In this ppt, I have discussed some special cases when a mother may be unsure if and how to breast feed her infant. In these special conditions, what should a doctor advise

1. Exclusive Breast
Feeding In Special
Cases…
“Doc… Should I or Shouldn't I?”
“Madam, You Should or you Should not!”

2. We Will Look Into Following
Cases In Brief:
 PLHA Mother
 Mother with Active Pulmonary Tuberculosis
 Mother who fails to quit Smoking or/& Alcohol
 Mother on Anti cancerous Chemotherapy
 Infant with Diarrhea
 Infant with ARI
 Multiple pregnancies
 Any other condition you want to think of?

3. Mother: “Doc, should I breastfeed my
baby, I am HIV+”?
Without
Non breast
ARVs, HIV-
infected
mothers have
10 to 15%
chance of
passing HIV
through
breast
milk, and still
lower if on
ARV
feeders are at
high risk of:
Malnutrition, ARI,
Diarrhea- All
leading causes of
deaths!
Baby may
survive, only to
suffer later in life
from
DM, Allergies, Au
to- immune
diseases

4. Without ARVs
<5% with ARV&
guidelines
<2% with ARV&
guidelines

5. Breastfeeding protects
Especially the youngest infants
IFE 1/4
Times more likely to die
if not breastfed
Studies
Quote infant
mortality
even up to
21% among
normal
population, w
ho are not
breastfed!
Age in months
WHO Collaborative Study Team. Effects of breastfeeding on infant and child mortality due to
infectious disease in less developed countries: a pooled analysis. The Lancet 2000;355:451-5
Risk of death if
breastfed is
equivalent to one.

6. Risks of not breastfeeding
Particular high risk of:
Diarrhoea and ARTI
Malnutrition
Can lead to:
- Ill health
- Poor development
- Affect can last for life
- DEATH
Aceh

7. Mother: “Doc, should I breastfeed my
baby, I am HIV+”?
Doc: “Madam, AFASS”

8. For Person Living with
HIV/AIDS
 If Baby is HIV+ due to
Prenatal Transmission
 If Baby is HIV-ve or
 Baby’s status is not
known
 Advise Exclusive
Breast feed, just as for
a HIV-ve mother
Acceptable
Feasibility
 Work it out according to
AFASS
Safe
Affordable
Sustainable

9. So to summarize:
 Ask for:
 HIV status of the child
 Viral load in the mother- higher the maternal plasma
HIV load (>3.7 log 10 copies/mL), higher the risk!
 CD4 Count< 200/ ml
 Breast health
 ARV therapy
 Motivation& SE Status of the mother& family to Assess
AFASS
 Whatever you advise the mother to do, do it exclusively

10.  You, as doc decide according to
(AFASS):
 Breastfeed with ARV intervention
or,
 Avoid All breastfeeding,
 Continue
ARV
mother, compulsorily
for
 Start
prophylactic ARV for
infant: Daily NVP un till 1 week
after
Stopping
Breast
feed, compulsorily
 For non breast feeders, Start
prophylactic ARV for infant:
Daily NVP till 4- 6 weeks of
age, compulsorily

11. Moral of the Story:
 HIV+ Mothers should exclusively breastfeed their
infants for the first 6 months of life, introducing
appropriate complementary foods thereafter, and
continue breastfeeding for the first 12 months of
life.
 Mothers known to be HIV-infected who decide to
stop breastfeeding at any time should stop
gradually within one month.
 Infants should continue prophylaxis for one week
after breastfeeding is fully stopped.

12.  Alternatives to breastfeeding include:
 For infants less than six months of age:
 Commercial infant formula milk as long as AFASS is met,
 Expressed, heat-treated breast milk
 NO to Home-modified animal milk in the first six months
of life.
 All children need complementary foods from six
months of age.

13. There’s always a tug of
war… In a Doc’s mind!
Between
5% minus 2%
&
21%

14. Break a Myth
Mixed feed is bad, so Is Abrupt Cessation of
breast feeding good for the baby of a HIV+
mother?...

15. Break a Myth
Mixed feed is bad, so Is Abrupt Cessation of
breast feeding good for the baby of a HIV+
mother?... NO

16. Baby of a Mother with Active
Pulmonary Tuberculosis
 Continue exclusive breast feeding till 6 months of age,&
thereafter as in normal population.
 Start ATT for mother immediately… Mother will be non
infective within 2 months of regular ATT
 Preventive Chemotherapy for baby- INH 5mg/kg/day* 6
months
 Use face mask while around the baby, till 2 months after
starting ATT
 BCG Vaccine at birth… Something is better than Nothing!
 Re- immunize with BCG after stopping Preventive
Chemotherapy

17. Remember, its not only
mother, Anybody (with TB) around can
infect the baby with Tuberculosis!

18. Break a Myth
Is ATT drug concentration in breast milk sufficient
for the baby?...

19. Break a Myth
Is ATT drug concentration in breast milk sufficient
for the baby?... NO

20. Baby of a Mother who fails
to quit smoking/ alcohol!!
 QUIT SMOKING & ALCOHOL!
 It is better to exclusively breast feed the baby than to
top feed her even if her mother smokes!
 Breast milk does pass nicotine to the baby, but more
harm happens due to passive smoking& the smoke dust
which
invisibly
“clings”
to
your
body, hands, clothes, hair& even beddings!
 Remember, Anybody smoking in the house would leave
the smoke dust to harm the baby

21. Baby of a Mother who fails
to quit smoking/ alcohol!!
 Alcohol passes freely into mother's milk & peaks about
30 to 60 minutes after consumption, 60 to 90 minutes
when taken with food.
 Avoid breast-feeding until alcohol has completely
cleared breast milk. This typically
hrs, depending on your body weight.
takes
2-3
 So, If you plan to drink alcohol, consider having a drink
just after breast-feeding so that the alcohol begins to
clear your breast milk during the natural interval
between breast-feeding sessions.
 Remember, infant’s hepatic system is immature till 2- 3
months age, even small amounts of alcohol can be
detrimental!

22. Break a Myth
Does Pumping and dumping breast milk speed
the elimination of alcohol from your body…

23. Break a Myth
Does Pumping and dumping breast milk speed
the elimination of alcohol from your body... NO

24. Breast feeding multiple
pregnancies
 Do Not put off breastfeeding because you're having
multiple babies.
 It's possible to breastfeed twins and even triplets. Many
are breastfed until they are weaned.
 Multiple babies are more likely to be born
prematurely, so there are even more benefits to
breastfeeding.
 Breast milk is better for premature babies as their gut is
immature and it's easier for them to tolerate and digest

27. Break a Myth
Will there be a “lack of milk”, if there are multiple
babies born?...

28. Break a Myth
Will there be a “lack of milk”, if there multiple
babies are born?... NO

29. Thank you!