Breastfeeding& special cases

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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

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  • Breastfeeding protects – below 6 months about 6 times more likely to die if not breastfed. BUT even at 6-8 months still twice as likely to die if not breastfed so continuing breastfeeding is important.
  • Breastfeeding& special cases

    1. 1. Exclusive Breast Feeding In Special Cases… “Doc… Should I or Shouldn't I?” “Madam, You Should or you Should not!”
    2. 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. 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. 4. Without ARVs <5% with ARV& guidelines <2% with ARV& guidelines
    5. 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. 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. 7. Mother: “Doc, should I breastfeed my baby, I am HIV+”? Doc: “Madam, AFASS”
    8. 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. 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. 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. 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. 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. 13. There’s always a tug of war… In a Doc’s mind! Between 5% minus 2% & 21%
    14. 14. Break a Myth Mixed feed is bad, so Is Abrupt Cessation of breast feeding good for the baby of a HIV+ mother?...
    15. 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. 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. 17. Remember, its not only mother, Anybody (with TB) around can infect the baby with Tuberculosis!
    18. 18. Break a Myth Is ATT drug concentration in breast milk sufficient for the baby?...
    19. 19. Break a Myth Is ATT drug concentration in breast milk sufficient for the baby?... NO
    20. 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. 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. 22. Break a Myth Does Pumping and dumping breast milk speed the elimination of alcohol from your body…
    23. 23. Break a Myth Does Pumping and dumping breast milk speed the elimination of alcohol from your body... NO
    24. 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
    25. 25. Break a Myth Will there be a “lack of milk”, if there are multiple babies born?...
    26. 26. Break a Myth Will there be a “lack of milk”, if there multiple babies are born?... NO
    27. 27. Thank you!

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