Transcript Feeding Children with HIV

Nutrition in Children with HIV
Paediatric Palliative Care
For Home Based Carers
Funded by
British High Commission, Pretoria
Small Grant Scheme
HIV and Malnutrition
Children with HIV are more likely to
become malnourished than other children
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Why?
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Recurrent illnesses
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Diarrhoea (prevents body from
absorbing nutrients)
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Loss of appetite
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Mouth Infections
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Poor access to nutritious foods
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? Ability of carer to prepare
nutritious foods
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Loss of household income due
to death of parent
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HIV and Nutrition
Poor
Nutrition
Increased nutritional
needs
reduced intake and
increased loss of nutrients
HIV
Poor ability to
fight HIV and other
infections
Increased vulnerability to
infections, poor
health, earlier and faster
progression to AIDS
National Department of Health, South Africa, 2001
Malnutrition and Diarrhoea
 Malnutrition can make diarrhoea
more severe
 If a child is malnourished, he
cannot digest food properly and
the stomach wall is weakened
 Food is therefore not absorbed
properly and lost as diarrhoea
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Psychological Changes
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This Child is Not Fat!
 Note!!
 Kwashiokor
 Appears fat due to oedema
 The child is actually wasted
 Moon face and muscle
wasting in shoulder muscles
• Thin hair, falls out easily
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Severe Kwashiorkor
Child 1:
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Flaking paint rash
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Skin very thin and weak
Child 2:
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Flaking paint rash
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Sores on face
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Sunken eyes & loss of skin
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Oedema has cleared with
dehydration
Child 3:
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Skin sores following
diarrhoea
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Road To Health Chart
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MUAC
 Mid Upper Arm Circumference
 Arm circumference is the same
between 1 and 5 years
 Useful measure of malnutrition
 More than 13.5 cm = well
nourished
 Picture 2 = child is
malnourished
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Nutritional Support for Children
with HIV
Essential throughout the course of
illness
Should start as early as possible
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To prevent them getting
infections
To help them recover from
infections
To promote the child’s growth
To improve quality of life
Food Hygiene
A child with HIV will get sick very easily if food is not prepared in a
hygienic way. Always counsel carer about:
 Hand Washing
 Clean surfaces and utensils
 Cook food thoroughly
 Avoid contact between raw foodstuffs and cooked foods
 Serve food immediately after preparation
 Only store cooked foods in fridge or cool place
 Store in fridge for one or two days only)
Food Hygiene
 If food is reheated, do so at a high temperature
 Wash fruits and vegetables before serving
 Use safe water that is boiled or filtered
 Clean cups and bowls
 Never use bottles for feeding babies
 Protect foods from insects, rodents, and other animals
 Store non-perishable foodstuffs in a safe place
No food available
If there is no food available in the house
 Refer to the Social Worker
 Ensure local schemes and grants are
accessed and received by carer
 When food supplements are given, ensure
carer knows how to use them properly
Good Foods for the Immune System
Important Vitamins
and Minerals
Best Food Sources
Functions
Vitamin A
All yellow, orange and green fruit and
vegetables, especially melon, mangoes and
paw paw; milk, garlic, egg yolk, liver
To make white blood cells; for
vision, healthy skin, teeth and bone
development; protection against
infection; antioxidant
Vitamin C
Sweet peppers, raw leafy green vegetables,
all fruits, especially guava, baobab pulp,
grapefruit and tomatoes
Builds healthy bones, teeth and
gums; helps fight infection;
antioxidants; Vitamin C helps the
body to take up iron in the blood
Vitamin E
Cold-pressed vegetable oils, nuts and
seeds, whole grains, eggs, legumes, dark
green vegetables, wheat germ
Increases disease resistance;
protects fats and vitamins A and C
from oxidation; prevents ageing;
treats scar tissue; antioxidant
Selenium
Brown rice, nuts, seafood, liver, egg yolk,
onions, garlic, meat, whole grains, milk
Prevents oxidation and breakdown
of fat and other body cells;
antioxidant
Zinc
Protects the immune system; needed for
digestion and enzymes; prevents HIV
locking on to CD4 cells, promotes wound
healing; Vit A metabolism
leafy, green vegetables, oily fish,
nuts, meat, whole grains, egg yolk,
garlic, chicken)
(Adapted from Francis, 2003)
Breastfeeding and HIV
 HIV may be passed from an HIV
positive mother to her child
during breastfeeding
 So, if the baby has not already
been infected during pregnancy
or during delivery, he/she may be
infected during breastfeeding
 HIV positive mothers therefore
need counselling about feeding
options for their babies
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Counsel the Mother
Breast feeding
Formula Feeding
 Increases the risk of passing
HIV to her baby
 HIV cannot be passed by
exclusive formula feeding
 Provides the baby with
nutrients and protection
against other infections
 Does not provide the same
nutrition or protection
against infections
 Provides comfort and close
bonding between mother
and child
 Increases the risk of other
infections from dirty water,
unhygienic preparation of
formula milk
 Free and readily available!
