Infant Feeding In Complex Needs

Question 1

Which infants cannot receive breast milk or any other milk other than specialised formula?

Answer 1

• infants with classic galactosemia
• infants with maple syrup urine disease
• infants with phenylketonuria

Question 2

Which infants may need additional food supplement to breast milk?

Answer 2

• Infants born weighing less than1500g
• infants born less than 32 weeks of gestational age
• newborns at risk or hypogylcemia

Question 3

What maternal condition can justify permenant avoidance of breastfeeding?

Answer 3

HIV infection

Question 4

Which maternal condition can justify tempoary avoidance of breast feeding?

Answer 4

• severe illnesses that prevent the mother from caring for her infant such as sepsis
• herpes virus type 1: direct contact between the leisons on the mothers breast and the infant should be avoided
• Maternal medication

Question 5

Which maternal medications would place tempoary avoidance of breastfeeding?

Answer 5

• sedating psychotherapeutic drugs, anti-epileptic drugs and opioids and their combinations may cause side effects such as drowsiness and respiratory depression and are better avoided if a safer alternative is available (7);
• radioactive iodine-131 is better avoided given that safer alternatives are available - a mother can resume breastfeeding about two months after receiving this substance;
• excessive use of topical iodine or iodophors (e.g., povidone-iodine), especially on open wounds or mucous membranes, can result in thyroid suppression or electrolyte abnormalities in the breastfed infant
• cytotoxic chemotherapy requires that a mother stops breastfeeding during therapy.

Question 6

State maternal conditions during which breastfeeding can still continue, although health problems can still be of concern

Answer 6

• Breast abscess: breastfeeding should continue on the unaffected breast; feeding from the affected breast can resume once treatment has started.
• Hepatitis B: infants should be given hepatitis B vaccine, within the first 48 hours or as soon as possible thereafter.
• Hepatitis C.
• Mastitis: if breastfeeding is very painful, milk must be removed by expression to prevent progression of the
  condition.
• Tuberculosis: mother and baby should be managed according to national tuberculosis guidelines.
• Substance use2 (11):
  •maternal use of nicotine, alcohol, ecstasy, amphetamines, cocaine and related stimulants has been demonstrated to have harmful effects on breastfed babies;
  •alcohol, opioids, benzodiazepines and cannabis can cause sedation in both the mother and the baby.