Mother’s milk substitutes

Almost all mothers can breastfeed successfully, which according to WHO and Unicef includes initiating breastfeeding within the first hour of life, breastfeeding exclusively for the first 6 months and continuing breastfeeding (along with giving appropriate complementary foods) up to 2 years of age or beyond. Exclusive breastfeeding in the first six months of life is particularly beneficial for mothers and infants. Positive effects of breastfeeding on the health of infants and mothers are observed in all settings. Nevertheless, a small number of health conditions of the infant or the mother may justify recommending that she does not breastfeed temporarily or permanently. Whenever stopping breastfeeding is considered, the benefits of breastfeeding should be weighed against the risks posed by the presence of the specific conditions listed. When deciding to interrupt, stop or supplement breastfeeding it should be noted that feeding at breast is first choice, directly followed by alternatively feeding mom’s own milk. If, even after optimizing breastfeeding management and techniques first choice for an alternative is another mother’s milk (donor-milk) or feeding at breast by another mother (cross-nursing). The 4th option, if no human milk in any form is available, is a specialized non-human milk based substitute or formula. Only children who are incapable to digest human or non-human milk the first and only alternative is a highly specialized and adapted milk substitute. This includes children with classic galactosemia, maple syrup urine disease and with phenylketonuria. A very short list of maternal medications contra-indicates breastfeeding for the duration of the therapy. Mothers who have several acute or chronic diseases can breastfeed a long as they are able to handle their child. One true contra-indication is HIV+, but only if formula is AFASS (acceptable, feasible, affordable, sustainable and safe). Other situations like pre- and dysmaturity, increased risk of hypoglycemia need to be addressed with optimized breastfeeding management and techniques, possibly with own mother’s milk supplements, and only if these do not lead to the aimed results supplements of non-human milk based substitute is indicated.
HIV infection1: if replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS)
http://www.borstvoeding.com/problemen/medicijnen/medicijnlijst-nl.html
WHO/Unicef: Acceptable medical reasons for use of breast-milk substitutes. WHO/NMH/NHD/09.01. WHO/FCH/CAH/09.01