A new study from South Africa found that more than two-thirds of mothers and other caregivers pre-chew food for their infants – possibly putting those babies at risk of HIV if the caregiver is HIV-positive.
Though the researchers didn't ask the caregivers whether or not they had the virus when they discussed infant feeding, about half of them were interviewed at an HIV clinic.
Many caregivers who premasticated also had bleeding gums and mouth sores, and some reported giving bloody, chewed food to infants – which could create a route for disease transmission if infants were teething or had any cuts in their own mouths.
Premastication has also been reported in the US and Latin America.
The current study, online in Paediatrics, is "yet one more setting around the world where someone has said that the practice of premastication is present in their society," said Dr Aditya Gaur, of St. Jude Children's Research Hospital in Memphis, who did not work on the new research.
"The next thing is to see how much of a risk this practice poses in terms of transmission of pathogens," he said.
Link between pre-chewing and new HIV infections in infants
Dr Gaur was part of the research team that first tied pre-chewed food to HIV transmission in the US. But in general, he said, "the actual proven cases where you can show this link are few."
The new study, led by Dr Elke Maritz of Stellenbosch University and Tygerberg Children's Hospital in Cape Town, also could not prove a link between pre-chewing and new HIV infections in infants. But it did show the need to caution caregivers about those risks, especially in areas with high rates of HIV and hepatitis B.
Dr Maritz and colleagues interviewed 154 infant caretakers, mostly mothers, in the waiting areas of HIV, paediatric and maternal clinics and caregivers' homes.
Just over two-thirds of them, or 106, said they pre-chewed food for their infants. Fifty-five of those had an oral condition, such as bleeding gums or mouth sores, and 41 reported seeing blood in the chewed food they gave to infants.
It was also common for babies who received pre-chewed food to be teething or to have their own sores or gum bleeding.
"The frequency of reporting blood mixed with the food is of concern, especially as the infants often had oral lesions as well," Dr Maritz said.
Pre-chewing is not always a bad thing
Caregivers who pre-chewed said they did it to test the food's taste or temperature, or to make it into a consistency that was easier for the baby to eat. Many of them said their own mothers had advised them to pre-chew food. Most probably didn't know the possible risks involved, researchers said.
"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," Dr Maritz said.
Pre-chewing is not always a bad thing, researchers added. For example, pre-chewed food might be a good source of nutrition for infants whose families don't have access to processed baby food and in areas where malnutrition is common.
But it's important to balance the risk of malnutrition with the potential to pass HIV through chewed food, Dr Gaur said.
Once researchers have a clearer picture of how common it is for HIV and other viruses to be transmitted that way, doctors can better counsel patients about their risks, and international infant feeding guidelines can reflect them, he added. But that will take further research.
"Once you become aware of the potential risk, you have to share it with your patients and you have to make the community aware of the potential risk," Dr Gaur concluded. "These studies should translate in terms of counselling and day-to-day practise."
(Reuters Health, Genevra Pittman, August 2011)