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

 ADVANTAGES

• There is no risk of transmitting HIV

• Home-modified animal milk may be
cheaper than commercial infant
formula, (if a mother has milk-
producing 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 cow’s milk; full

fat cow’s 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 cow’s milk

• buffalo or goat’s 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 added…
makes 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 cow’s 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 cow’s 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 child’s 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 infant’s
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 .. too much..

kidney overload not enough nutrient
w/ minerals not grow well
&protein waste
 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
baby’s 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 cow’s or
goat’s 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