I have received a question from a colleague, a former LLLL, who currently works with AIDS sufferers, including babies of women with AIDS, in a fairly isolated rural area of Zimbabwe. She has been working with two babies of mothers with AIDS, and has noticed a similarity in the response of both babies since they have been fed by bottle, and I wondered if anyone would have information on this. The first baby was born in February, and was breastfed for the first 4 - 5 months of life, until his HIV-infected mother became too ill with TB to breastfeed him. He was then fed diluted cow's milk with micronutrients and did very badly, had little/no weight gain, was very thin "chesty." My friend was able to source some powdered formula for him, and he was then fed formula by cup. This is because the Ministry of Health guidelines for replacement feeding state that bottles and teats are dangerous and any baby who is not breastfeeding should be fed by cup. Once on formula the baby caught up very quickly and doubled his weight. However, my friend still didn't think he was "right" and wondered about the baby's need for sucking. She was given a couple of bottles, and taught the village women who were by now feeding the baby how to clean and sterilize the bottles, and the baby has received formula by bottle/teat for the last month. Apparently the difference in the baby since he has been able to suck is nothing short of amazing. From being very listless and inactive within one month he has learned to sit, crawl and is learning to stand. The second baby is 4 months. He was born by C/section to a mother with active AIDS and because of her weakened immune system she has had repeated infections related to the C/section and she has not been breastfeeding at all. This baby has been on formula by cup from the beginning. However, in the last month he has also received the formula in a bottle, and my friend says that the difference in this baby is also very noticeable. He was "flat", but now he is much more active, has started rolling over, makes eye-contact, and is "chatting" to his carers. My friend says that the only difference in the care of these babies is that they have been given bottles, when they had been fed by cup, and she thinks that it is the sucking itself per se in the last month which has made the difference in their behaviour. She asks if it is possible for babies to have a kind of "infant depression" if they are not able to exercise their strong need to suck. I have to confess that I myself have had some misgivings about the lack of sucking that babies of HIV+ mothers would suffer if fed replacements in accordance with the UNAIDS HIV and infant feeding guidelines. The need for babies to suck seems to be so strong. So we're not really talking about formula here, but about the method of delivery. I said I would ask the experts. So what do you think?? Pamela Morrison IBCLC Harare, Zimbabwe [log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html