breastfeeding& special cases
Post on 07-May-2015
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Exclusive Breast Feeding In Special
Cases…“Doc… Should I or Shouldn't I?”
“Madam, You Should or you Should not!”
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?
Mother: “Doc, should I breastfeed my baby, I am HIV+”?
So… Weigh before you say!
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
Without ARVs
<5% with ARV& guidelines
<2% with ARV& guidelines
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.
Tim
es m
ore
likel
y to
die
if n
ot b
reas
tfed
Age in months
Studies Quote infant mortality even up to 21% among normal population, who are not breastfed!
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
Mother: “Doc, should I breastfeed my baby, I am HIV+”?
Doc: “Madam, AFASS”
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 Sustainabl
e
Safe
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
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
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.
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.
There’s always a tug of war… In a Doc’s mind!
5% minus 2% & 21%
Between
Break a MythMixed feed is bad, so Is Abrupt Cessation of breast feeding good for the baby of a HIV+ mother?...
Break a MythMixed feed is bad, so Is Abrupt Cessation of breast feeding good for the baby of a
HIV+ mother?... NO
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
Remember, its not only mother, Anybody (with TB) around can
infect the baby with Tuberculosis!
Break a MythIs ATT drug concentration in breast milk sufficient for the baby?...
Break a MythIs ATT drug concentration in breast milk
sufficient for the baby?... NO
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
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!
Break a MythDoes Pumping and dumping breast milk speed the elimination of alcohol from your body…
Break a MythDoes Pumping and dumping breast milk speed the elimination of alcohol from
your body... NO
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
Break a MythWill there be a “lack of milk”, if there are multiple babies born?...
Break a MythWill there be a “lack of milk”, if there
multiple babies are born?... NO
Thank you!
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