Unit 6 infant feeding and pmtct


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Unit 6 infant feeding and pmtct

  1. 1. Infant feeding and PMTCT
  2. 2. Session Objective and content <ul><li>Objective: At the end of the session the participant should be able </li></ul><ul><ul><ul><li>Discuss issues related to infant feeding and PMTCT </li></ul></ul></ul><ul><ul><ul><li>Discuss National guidelines with regard to HIV and infant feeding </li></ul></ul></ul><ul><li>Content </li></ul><ul><ul><ul><li>Benefits of breastfeeding </li></ul></ul></ul><ul><ul><ul><li>Breast milk transmission of HIV – risk and risk factors </li></ul></ul></ul><ul><ul><ul><li>Infant feeding options </li></ul></ul></ul><ul><ul><ul><li>National guidelines on infant feeding </li></ul></ul></ul>
  3. 3. MTCT and Breastfeeding <ul><li>ARV treatment and prophylaxis can reduce MTCT of HIV by at least 50%. </li></ul><ul><li>ARV prophylaxis does not provide long-term protection for breastfed infant. </li></ul><ul><li>Without interventions (ARV prophylaxis or therapy) </li></ul><ul><ul><li>5 – 15% of infants born to mothers infected with HIV can become HIV-infected during breastfeeding. </li></ul></ul>
  4. 4. 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
  5. 5. Infant Feeding Options <ul><li>Breast milk feeding options </li></ul><ul><ul><li>Option 1: Exclusive breastfeeding </li></ul></ul><ul><ul><li>Option 2: Exclusive breastfeeding with early cessation </li></ul></ul><ul><ul><li>Option 3: Wet nursing </li></ul></ul><ul><ul><li>Option 4: Expressing and heat-treating breastmilk </li></ul></ul><ul><li>Replacement feeding options </li></ul><ul><ul><li>Commercial infant formula </li></ul></ul><ul><ul><li>Home prepared formula </li></ul></ul>
  6. 6. 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.
  7. 7. Exclusive Breastfeeding <ul><li>Mother gives her infant only breastmilk -----not even water, except for drops or syrups consisting of vitamins, mineral supplements, or medicines (when indicated). </li></ul>
  8. 8. Exclusive Breastfeeding <ul><li>Advantages </li></ul><ul><ul><li>Easily digestible </li></ul></ul><ul><ul><li>Nutritious, complete </li></ul></ul><ul><ul><li>Always available </li></ul></ul><ul><ul><li>No special preparation needed </li></ul></ul><ul><ul><li>Reduces mother’s risk of breast cancer </li></ul></ul><ul><ul><li>Increases birth spacing </li></ul></ul><ul><ul><li>Protects from diarrhoea, pneumonia, other infections/diseases </li></ul></ul><ul><ul><li>Compared to mixed feeding, lowers risk of HIV </li></ul></ul><ul><ul><li>Promotes bonding </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>R isk of passing HIV to baby </li></ul></ul><ul><ul><li>Increased risk if mother has breast infection </li></ul></ul><ul><ul><li>?Increases risk of death in immunosu p pressed women </li></ul></ul><ul><ul><li>Mother requires additional calories to support breastfeeding </li></ul></ul><ul><ul><li>Requires feeding on demand </li></ul></ul>
  9. 9. Management of Early Cessation <ul><li>Express enough breastmilk to prevent engorgement and reduce discomfort. </li></ul><ul><li>Encourage early practice of cup or cup and spoon feeding with expressed breast milk. </li></ul><ul><li>Enlist family members to assist with feeding and comforting of the infant. </li></ul><ul><li>Alternate warm/cold compresses to reduce breast discomfort and swelling. </li></ul><ul><li>Provide assurance that challenges are time-limited. </li></ul>
  10. 10. Management of Mastitis <ul><li>Mastitis – a sudden, painful inflammation of the breast tissue surrounding the milk ducts. </li></ul><ul><li>CARESS model of management: </li></ul><ul><ul><li>C compresses (hot and cold) </li></ul></ul><ul><ul><li>A antibiotics (if necessary) </li></ul></ul><ul><ul><li>R rest </li></ul></ul><ul><ul><li>E effective removal of breastmilk </li></ul></ul><ul><ul><li>S stress identification and management </li></ul></ul><ul><ul><li>S support and follow-up </li></ul></ul>
  11. 11. Replacement Feeding <ul><li>Commercial infant formula </li></ul><ul><li>Home-modified formula with micronutrient supplements </li></ul><ul><li>Cup feeding is recommended over bottle feeding </li></ul>
  12. 12. Replacement Feeding <ul><li>Commercial infant formula </li></ul><ul><li>Home-modified animal milk formula </li></ul><ul><ul><li>Consider </li></ul></ul><ul><ul><li>Cost and sustained availability </li></ul></ul><ul><ul><li>Reliable sources of animal milk products and multi-nutrient supplements </li></ul></ul><ul><ul><li>Education in safe preparation and storage </li></ul></ul>
  13. 13. Replacement feeding <ul><li>Advantages </li></ul><ul><ul><li>No risk of transmitting HIV to the infant </li></ul></ul><ul><ul><li>Contains most nutrients needed by infant </li></ul></ul><ul><ul><li>Other family members can help feed the infant </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Expensive </li></ul></ul><ul><ul><li>Contains no antibodies to protect infant </li></ul></ul><ul><ul><li>Can increase risk of diarrhoea </li></ul></ul><ul><ul><li>May not contain all the nutrient requirements for the infant </li></ul></ul><ul><ul><li>Can be more difficult to digest </li></ul></ul><ul><ul><li>Must be carefully prepared and stored </li></ul></ul>
  14. 14. Kenya infant feeding Policy <ul><li>Right of parents of HIV-exposed infants to choose how and what to feed infants following counselling. </li></ul><ul><li>Exclusive breastfeeding for first 6 months for mothers who are HIV-negative and mothers of unknown HIV status. </li></ul><ul><li>Replacement feeding where </li></ul><ul><ul><li>A --Acceptable </li></ul></ul><ul><ul><li>A --Affordable </li></ul></ul><ul><ul><li>F --Feasible </li></ul></ul><ul><ul><li>S --Sustainable </li></ul></ul><ul><ul><li>S --Safe </li></ul></ul>