Pre-Chewed Food May Pose HIV Threat to Infants

In a new study in South Africa, more than two-thirds of mothers and caregivers reported pre-chewing food for their infants, a practice that could put the babies at risk of HIV if the caregiver is infected.

The research, led by Dr. Elke Maritz of Stellenbosch University and Tygerberg Children's Hospital in Cape Town, did not prove a link between pre-chewing and new HIV infections in infants. It does, however, demonstrate the need to warn caregivers about the risks of the practice, particularly in areas with high rates of HIV and hepatitis B.

In their introduction, the authors noted that while "premastication of food for weaning infants might have nutritional benefits, it is also associated with transmission of pathogens." In addition to Africa, the practice has been reported in the United States and Latin America.

The team adapted a previously reported questionnaire to collect data from a convenience sample of infant caregivers recruited at public maternal/pediatric clinics, HIV clinics, and home visits. A total of 154 caregivers took part; their median age was 29; and 92 percent were the biological mothers of the infants. Pre-chewing food for the babies was reported by 106 (69 percent) of caregivers. The median age of the infants eating the food was six months; 46 babies (43 percent) were teething; and 44 (42 percent) had oral mucosal lesions while receiving the pre-chewed food.

Fifty-five caregivers (52 percent) reported an oral condition, chiefly bleeding gums, mouth sores, and thrush. Forty-one caregivers (39 percent) reported seeing blood in the pre-chewed food they gave the infants.

"Premastication practices were cultural (40 percent), habit (20 percent), and on mother's advice (75 percent). Reasons for premastication were to pretaste (68 percent), encourage eating (61 percent), estimate food temperature (85 percent), and homogenize food (60 percent)," according to the report.

"Due to its long history and cultural acceptance, premastication seems to be considered so harmless and natural by caregivers that they tend not to mention it during health interviews, or suspect that there could be something wrong with this feeding method," Maritz told Reuters Health. However, "The frequency of reporting blood mixed with the food is of concern, especially as the infants often had oral lesions as well."

"Counselors and caregivers should be aware of the adverse effects of premastication," the authors concluded. "Education should include advice to avoid premastication and to seek health advice for oral conditions in the caregiver and child. More studies are needed to better define the extent and risks of premastication, including its possible role in increasing HIV-1 transmission."

The study, "Premasticating Food for Weaning African Infants: A Possible Vehicle for Transmission of HIV," was published in Pediatrics (08.28.11;doi:10.1542/peds.2010-3109).

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