Unit 6 infant feeding and pmtct
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Unit 6 infant feeding and pmtct

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Unit 6 infant feeding and pmtct Unit 6 infant feeding and pmtct Presentation Transcript

  • Infant feeding and PMTCT
  • Session Objective and content
    • Objective: At the end of the session the participant should be able
        • Discuss issues related to infant feeding and PMTCT
        • Discuss National guidelines with regard to HIV and infant feeding
    • Content
        • Benefits of breastfeeding
        • Breast milk transmission of HIV – risk and risk factors
        • Infant feeding options
        • National guidelines on infant feeding
  • MTCT and Breastfeeding
    • ARV treatment and prophylaxis can reduce MTCT of HIV by at least 50%.
    • ARV prophylaxis does not provide long-term protection for breastfed infant.
    • Without interventions (ARV prophylaxis or therapy)
      • 5 – 15% of infants born to mothers infected with HIV can become HIV-infected during breastfeeding.
  • Outcomes of Infants Born to Women with HIV Infection 5–10 infants infected during pregnancy About 15 infants infected during labour and delivery 5 –15 infants infected during breastfeeding 25–40 infants will be HIV-infected 60 – 75 infants will not be HIV-infected 100 infants born to women who are HIV infected, without any interventions
  • Infant Feeding Options
    • Breast milk feeding options
      • Option 1: Exclusive breastfeeding
      • Option 2: Exclusive breastfeeding with early cessation
      • Option 3: Wet nursing
      • Option 4: Expressing and heat-treating breastmilk
    • Replacement feeding options
      • Commercial infant formula
      • Home prepared formula
  • Infant Feeding Counselling Step 3 Explore with the mother her home and family situation. Offer to discuss with her partner before she decides and acknowledge her right to change her decision. Step 4 Help the mother choose an appropriate feeding option. Step 5 Demonstrate how to practise the chosen feeding option. Provide take-home flyer. How to practise exclusive breastfeeding How to practise other breastmilk options How to practise replacement feeding Step 6  Provide follow-up counselling and support.  Repeat Steps 3-5 if the mother changes her original choice. Explain when and how to stop breastfeeding early. Postnatal Visits  Monitor growth.  Check feeding practices and whether any change is desirable.  Check for signs of illness. Discuss feeding 6 to 24 months. Step 2 Explain the advantages and disadvantages of different feeding options starting with the mother's initial preference. Step 1 Explain the risks of MTCT.
  • Exclusive Breastfeeding
    • Mother gives her infant only breastmilk -----not even water, except for drops or syrups consisting of vitamins, mineral supplements, or medicines (when indicated).
  • Exclusive Breastfeeding
    • Advantages
      • Easily digestible
      • Nutritious, complete
      • Always available
      • No special preparation needed
      • Reduces mother’s risk of breast cancer
      • Increases birth spacing
      • Protects from diarrhoea, pneumonia, other infections/diseases
      • Compared to mixed feeding, lowers risk of HIV
      • Promotes bonding
    • Disadvantages
      • R isk of passing HIV to baby
      • Increased risk if mother has breast infection
      • ?Increases risk of death in immunosu p pressed women
      • Mother requires additional calories to support breastfeeding
      • Requires feeding on demand
  • Management of Early Cessation
    • Express enough breastmilk to prevent engorgement and reduce discomfort.
    • Encourage early practice of cup or cup and spoon feeding with expressed breast milk.
    • Enlist family members to assist with feeding and comforting of the infant.
    • Alternate warm/cold compresses to reduce breast discomfort and swelling.
    • Provide assurance that challenges are time-limited.
  • Management of Mastitis
    • Mastitis – a sudden, painful inflammation of the breast tissue surrounding the milk ducts.
    • CARESS model of management:
      • C compresses (hot and cold)
      • A antibiotics (if necessary)
      • R rest
      • E effective removal of breastmilk
      • S stress identification and management
      • S support and follow-up
  • Replacement Feeding
    • Commercial infant formula
    • Home-modified formula with micronutrient supplements
    • Cup feeding is recommended over bottle feeding
  • Replacement Feeding
    • Commercial infant formula
    • Home-modified animal milk formula
      • Consider
      • Cost and sustained availability
      • Reliable sources of animal milk products and multi-nutrient supplements
      • Education in safe preparation and storage
  • Replacement feeding
    • Advantages
      • No risk of transmitting HIV to the infant
      • Contains most nutrients needed by infant
      • Other family members can help feed the infant
    • Disadvantages
      • Expensive
      • Contains no antibodies to protect infant
      • Can increase risk of diarrhoea
      • May not contain all the nutrient requirements for the infant
      • Can be more difficult to digest
      • Must be carefully prepared and stored
  • Kenya infant feeding Policy
    • Right of parents of HIV-exposed infants to choose how and what to feed infants following counselling.
    • Exclusive breastfeeding for first 6 months for mothers who are HIV-negative and mothers of unknown HIV status.
    • Replacement feeding where
      • A --Acceptable
      • A --Affordable
      • F --Feasible
      • S --Sustainable
      • S --Safe