INFANT AND YOUNG CHILD

FEEDING IN HIV
By:
Dr. Nicholas Ochieng &
Faith Muthoki
KMTC-Nairobi
A breastfeeding mother

2
 Purpose of this lesson

To promote good infant and young child feeding

practices to improve counseling skills on infant
feeding to mothers who are HIV positive

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 Learning Objectives
By the end of this lesson, learners should be able
to:
•Describe optimal infant and young child feeding
practices.
•Explain infant feeding options for HIV-infected
mothers.
•Educate women, care givers, and their families on
infant feeding in cases of HIV infected mothers.

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 Session Outline

• Overview of a comprehensive PMTCT of HIV

approach
• Making informed choices and AFASS criteria
• Description of infant feeding practices
• Counseling & educating of HIV-infected
mothers on good feeding practices

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 Comprehensive PMTCT Approach

Prevention of
Obstetrical HIV
care transmission

Government VCT
Maternal & child Organizations
health services Community
Private sector

Treatment
Counseling
Infant feeding
6
PMTCT Entry Points for Infant Feeding
Pregnancy Post-natal period
Counsel on infant Counsel on support infant
feeding options and feeding options.
self-care including Prevent and treat
nutrition and breastfeeding problems.
preparation for the
future. Treat infant thrush and oral
lesions.
Counsel on complementary
feeding and breastfeeding
cessation.
Counsel on preventing re-
infection by HIV. 7
A young child self-feeding

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 Infant Feeding Counseling
HIV negative Unknown status HIV positive
Exclusive Exclusive Exclusive
breastfeeding breastfeeding breastfeeding or
exclusive
replacement feeding
Early cessation of B/F
Management of
breastfeeding
problems
Complementary Complementary Complementary
feeding feeding
feeding
Prevention Prevention Prevention
ART 9
 Making informed Choices
HIV and breastfeeding policy supports
breastfeeding for infants of women without
HIV infection or of unknown status and the
right of women infected with HIV who are
informed of their serostatus to choose an infant
feeding strategy based on full information about
the risks and benefits of each alternative.

UNAIDS/WHO/UNICEF

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 WHO Recommendations on Infant
Feeding for HIV-Positive Women

HIV-negative or unknown HIV status women

• Exclusive breastfeeding for 6 months and continued
breastfeeding for 2 years or beyond
HIV-positive women
• The most appropriate infant feeding option for HIV-
exposed infant depends on individual circumstances,
including consideration of health services, counselling
and support
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A happy healthy baby

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 AFASS CRITERIA
• AFASS is an acronym, meaning Acceptable,
Feasible, Affordable, Sustainable and Safe
• It is intended to help HCWs and mothers to
think about specific conditions that are
needed for babies requiring replacement of
formula feeds
• Mothers are asked a set of questions and
depending on the responses, Yes or No, she
may qualify or not be fit to use formula feeds
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AFASS Criteria for determining if a parent can
give formula feeds successfully
NO YES YES

uestions
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able
have
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able totoprepare
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problem
problemwith with clean
cleansafe
safe totobuy enough
buy enough feeds
feedsforforthe
the
your family
your family water, keep
water, keep infant
infantformula
formula child
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every
ororfriends
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utensilsclean,
clean, ororanimal
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hoursbothboth
you YES
youdo doNOT
NOT use
useaacup
cupand
and milk?
milk? day
dayand
and
breastfeed?
breastfeed? spoon?
spoon? night?
night?
YES NO NO NO

Support
Counsel mother on exclusive breastfeeding. replacement
feeding with
formula or
animal milk.
AFASS: stands for Acceptable, 14
Feasible, Affordable. Sustainable & Safe
 Algorithm on
Infant Feeding Options and Actions
Counsel all HIV-positive pregnant women on the risks of MTCT and two
feeding options: exclusive breastfeeding or exclusive replacement feeding.
Determine whether replacement feeding is AFASS.

Replacement feeding Replacement feeding

not AFASS AFASS

Counsel on exclusive Counsel on exclusive

breastfeeding options replacement feeding options

Exclusive Heat-treating Wet nursing by Commercial Home-modified

breastfeeding breastmilk HIV-negative infant formula animal milk
by mother (cup feeding) woman (by cup) (by cup)

Counsel on optimal Counsel on Counsel on optimal Counsel and Counsel and

breastfeeding, expressing, breastfeeding and demonstrate demonstrate correct
breast/infant mouth heat treating, wet nurse remaining correct and and hygienic mixing;
health, and and cup HIV negative. hygienic mixing. provide 15
cessation. feeding. multivitamins.
Which type of feeding is this?