Counsel the Mother
 Mothers must be counselled so that they can make their own
decision
 There is some evidence that Mixed Feeding increases the risk
of HIV infection
 Mixed Feeding = breast feeding AND formula feeding
Counsel the Mother
Mothers with HIV should be advised to either:
Exclusively breast feed up to 6 months of age
 DO not give other foods or fluids
 Rapid change from breast milk to none at 4 -6 months
OR
Exclusively formula feed
 No breast milk at all
 Give formula feed or modified cow’s milk
Counsel the Mother
For a child who is being breastfed:
 If at 4-6 months, it is confirmed that
the child has HIV, the mother may
continue to breastfeed
 There is no danger of her passing
HIV to her child through
breastfeeding as the child is already
infected
Counsel the Mother
We also know that the risk of passing HIV to the child through
breastfeeding may be increased by:
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Sore, cracked nipples
Mastitis
Thrush
Breast abscesses
Oral thrush in the baby
High levels of virus in the mother
New infection in the mother
A breastfeeding mother needs counselling on preventing/treating
all of the above
Some General Principles
A child with HIV needs:
 More food than other children, particularly when he is ill
 A variety of different foods (once foods introduced)
 Family foods – more nutritious, healthier and cheaper
 To drink more when they do not feel like eating
 2- 3 glasses of fresh milk over 1 year of age
 At least 3 glasses of clean water every day
 Margarine and oil added when cooking food
Some General Principles
 At least one portion of fish/chicken/meat/dry
beans/eggs/peanut per day
 Sweets, chocolates and crisps should not replace food
 Dry beans have the same nutritional value as meat and can be
eaten as often as possible
 Bread, pap, samp, rice, mealies as much as the child wants,
provided they are mixed with meat/beans/fish/ chicken/sour
milk/peanut butter
 Plant a vegetable garden
 Eat at least 1 fruit or vegetable (not potato) every day
 Make food look and taste good
Up to 6 Months of Age
 Breastfeed as often as the
child wants, day and night
 Feed at least 8 times in 24
hours
 Do not give other foods or
fluids
(IMCI, 2002)
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6 to 12 Months (HIV Confirmed)
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Continue to breastfeed as often as the
child wants
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Give 3 servings of nutritious
complementary foods
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ALWAYS mix margarine, fat, oil,
peanut butter or ground nuts with
porridge
Also add:
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Chicken, egg, beans, fish or full
cream milk
Or
Mashed fruit and vegetables, at least
once each day
(IMCI, 2002)
6 – 12 Months
 If baby is not breastfed, give 3 cups (3x200ml) of full cream milk
as well
 If baby gets no milk, give 6 complementary feeds per day
(IMCI, 2002)
1 – 2 Years
 Continue to breastfeed as often as the child wants
 Breast milk is still an important food at this age and helps
prevent infections
 Give at least 5 adequate nutritious feeds
 Increase the variety and quantity with family foods:
 Mix margarine, fat, oil, peanut butter or ground nuts with
porridge
 Give egg, meat, fish or beans daily
 Give fruit or vegetables twice every day
 Give milk every day, especially if no longer breastfeeding
 Feed actively with her own serving
(IMCI, 2002)
2 Years and Older
 Give the child his own
serving of family foods 3
times a day
 In addition, give 2 nutritious
snacks such as bread with
peanut butter, full cream
milk or fresh fruit between
meals
 Continue active feeding
(IMCI, 2002)
During Illness
Remember to encourage
feeding during illness
and to advise an extra meal a
day for one week after an illness
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Poor Appetite
A child with HIV commonly has a
poor appetite
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Plan small frequent meals
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Give milk rather than other
fluids except where there is
diarrhoea with some
dehydration
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Give foods with a high energy
input
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Give snacks between meals
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Check for oral thrush and
mouth ulcers
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Nausea and Vomiting
 The child must eat!
