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How you help a mother to feed her young baby depends on whether the mother is HIV- (negative), of unknown HIV status or HIV+ (positive). Much research is presently being done on the feeding of babies whose mothers are HIV+. The advice given in this topic is what nutritionists currently (in 2004) recommend (see WHO/UNICEF/UNFPA/UNAIDS. 2003. HIV and infant feeding listed in Appendix 3).


Exclusive breastfeeding means an infant receives only breastmilk from the mother or a wet nurse, or expressed breastmilk, and no other liquids or solids except drops or syrups consisting of vitamins, mineral supplements or medicines.

If the mother is HIV- or of unknown HIV status

Most babies should breastfeed exclusively for six months

Advise the mother to exclusively breastfeed until the baby is six months (180 days) old.

Breastmilk provides all the food and water young babies need

Ways to encourage exclusive breastfeeding include:

Figure 9. Suckling in the correct position

Baby’s body is turned towards mother, the chin touches mother’s breast, the mouth is wide open and both lips are turned outwards. More areola is above than below baby’s mouth. The baby takes slow deep sucks and you can hear the baby swallowing.

Colostrum is the best and safest food for newborns

Also advise families that breastfeeding mothers need:

Make sure mothers know that HIV can be passed to their babies through breastmilk and how to avoid that their babies become infected.

If the mother is HIV+

Explain the risks and benefits of breastfeeding and replacement feeding to HIV+ mothers and their partners before the baby is born

While the mother is still pregnant:

Replacement feeding means feeding a child who is not receiving breastmilk with a diet that provides all the nutrients the child needs. During the first six months this should be a suitable breastmilk substitute, such as commercial or home-made formula.


Exclusive breastfeeding

  • It gives immunity from other infections, is the best source of nutrients and safe water, reduces the risk of pregnancy and prevents the possible stigma of not breastfeeding.

  • There is a risk of passing HIV to the baby but this is lower if:

    - the mother gives no other food or drink;
    - the mother does not have cracked nipples or mastitis, or is not clinically ill with AIDS;
    - the baby does not have sores or thrush in the mouth.

Replacement feeding

  • There is no risk of passing HIV to the baby.

  • There is a high risk of diarrhoea and other infections if the family lacks the resources to buy and prepare other milk feeds safely.

  • There is a risk that the caregiver will prepare the feed incorrectly (e.g. overdilute it) so that the child becomes malnourished.

  • There is the possibility of stigma and of others knowing the mother’s HIV status.

Replacement feeds should only be given where they are acceptable, feasible, affordable, sustainable and safe.

Feeding both breastmilk and breastmilk substitutes

  • There is a higher risk of passing HIV to the baby than with exclusive breastfeeding.

  • There is a risk of other infections and malnutrition if breastmilk substitutes are not prepared safely and correctly.

When a HIV+ mother has decided how to feed her baby, give her support and advice. If the mother agrees, try to talk with relatives (e.g. her husband, partner and/or mother) so they can also support and help her.

If the mother decides to breastfeed:


HIV+ mothers should stop breastfeeding over a shorter period than usual (i.e. the change-over period from exclusive breastfeeding to replacement feeding should last only about two weeks or less). This is because the baby is at higher risk of HIV infection during the change-over period.

However, ceasing breastfeeding over a short period increases the risk of difficulties such as mastitis and breast abscesses, and objections from families - and the babies may become distressed and lose their appetites.

To help mothers and babies during the change-over period, health workers can:

  • show a mother how to express her breastmilk and then heat-treat it (heattreating destroys the HIV virus). This reduces the risk of engorgement for the mother and allows the baby to continue receiving breastmilk while becoming used to the tastes of replacement feeds and to cup feeding. To heat-treat breastmilk, put the milk in a small pot, heat until the milk boils and then put the pot into a container of cold water so the milk cools quickly;

  • advise a mother (and her relatives if possible) on suitable replacement feeds and how to prepare them. Babies aged less than six months should receive only breastmilk substitutes (home-made or commercial infant formula) or heattreated breastmilk. After that they should also have complementary feeds (see Topic 7);

  • tell a mother to give extra attention and love to her baby and to give replacement feeds or expressed heat-treated breastmilk herself;

  • advise a mother to seek health care immediately if she has any signs of mastitis and/or sore nipples;

  • if appropriate, explain to relatives the reasons for ceasing breastfeeding earlier than usual.

If the mother decides not to breastfeed:

Monitoring baby’s weight


Before sharing this information with families, you may need to:

1. Find out. How local babies aged 0-6 months are fed. Whether mothers exclusively breastfeed, and if so, for how long. If not, which other foods, water or other drinks are given. What the blocks to exclusive breastfeeding for six months are. How women who are HIV+ feed their babies. What their knowledge of the risks and benefits of different feeding methods is. Who decides how babies are fed. What advice and resources are needed by mothers who decide not to breastfeed. Which breastmilk substitutes are available locally and what their costs are. What breastfeeding women do if they have breastfeeding problems, such as sore nipples or engorged breasts, or if their babies have thrush.

2. Prioritize. Decide which information is most important to share. This may depend on whether you are communicating with groups of mothers or parents, with individual HIV+ mothers, with mothers who are HIV- or whose status is unknown, or with traditional midwives.

3. Decide whom to reach. For example: mothers, other caregivers and, if appropriate, their partners and other relatives; traditional midwives.

4. Choose communication methods. For example: individual counselling and group discussions at antenatal and postnatal clinics, in maternity wards and at young child clinics; demonstrations of suckling position, replacement feeding and heat-treating expressed breastmilk.

Examples of questions to start a discussion
(choose only a few questions that deal with the information families need most)

What is exclusive breastfeeding? Why do we recommend exclusive breastfeeding?

Why is colostrum an excellent food for newborns? Do we give colostrum to our babies? If not, why not?

Do breastfed babies need extra water?

What foods or drinks other than breastmilk do we sometimes give young babies? Why? Could we stop doing this?

What should women who have sore nipples or engorged breasts do?

Do breastfeeding women need extra food? Which foods are good for breastfeeding women?

Discuss the feeding of babies of HIV+ mothers only if a group wants to. Do this in a sensitive way. Otherwise counsel mothers individually.

Can the virus be passed to a baby through breastmilk? Explain that the risk may be less if a baby is exclusively breastfed.

What are the dangers of replacement feeding? Explain the risks and benefits of both exclusive breastfeeding and replacement feeding. Explain the risks of giving both breastmilk and breastmilk substitutes.

How can breastmilk be made safe during the time that a mother is changing from exclusive breastfeeding to replacement feeds? Explain why and how to express and heat-treat breastmilk.

If replacement feeding occurs in the area

Which breastmilk substitutes are available and used here? How much do they cost? Do mothers know how to prepare them in a safe and hygienic way? Are they culturally acceptable?

Why is it dangerous to feed with a bottle? Do women know how to feed with a cup?

Demonstrate preparing and giving a feed using a breastmilk substitute that local families can afford.

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