Different Methods of Feeding Baby with HIV Positive Mother

Option 1: Exclusive breastfeeding with early weaning or when replacement feeds meet AFASS criteria.

• Breastfeeding is discontinued after the baby is able to be weaned to a nutritionally adequate replacement food, which is AFASS (acceptable, feasible, affordable, sustainable, and safe).
• For a limited time, the baby receives just breast milk until AFASS criteria are met or it is safe to introduce other foods (about 6 months).

Benefits

• Breastfeeding exclusively and weaning by 6 months lower the risk of HIV transmission.
• During the vital early months of life, the mother provides the infant with all of the benefits of nursing (best diet for baby, protection from illness, optimal growth and development).
• The risk of infection from using a feeding bottle is avoided.

Risks and Disadvantages

• Early weaning adds to the mother's workload because she must make a breast milk substitute.
• Feeding with a breast milk replacement is costly.
• Breast milk substitute feeding raises the baby's risk of infection and poor health.
• Both the mother and the infant struggle with early weaning. For a few days, the mother's breast will be painfully engorged.
• The mother may face criticism and stigma if she weans her child too soon.
• AFASS standards may be challenging to meet.

Option 2: Expressing breast milk and Heat treating it before feeding

HIV in breast milk is killed by heat treatment. The mother extracts and heats her breast milk before feeding it to the infant in a cup.

Methods to Heat Breast Milk

• Flash boiling: Bring the milk to a boil quickly, then chill it before feeding it to the infant.
• Holder (prescriptive) pasteurization
  • Fill a clean glass jar halfway with breast milk and screw on the lid.
  • Fill a one-liter aluminum pot halfway with water and bring it to a boil.
  • When the water begins to boil, remove the saucepan from the heat and immediately immerse the jar of breast milk in the boiling water. Allow the jar of breast milk to stand in hot water for 15 minutes.
  • If the jar is not opened or handled, pasteurized milk can be safely stored at room temperature for up to 12 hours.

Benefits

There is almost no risk of transmitting HIV.

• Breast milk provides nutritional benefits to the newborn. Although boiling removes some of the qualities of breast milk, it is still preferable to formula made from animal milk for newborns.
• The risk of infection is lower with cup feeding than with bottle feeding.

Risk or Disadvantages

• The mother must devote a significant amount of time to expressing breast milk, heating it, and cleaning the container and cup.
• Every day, the mother needs to spend money on gasoline to heat and treat breast milk.
• The baby should be stigmatized for not being breastfed directly.
• Some countries have cultural impediments to this practice.

Option 3: Wet nursing by a woman who is HIV negative

The family finds a woman to breastfeed the infant who tests HIV negative and is unlikely to be exposed to future HIV infections. Because the danger of transmission to the infant is very high if she becomes infected while breastfeeding, the woman is given instructions on how to conduct safe sex.

Benefits

• Breastfeeding by another woman provides nearly all of the same protective benefits to the newborn as breastfeeding by the mother.
• As long as the wet nurse does not get infected, there is no risk of HIV transmission during feeding.
• The use of a feeding bottle eliminates the possibility of infection.

Risk or Disadvantages

• It may be difficult to ensure that another individual is HIV negative and will remain so.
• To keep their relationship tight, the mother must spend concentrated time with her kid.
• It is not always simple to locate a lady prepared to take on the duty of wet nursing.
• In some nations, there are cultural hurdles to this technique.
• The mother may be stigmatized for not nursing her own child.
• If the infant is born with HIV, there is a very small chance that breastfeeding will spread the infection to the wet nurse if she has a cracked, bleeding nipple or other breast ailments.
• If the mother does not breastfeed, she forfeits the child spacing benefits of breastfeeding.

Option 4: Replacement feeding with commercial infant formula.

From birth, the infant is fed commercial infant formula (no breastfeeding).

Option 5: Replacement feeding with home modified animal milk

From birth, the infant is fed adequately adjusted animal milk (no breastfeeding).

Benefits of replacement feeding

• There is no risk of HIV transmission through nursing (although the baby could have acquired HIV infection during pregnancy or birth). Other individuals besides the mother can help feed the baby.
• Mother and child can be separated. If the mother becomes ill or dies, the infant's feeding is not interrupted.
• Other persons outside the mother can form strong attachments to the infant.

Risks and disadvantages

• Safe replacement feeding requires:
  • A consistent and reasonable supply of the chosen substitute food, as well as a secure location, to keep it.
  • Commercial infant formula with appropriate nutrition or home-modified animal milk.
  • To prepare the replacement food, use clean water.
  • A sufficient supply of gasoline.
  • Good hygiene and a favorable situation.
  • It's time to prepare and feed the baby's replacement food.
  • Knowledge of how to properly modify cow milk, or the ability to read the directions on the infant formula box chosen.
• Anti-infective antibodies are lacking in breast milk replacement.
• Breast milk compensates for a shortage of growth hormones.
• The cost of purchasing enough breast milk substitutes to feed an infant can take a significant percentage of a family's income.
• Improperly prepared breast milk replacements might result in diarrhea and/or malnutrition.
• Women who do not breastfeed lose the benefit of child spacing and require access to cheap and adequate family planning services.
• Infants who do not breastfeed may not receive appropriate psychosocial stimulation and may not form strong bonds with their moms.
• Women who do not breastfeed may face shame and marginalization in areas where nursing is the norm.