Re: [pronut-hiv] Breastfeeding and thrush (2)

["Rachel Stern" <sternworks@verizon.net>]

Setting aside the question of rapid cessation and "breast damage", how do 
you react to the recommendation that (exclusive) breastfeeding should be 
ended abruptly at 6 months if mother is HIV+, and replaced with something 
else?

Thrush, small abrasions, lesions that accompany minor colds - these are all common in very young infants, infants not yet likely to receive foods other than breastmilk.  Isn't transmission across such lesions as high as it is through lesions elsewhere on the body?

Rachel Stern

----- : "Ted Greiner" wrote: 

Breastfeeding and thrush


The decision on how to feed is intended to be taken prenatally when of 
course infant thrush is not an issue. Nor is thrush some kind of permanent 
state, based on which infant feeding decisions can be taken. When it occurs, 
it should be treated as soon as possible; doing so is not complex or 
expensive and the drug required is commonly available, even in most poorly 
resources health centers.

  Thrush and candidiasis should be treated simultaneously and indeed 
probably could lead to increased HIV transmisison. This does not mean that 
100% of breast fed babies will get HIV, just that a marginal increase in 
risk is likely to occur. Breastfeeding HIV+ mothers should thus be alerted 
to what thrush looks like, asked to watch for it, and advised to go to the 
health center for treatment as soon as it occurs.

  Asking whether breastfeeding is still recommended with infant thrush 
implies that perhaps rapid cessation is a reasonable option. It is not, with 
or without HIV. It often leads to breast damage, greatly increasing the risk 
of HIV transmisison during whatever short period of breastfeeding remains 
and subjecting the mother to a high risk of mastitis, not a good idea if her 
immune status is compromised. One study in Uganda found that about half the 
mothers who rapidly stopped breastfeeding before 6 months of age got 
mastitis.

  The older the baby gets, the less breast milk it tends to be drinking and 
the less risk rapid cessation is likely to be for the breasts of the mother. 
However, rapid cessation always is a risk for the baby. For younger babies 
there are serious concerns about how to replace the nutritional, 
immunological and care functions that breastfeeding serves. For older ones, 
there are more serious psychological problems for the child when 
breastfeeding stops rapidly, with the child often becoming anorexic and 
sometimes either ill or malnourished.

  Ted Greiner
  _____________________________

  Uganda: HIV Positive
Moms And Breastfeeding
 (2)
To: "Nutrition and HIV/AIDS"
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Suppose a young infant has thrush, and mom is
HIV-positive. Is breastfeeding
still recommended?

Rachel Stern