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