HIV&lactation in US:question

quiltncatch · Mar 30, 2006

When looking at formula feeding in developing countries, you must always take into consideration the quality of water being used to make the formula. Also, is the formula within it's dates and is it being mixed properly? (some families water it down to make it stretch farther)

I'm not a fan of formula, breast is best. It's just that these babies may have had diarrhea for reasons other than not being breastfed. Diarrhea kills many children worldwide due to unclean water supply. My question would be, if these babies aren't already HIV positive, than what is the chance of getting this through breastmilk? I don't ever see it here, so I really don't know.

Finallyat40 · Mar 30, 2006

and we don't accept breast milk from our HIV moms....they are exclusively bottle fed. That being said, we also begin administering anti-retrovirals at birth and for six weeks. Typically (best case scenario), mom is/has also been on the meds through the pregnancy.

While I do believe that breast is best, I also agree with the above poster....there are many more factors at play here when comparing the US to the third world. Water, sanitation, formula (is it the same as here? I don't know and would suspect not). There's a risk of HIV transmission in the breastmilk, as you know, and it's just not worth the risk, IMHO.

Jamie

ZASHAGALKA, RN · Mar 30, 2006

Another thing to know is that if you cannot afford formula, there are gov't programs in the US (WIC - stands for Women - Infant - Children food program) that will supply formula free of charge.

So, cost isn't a factor in formula over breast milk.

~~~~~

From La Leche, a well-known US advocacy group for breast feeding:

Breastfeeding and HIV

July 4, 2001

La Leche League International (LLLI) acknowledges the worldwide challenge of making informed infant feeding decisions when HIV transmission is a consideration. Parents and health care providers are urged to weigh the well-known, documented health and emotional benefits of human milk and breastfeeding for both mother and child against the known, documented health hazards of breast milk substitutes, the rates of childhood illness and death from infectious diseases in the mother’s area of the world, and the incomplete understanding of the risk of HIV transmission through human milk. La Leche League International challenges the scientific community to undertake the research necessary to fully define the role of breastfeeding and human milk in HIV transmission and infant protection.

In general, for women who know they are HIV positive and where infant mortality is high, exclusive breastfeeding may result in fewer infant deaths than feeding breast milk substitutes and remains the preferred feeding approach. While breastfeeding where infant mortality is low may also carry a risk of HIV transmission for infants whose mothers test HIV positive, there is no clear, published evidence that feeding breast milk substitutes results in lower infant morbidity and mortality in any infants.

The social costs of not breastfeeding also must be considered. When a woman gives breast milk substitutes in a culture where breastfeeding is traditional, her community may suspect that she is HIV-positive, potentially putting her at risk for physical abuse, ostracism, and abandonment. In most parts of the world women do not know their HIV status, therefore ongoing support of exclusive breastfeeding is most appropriate and much needed.

While current scientific thinking accepts a risk of vertical transmission with breastfeeding in general, research studies that fully define the role of breastfeeding patterns (particularly exclusive breastfeeding and optimal breastfeeding management) and related maternal and child health on HIV transmission have not yet been done.

LLLI is not making a recommendation about breastfeeding for HIV positive mothers at this time due to the inconclusive nature of the research and its various interpretations.

See also this link on the LLLI website:

http://www.lalecheleague.org/llleaderweb/LV/LVFebMar99p3.html

~faith,

Timothy.

hospitalstaph · Mar 30, 2006

Another thing to know is that if you cannot afford formula, there are gov't programs in the US (WIC - stands for Women - Infant - Children food program) that will supply formula free of charge.
So, cost isn't a factor in formula over breast milk.
~~~~~
From La Leche, a well-known US advocacy group for breast feeding:
Breastfeeding and HIV
July 4, 2001
La Leche League International (LLLI) acknowledges the worldwide challenge of making informed infant feeding decisions when HIV transmission is a consideration. Parents and health care providers are urged to weigh the well-known, documented health and emotional benefits of human milk and breastfeeding for both mother and child against the known, documented health hazards of breast milk substitutes, the rates of childhood illness and death from infectious diseases in the mother's area of the world, and the incomplete understanding of the risk of HIV transmission through human milk. La Leche League International challenges the scientific community to undertake the research necessary to fully define the role of breastfeeding and human milk in HIV transmission and infant protection.
In general, for women who know they are HIV positive and where infant mortality is high, exclusive breastfeeding may result in fewer infant deaths than feeding breast milk substitutes and remains the preferred feeding approach. While breastfeeding where infant mortality is low may also carry a risk of HIV transmission for infants whose mothers test HIV positive, there is no clear, published evidence that feeding breast milk substitutes results in lower infant morbidity and mortality in any infants.
The social costs of not breastfeeding also must be considered. When a woman gives breast milk substitutes in a culture where breastfeeding is traditional, her community may suspect that she is HIV-positive, potentially putting her at risk for physical abuse, ostracism, and abandonment. In most parts of the world women do not know their HIV status, therefore ongoing support of exclusive breastfeeding is most appropriate and much needed.
While current scientific thinking accepts a risk of vertical transmission with breastfeeding in general, research studies that fully define the role of breastfeeding patterns (particularly exclusive breastfeeding and optimal breastfeeding management) and related maternal and child health on HIV transmission have not yet been done.
LLLI is not making a recommendation about breastfeeding for HIV positive mothers at this time due to the inconclusive nature of the research and its various interpretations.
See also this link on the LLLI website:
http://www.lalecheleague.org/llleaderweb/LV/LVFebMar99p3.html
~faith,
Timothy.

The WIC program does indeed provide some formula, however not all the formula that a baby needs for the entire first year of life. The estimate that I have heard is that once the baby reaches about 10 lbs that the family should expect to be buying some formula to supplement the amount provided by WIC. I think this is inportant information for low income mothers to have when they are considering whether to breastfeed or formula feed.

BTW way thanks for the LLL link:)

T

LilPeanut, MSN, RN, NP · Mar 31, 2006

Everything I've heard from research is that if the mom exclusively breastfeeds, meaning absolutely no other things going into that baby's mouth and tummy, there is very little/no risk of transmission, but the moment they have a solid, a drop of formula or anything else, transmission rates go up because of the change/damage to the flora and the gut.

In third world countries where water quality is an issue and formula is an issue, it is definitely possible and responsible to counsel moms to exclusively breastfeed, but that once the child starts eating solids, they must be weaned.

In the US, I don't think it is necessary. Formula is a safe alternative, though I suppose if an HIV+ mom really really wanted to breastfeed, she should instructed how to do it with the least amount of risk to her child.