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 Other Infant Feeding Options
for HIV-Positive Mothers
The available options for infant feeding are:
•Expressing and heat-treating breastmilk.
•Wet nursing by an HIV-negative woman
•Feeding commercial infant formula
•Feeding home-modified animal milk

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 Exclusive Breastfeeding Practices
• Give the infant only breast milk.
• Initiate breastfeeding within 1 hour of birth.
• Make sure the infant is attached and positioned
correctly at the breast.
• Breastfeed frequently as the baby demands.
• Continue breastfeeding even when the mother or infant
is sick.
• Express breast milk & give using cup and spoon if
baby not able to breast feed directly.

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Additional Breastfeeding Practices
for HIV-Positive Mothers
• Stop breastfeeding from the infected breast and
seek treatment.
• Seek medical care when ill.
• Check the infant’s mouth for sores and seek
treatment if necessary.
• Transition to replacement feeding when it
becomes AFASS.

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 Babies require small frequent
meals in softer & semi-fluid form

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 Expressing and Heat-Treating
Breastmilk
• The breastmilk is heated to 62.5°C for 30 minutes or
boiled briefly and cooled immediately.
• Heat destroys HIV.
• The milk retains some nutritional benefits but loses
anti-infective factors.
• The milk should be stored in a cool place.
• The milk should be fed to the infant in a cup, not a
bottle.
• This is time consuming and difficult to maintain.
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 Role of Wet nursing
by an HIV-Negative Woman
• Who is a Wet Nurse? Any woman who breast feeds
and cares for another’s child
• The wet nurse must be confirmed HIV negative and
understand the importance of safe sex.
• The wet nurse must follow optimal breastfeeding
practices.
• The wet nurse must be able to feed the infant
frequently, including at night.
Q. Can this be practiced in Kenya? 22
Artificial/Commercial Infant Formulas
• Requires support from the health care workers
and the community
• Requires clean water, sterilized utensils, and
correct hand washing
• Requires a steady supply of commercial or home-
prepared formula—20 kg over 6 months
• Requires correct mixing in order to be successful

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ARTIFICIAL OWDERED BABY
MILK & SUPLEMENTS
Examples of commercial baby feeds in Kenya
include:
•Lactogen
•Cerelac
•NAN
Milk supplements for bigger children are:
NIDO, MIKSI, HIGHLAND & KLIM powdered
milks

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Artificial baby feeds

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Artificial baby feeds cont

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 Home-Modified Animal Milk
The commonly used animal milks are – Cow’s,
goat’s, sheep, camel or buffalo’s.
•Requires support from the health system and
community
•Requires clean water, sterilized utensils, and
correct hand washing
•Requires a reliable and affordable supply of
animal milk
•Requires correct mixing with clean water, boiling,
adding sugar, etc. 27
 When to stop Breastfeeding
• Gradually reduce the frequency of breastfeeding.
• Increase breastfeeding intervals to every 4–6 hours.
• Gradually cut out one or more night feeds.
• Teach the infant to drink expressed breast milk from
a cup.
• Cup feed expressed breast milk in between
breastfeeds.
• Avoid breastfeeding the infant to sleep.
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 Feeding the Non-breastfed Child
6−24 Months Old

Age Kcal Feeding frequency

Meals: 4−5 times a day

6−8 months 600/day
Snacks: 1−2 times a day
9−11 Meals: 4−5 times a day
700/day
months Snacks: 1−2 times a day
12−23 Meals: 4−5 times a day
900/day Snacks: 1−2 times a day
months
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 Complementary Feeding
This is foods given to complement breastfeeding

The recommendations are:

•Feed the child in a separate bowl.

•Interact with the child during feeding
(responsive feeding).

•Practice good hygiene and safe food

preparation.

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Picture of complementary feeds

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 Feeding the Sick Child
• Increase breastfeeding or replacement AND
complementary feeding during and after illness
• Increase fluids (including breastmilk) during and
after illness.
• For diarrhea, give zinc supplementation for 10−14
days according to WHO protocol.
• For diarrhea, give provide low osmolarity ORS to
children over 6 months old.
• Seek help if illness persists or if the child is unable
to eat after several days. 32
 Summary
• HIV-positive women must weigh the benefits and
risks of breastfeeding before making infant
feeding choices.
• Alternatives to breastfeeding must meet AFASS
criteria.
• Women need good counseling and support to
select the best feeding options and follow
optimal practices.

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 Feeding by spoon
spoon

Thank You 34