Integrated Maternal and Newborn Care Basic Skills Course ...

Special Guidelines for Mothers Who Are HIV-Positive
Feeding options for HIV-positive mothers include the following:
• Exclusive breastfeeding, taking care to avoid problems such as engorged breasts and
sore nipples, until six months, followed by rapid switch to formula feeds and
complementary feeding with semi-solids.
• Use of expressed breast milk rendered safe by flash heating of the milk (see below),
along with complementary feeds with semi-solids from the age of six months.
• Use of formula feeds from birth, if AFASS conditions are met (when replacement feeding
is acceptable, feasible, affordable, sustainable, and safe – WHO 2009) with semi-solids
from the age of six months.
Flash heating of expressed milk
Flash heating of expressed breast milk is a method to destroy the HIV while still retaining the
nutrients and much of the anti-infective factors unique to breast milk. This permits the HIVpositive
mother to give breast milk to the baby and avoid formulas.
Guidelines for the mother and family
• Items required:
o cups and spoons for feeding
o jars with lids to collect and sterilize EBM
o a container to boil the milk
• Wash all utensils with soap and water. Sterilize these by boiling in a container of water
for 10 minutes.
• Express breast milk into the glass jar as noted above in this chapter. Remember to
express the breasts as completely as possible so as to get the nutritious milk obtained at
the end. The amount of milk to be collected in one jar is between 50-150 mL. If there is
more milk, divide it into two jars.
• Place the jar in a pan/container of water, making sure that the level of water is two
fingers above the level of milk.
• Heat the water on a very hot fire or, if on a stove top, turn the knob/dial to the highest
setting until the water reaches a rolling boil (when it is boiling well with large bubbles).
Stay close by because the process after this takes only a few minutes. Do not let the
water boil too long as it will destroy the special nutrients in breast milk.
• Remove the jar from the container as soon as the water comes to a good boil. Place the
jar in a container of cool water, cover it with its clean lid, and let it stand until it reaches
room temperature. This milk can then be kept at room temperature for six hours and fed
to the baby.
• Use a small cup, preferably directly to feed the baby. It is better than using a bottle which
is more difficult to clean and carries the risk of causing diarrhea in the baby.
136
Integrated maternal and newborn care
Basic skills course