Follow up
Q.55 How can health workers help mothers stop breastfeeding? How to counsel a mother on weaning her infant off the breast?
Experience suggests that it helps to discuss cessation of breastfeeding with a mother ahead of time, so that she can be prepared for the process. Mothers should plan ahead and decide when, according to circumstances, it will be best to stop. It is recommended that HIV-infected mothers should breastfeed until 12 months and only then consider stopping, depending on the availability of an adequate diet that does not include breast milk. Mothers or infants who have been receiving ARV prophylaxis should continue prophylaxis for one week after breastfeeding has completely stopped.
Expressing milk may help mothers to avoid engorgement of the breast, or to give to infants. Health workers can show a mother how to use a cup for feeding, and invite her to come to the clinic when she starts to stop breastfeeding. How to express breast milk should be explained and if needed and appropriate, she can be given practical assistance. Her knowledge and confidence should be verified, and if needed it should be explained again.
Before cessation, health workers should discuss with the mother what foods she will give to her infant after stopping breastfeeding and check if these will be sufficient for the child's growth and development.
Health workers should also help mothers plan how they will comfort their babies when they cry when they are tired or upset, without offering the breast. Some methods include cuddling, rubbing and rocking the baby, or offering a finger or forearm to suck on. Ahead of stopping breastfeeding, the baby should be accustomed to means of comfort provided by people other than the mother. If the baby is used to being breastfed before being put to bed at night and/or breastfed first thing in the morning, it is better to have someone else put the baby to bed and to pick them up in the morning.
To begin cessation, a mother will need to express her breast milk, and then replace one breastfeed with a cup feed each day. The number of cup feeds per day can be increased each few days, until the baby is taking enough and the mother can stop putting the baby to the breast. Cup feeds of breast milk can then be replaced with a suitable breast-milk substitute or cows milk, depending on the age of the baby. From 6 months of age, children can take animal milks such as boiled or pasteurized full-cream cow milk. Infant formula is not indicated at 12 months of age. During this process, if the mother or baby is not receiving ARVs to prevent HIV transmission, breast milk may be heat-treated (brought to the boil) to destroy HIV.