• The first and preferred infant feeding option in low-resource settings is exclusive breastfeeding for the first six months of life (see Figure below). Stopping breastfeeding earlier than this should be avoided since this is associated with increased risk of death from diarrheal illnesses, malnutrition and pneumonia.
• Exclusive replacement feeding (formula feeding) is the second possible option for a minority of mothers. If this is the option chosen by a mother you have to make every effort to ensure that she does this safely. Some mothers may choose this option first but because of economic problems or cultural influences, they may end up mixing the formula with breastmilk, which will increase the risk of transmission.

As a health professional you should try to support mothers to decide on the first option. If this is not chosen, you should do your best to ensure safety before you agree with a mother that she uses the exclusive replacement feeding option. Only very few mothers could make it safe.

If a mother is using replacement feeding, infant formula is preferred for the first six months of life. Home-modified animal milk if used should be a temporary measure, and given for short periods only.