some commercial formulas.

How milks can be modified to make replacement feeds

In full strength full cream milk, the level of protein and some minerals is too high difficult for an infants immature kidneys to excrete the extra waste.

Needs some modification to make the proportions more appropriate.

How milks can be modified to make replacement feeds

Commercial formula
has been modified the proportions of different nutrients are appropriate for infant feeding micronutrients have been added . Formula needs only to be mixed with the correct amount of water.

Commercial formula

Proportions of nutrients in either commercial or home-prepared formula can be altered BUT their quality cannot be made the same as breast milk. The immune factors and growth factors present in breast are NOT present in animal milk or formula, and they CANNOT be added

Commercial formula

dilute them with water - makes the energy too low add sugar to increase the energy. Add water
too little .. kidney overload w/ minerals &protein waste too much.. not enough nutrient not grow well

How milks can be modified to make replacement feeds

Fresh animal milk

needs to be boiled to make the protein easier to digest, and less likely to irritate and damage the babys intestinal mucosa. Processed milk (such as tinned liquid or powdered milk) has already been heat-treated.

How milks can be modified to make replacement feeds

Sheep or buffalo milk contains more fat than cows or goats milk so they need to be diluted more, and less sugar is needed

RECIPES FOR HOME-PREPARED FORMULA Milk is diluted, sugar added Needs accurate scoop Needs additional micronutrients May not be easily available iron, zinc,Vit C, folic acid TIME , PATIENCE