 Give food that he likes
 Small regular meals and rest after eating
 Drink fluids between meals and not with meals
 Cold foods may be better than warm cooked foods
 Eat bread, porridge and rice without gravies
Nausea and Vomiting
 Drink extra fluids
 ORS
 Eat before taking medicines
 Dry toast, rusks and dry crackers may help to relieve nausea
 Avoid fatty, sweet food
 Avoid tea and coffee, milk and milk products, spicy food
Mouth Sores
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Give paracetamol an hour before feeds
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Do not give acidic (sour) cold drinks
like orange juice
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Sour milk and porridge are allowed
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Soft and mashed food is easier to eat
(eggs, mashed potatoes, pumpkin,
avocado
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Avoid spicy, salty and rough foods
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Chop foods finely and give cold drinks
or crushed ice, if available
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Diarrhoea
 Drink enough fluids and ORS every time the child has to go to
the toilet
 The child must eat!
 Bread, rice, pap and porridge good
 DO not give the child the skin and pips of fruit or vegetables
(eg peas and beans)
 DO not give food left over from previous day
Encephalopathy
• Monitor the child’s feeding
skills
• May have to change texture
and consistency of food
• Modify eating techniques
and utensils
• Refer to speech therapy for
assistance with feeding
Poor Weight Gain
 Counsel the mother about feeding
practices used
 Advise mother about foods to give
as per recommendations already
outlined
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 Give the child an extra meal each
day
 Offer snacks that he likes
 Ensure child is weighed again in 14
days
Protein-Energy Malnutrition Scheme
 Administered by local authorities
 Part of Integrated Nutrition Programme
 Provides food supplements to those children underweight
(below 3rd percentile on the Road to Health Chart)
 All children are eligible to benefit from the PEM scheme
 Should not be administered in isolation
 Also refer to existing community support agencies
Remember!
If a child is sick, he not only needs more food but also more fluids
 If child is breastfed, breast feed more frequently and for longer at
each feed
 Increase other fluids ef give soft porridge, amasi, SSS or clean
water
 If the child has diarrhoea, giving extra fluids can be life-saving
Breast Feeding Problems
Common reasons why mothers add other feeds or stop
breastfeeding:
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Problems with Positioning and Attachment
“Not Enough Milk”
Sore or Cracked Nipples
The Baby Feeds often or cries a lot
Usually, mother has enough milk but lacks confidence that it is
enough
Observe feeding practice and advise on attachment and
Positioning
Offer support and encouragement
Safe Preparation of Formula Milk
 Always use a marked cup or glass and spoon to measure water
and the scoop to measure the formula powder
 Wash your hands before preparing a feed
 Bring the water to the boil and then let it cool. Keep it covered
while it cools
 Follow the instructions on the tin, ensuring the scoops of
powder are LEVEL and the powder and water are MIXED WELL
 Feed the baby using a cup
 Wash the utensils
How to Feed a Baby with a Cup
 Hold the baby sitting upright or semi-upright on your lap
 Hold a small cup of milk to the baby’s lips
- tip the cup so the milk just touches the baby’s lips
- the cup rests gently on the baby’s lower lip and the edges of
- the cup touch the outer part of the baby’s upper lip
- the baby becomes alert and opens his mouth and eyes
 Do not pour the milk in to the baby’s mouth. Just hold the cup t
his lips and let him take it himself
 When the baby has had enough he closes his mouth and will
not take any more
Counsel the Mother
 If the mother or main carer is
sick or malnourished, she
will be unable to care for the
child
 Counsel the mother to keep
up her own strength and
health
 Advise her about her own
nutrition and the importance
of a well balanced diet to
keep herself healthy
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So How Can You Help?
You have a vital role to play in
identifying potential problems and
preventing malnutrition…….
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Check the Road to Health Card
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Explain the importance of
weight checks to the carer
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Advice the carer about the
foods required by the child
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Counsel the mother about food
preparation and availability
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Refer any concerns!