Leading transformational change: inner and outer skills
Breastfeeding& special cases.pptx
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
ARVs, HIV-
infected
mothers have
10 to 15%
chance of
passing HIV
through
breast milk,
and still lower
if on ARV
Non breast
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, Auto-
immune diseases
5. Breastfeeding protects
Especially the youngest infants
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
IFE 1/4
Risk of death if
breastfed is
equivalent to one.
Timesmorelikelytodie
ifnotbreastfed
Age in months
Studies
Quote infant
mortality
even up to
21% among
normal
population,
who are not
breastfed!
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
8. For Person Living with
HIV/AIDS
Work it out according to
AFASS
Advise Exclusive
Breast feed, just as for
a HIV-ve mother
If Baby is HIV+ due to
Prenatal Transmission
If Baby is HIV-ve or
Baby’s status is not
known
Acceptable
Feasibility
Affordable Sustainable
Safe
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 for mother,
compulsorily
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!
5% minus 2% & 21%
Between
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 takes 2-3 hrs,
depending on your body weight.
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
breast milk
25.
26.
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