Breastfeeding& special cases

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

1. Exclusive Breast Feeding In Special Cases… “Doc… Should I or Shouldn't I ?” “Madam, You Should or you Should not !”

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. 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! B aby may survive, only to suffer later in life from DM, Allergies, Auto- immune diseases

4. Without ARVs <5% with ARV& guidelines <2% with ARV& guidelines

5. 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. Times more likely to die if not breastfed Age in months Studies Quote infant mortality even up to 21% among normal population, who are not breastfed!

6. Risks of not breastfeeding Particular high risk of: Diarrhoea and ARTI Malnutrition Can lead to: I ll health Poor development Affect can last for life DEATH Aceh

7. Mother: “Doc, should I breastfeed my baby, I am HIV+”? Doc: “Madam, AFASS”

8. 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 Sustainable Safe

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. 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

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. 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. There’s always a tug of war… In a Doc’s mind! 5% minus 2% & 21% Between

14. Break a Myth Mixed feed is bad, so Is Abrupt Cessation of breast feeding good for the baby of a HIV+ mother?...

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. 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. Remember, its not only mother, Anybody (with TB) around can infect the baby with Tuberculosis!

18. Break a Myth Is ATT drug concentration in breast milk sufficient for the baby?...

19. Break a Myth Is ATT drug concentration in breast milk sufficient for the baby?... NO

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. 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!

22. Break a Myth Does Pumping and dumping breast milk speed the elimination of alcohol from your body…

23. Break a Myth Does Pumping and dumping breast milk speed the elimination of alcohol from your body ... NO

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 breast milk

25. Break a Myth Will there be a “lack of milk”, if there are multiple babies born?...

26. Break a Myth Will there be a “lack of milk”, if there multiple babies are born?... NO

27. Thank you!