Breastfeeding, maternal health and everyday living
Q.14 The Guidelines recommend that mothers should stop breastfeeding gradually, and not suddenly or abruptly. What does 'gradually' mean?
For mothers known to be HIV-infected who decide to stop breastfeeding at any time, “gradually” means within one month. Stopping breastfeeding abruptly is not advisable as it may cause engorgement which may be painful for the mother.
Before cessation, health workers should discuss with the mother what foods she will give to her infant after stopping breastfeeding and 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 or when they are tired or upset, without offering the breast. Mothers or infants who have been receiving ARV prophylaxis should continue prophylaxis for one week after breastfeeding is fully stopped.
To stop gradually, a mother will need to teach her baby to drink expressed breast milk from a cup, 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 substituted with infant formula or other suitable breast-milk substitute or milk, depending on the age of the baby. During this process, if the mother or baby is not receiving ARVs to prevent HIV transmission, then breast milk may be heat-treated to destroy HIV. (See Q16 for more information on heat treatment.)