We read with interest the IYCF Guidelines 2016 [1]
published recently in Indian Pediatrics. We would like to bring to the
attention of the readers and policy makers the following issues:
1. Regarding "HIV and infant feeding", point "h"
needs attention inlight of WHO recommen-dations and recent
literature [2,3]. In its guiding practice statement, WHO clearly
states that in mothers living with HIV, mixed feeding is better than
"no breastfeeding at all."
2. Mothers living with HIV who plan to return to
work/school (increasing trend seen in young Indians), a shorter
duration of breastfeeding is better than not initiating
breastfeeding at all [2].
3. Regarding "HIV and infant feeding", point "m"
dealing with exclusive replacement feeding (ERF), WHO is more
emphatic regarding avoidance of animal milk in first six months of
life. However, animal milk is a valid option for ERF in children
above six months [2].
4. Regarding "Infant feeding in various
conditions related to the infant", point (iv) deserves attention as
recent literature shows that "upright positioning for 30 minutes
after feeds" does not hold true in reducing gastroesophageal reflux
(GER) [4]. The prone position was superior to the supine or upright
positions while patients were awake or asleep. However, prone
position cannot be recommended due to its association with sudden
infant death syndrome (SIDS). The policy statement on task force on
SIDS recommends supine position for infants including infants with
GER [4].
References
1. Tiwari S, Bharadva K, Yadav B, Malik S, Gangal P,
Banapurmath CR, et al, for the IYCF Chapter of IAP. Infant and
Young Child Feeding Guidelines, 2016. Indian Pediatr. 2016;53:703-13.
2. WHO. Updates on HIV and Infant Feeding. Available
from:
http://www.who.int/maternal_child_adolescent/documents/hiv-infant-feeding-2016/en/
. Accessed September 5, 2016.
3. Victora CG, Bahl R, Barros AJD, França GVA, Horton
S, Krasevec A, et al. Breastfeeding in the 21st century:
epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475-90.
4. Task Force on Sudden Infant Death Syndrome,
Moon RY. SIDS and other sleep-related infant deaths: expansion of
recommendations for a safe infant sleeping environment. Pediatrics.
2011;128:1030-9.
Editor’s note: The corresponding author of the guidelines in
question did not provide a point-by-point response to these queries, and
stated that these issues will be addressed at the time of next revision
of guidelines.
