[pronut-hiv] Nutrition and care for HIV positive infants and children

[Pamela Morrison <pamela@ecoweb.co.zw>]

Pamela Morrison wrote:


Thank you to Dr Nieburg who brings up an excellent point about the 
impossibility of assessing the HIV status of infants during the first 
weeks/months of life - an omission which could otherwise guide 
recommendations about optimal nutrition for each individual baby.

I'm wondering if there is a focus on assisting all mothers to exclusively 
breastfeed their infants for the first six months?  Really exclusive 
breastfeeding (breastmilk only, no other foods or liquids at all) not only 
reduces the risk of postpartum transmission of HIV through breastmilk but 
also reduces the incidence and severity of other infections.  This would be 
particularly important for HIV-infected infants who could be expected to 
live twice as long if breastfed, than if fed replacements.  On the other 
hand, mixed "breastfeeding" (with other milks/liquids/premature 
introduction of other foods) not only increases the risk of MTCT compared 
to exclusive breastfeeding, but also increases the risk of infections other 
than HIV.  Bearing in mind that approximately twice as many infants are 
already infected in utero or during birth than will be infected by 
(non-exclusive) breastfeeding, and even fewer will be infected if 
exclusively breastfed for a full six months, I'm wondering if the way 
forward is not to aggressively promote exclusive breastfeeding for *all* 
babies in our region, irrespective of the HIV status of their mothers?

The feasibility of promoting exclusive breastfeeding is sometimes given 
rather bad press.  Doubts are often expressed that mothers, grandmothers 
and even healthcare workers believe that babies "need" little sips of water 
in hot weather, or oil as a laxative, or early "porridge" because 
breastmilk might not provide enough food for a full six months, or simply 
that exclusive breastfeeding is not "cultural".  However, once mothers 
receive enough convincing information to reassure them (eg that breastmilk 
contains 87% water, and babies stay better hydrated if *not* given extra 
fluids, mothers can be taught how to check the colour of the baby's 
urine);  that "just" breastmilk *does* provide enough calories to sustain 
good growth for the first half-year of life (which can be confirmed by 
regular weight checks); and if they receive enough practical help to 
successfully breastfeed, (especially practical techniques about how to 
avoid breast engorgement as the milk comes in during the first week 
postpartum and how to cope with fluctuations in breastmilk supply in the 
following weeks and months);  then they can - easily - exclusively breastfeed.

So since exclusive breastfeeding would enhance the nutrition of all babies, 
reduce the incidence of all infections, including HIV, and provide absolute 
food security for infants in these troubled times, I wonder if other 
members of the Pronut-HIV list see this as a way to reduce infant 
morbidity/mortality for our region?

Pamela Morrison
International Board Certified Lactation Consultant
Harare, Zimbabwe
Email: pamela@ecoweb.co.zw 

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