HIV AND INFANT FEEDING COUNSELLING TOOLS Reference Guide World Health Organizationii WHO Library Cataloguing-in-Publication Data HIV and infant feeding counseling tools : reference guide. 1.HIV infections - transmission 2.Breast feeding 3.Infant nutrition 4.Disease transmission, Vertical - prevention and control 5.Counseling 6.Teaching materials I.World Health Organization II.UNICEF III.United States. Agency for International Development.ISBN 92 4 159301 6 (NLM classi cation: WC 503.2) World Health Organization 2005 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: bookorderswho.int). Requests for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: permissionswho.int). e designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization or of the United Nations Childrens Fund concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. e mention of speci c companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization or the United Nations Childrens Fund in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. e responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or the United Nations Childrens Fund be liable for damages arising from its use. is publication re ects the activities of separate agencies around an issue of common concern. Each agency implements actions in accordance with the principles and policies of its mandate. is publication was produced by the Support for Analysis and Research in Africa (SARA) Project, operated by the Academy for Educational Development (AED) with subcontractors Tulane University, JHPIEGO, Morehouse School of Medicine, and Population Reference Bureau. SARA is funded by the U.S. Agency for International Development, Bureau for Africa, O ce of Sustainable Development (USAID/AFR/ SD) under Contract No. AOT-C-00-99-00237-00. e opinions expressed herein do not necessarily re ect the views of USAID or AED. Printed in Canada Designed by Raymond Lambert and H.J. Lee Bennett, IIIiii CONTENTS Acknowledgements v Acronyms and Abbreviations vi Chapter 1: Introduction 1Overview of the Counselling Tools 1Adapting the Tools to the Local Situation 2Objectives of Infant Feeding Counselling 4Timing of Infant Feeding Counselling 5Snapshot of a Counselling Session 5Feeding Options 6Counselling Flow Chart 8Review of Counselling Basics 10Supplies Needed 10 Chapter 2: Help the Mother to Choose a Feeding Option (Steps 1-4) 13Beginning the Counselling Session 14Explaining the Risk of Mother-to-Child Transmission 14Overview of Infant Feeding Options 15Advantages and Disadvantages of Commercial Infant Formula 17Advantages and Disadvantages of Exclusive Breastfeeding 18Advantages and Disadvantages of Expressing and Heat-Treating Breast Milk 20Advantages and Disadvantages of Wet-Nursing 21Advantages and Disadvantages of Home-Modi ed Animal Milk 23Assessing the Mothers Situation 25Helping the Mother to Choose a Feeding Option 27Family Support for Infant Feeding 28Disclosing HIV Status 29 Chapter 3: Teach the Mother How to Practise the Chosen Feeding Option (Step 5) 31Con rming the Womans Decision 31Overview of Exclusive Breastfeeding 32How to Start Breastfeeding 34Preventing and Treating Cracked Nipples 35Preventing and Treating Mastitis 36How Much to Feed a Baby from Birth to 6 Months 37Hygienic Preparation of Formula, Milk and Food 39ivCup-Feeding 40Commercial Formula: Important Facts 41How to Prepare Commercial Formula 42Home-Modi ed Animal Milk: Important Facts 43How to Prepare Home-Modi ed Animal Milk 45How to Express Breast Milk 47How to Heat-Treat and Store Breast Milk 48Wet-Nursing (Breastfeeding by Another Woman) 49Dealing with Infant-Feeding Pressure from Others 50Getting Community Support 51Chapter 4: Prov