Web edition: July 27, 2009
Although this is one of those “Ewwww” stories, it also contains a potentially life-saving observation. To wit: People with HIV/AIDS should never give a child food they’ve chewed. Especially if that chewer has bleeding gums.
A report in the August Pediatrics shares information from three black families that learned tragically the ramifications of this age-old practice in an era of AIDS.
I was raised on baby food that came in jars. My daughter showed a preference for some reconstituted freeze-dried fruits and veggies over fresh cooked (and mashed) produce or those that came in jars.
But many cultures don’t go the commercial route or rely on a food processor or potato masher to prepare weaning meals. Instead, an adult chews meat or some veggie until it is soft. Then mom or whomever spits the mush into a spoon and serves it to baby. A new paper describes a trio of U.S. cases that together “provide compelling evidence linking premastication [i.e. pre-chewed food] to HIV infection.”
Indeed, these cases point to “a possible explanation for some of the reported cases of ‘late’ HIV transmission in infants, so far attributed to breastfeeding,” according to Aditya Gaur of St. Jude Children’s Research Hospital, in Memphis, and his colleagues from the University of Miami School of Medicine and Centers for Disease Control and Prevention.
The earliest case this team investigated dates back to 1993, when a Miami pediatrician saw a 15-month old toddler for recurrent ear aches and diarrhea. Although the boy had previously been healthy, the doctor decided to take a blood test for HIV. The boy’s blood came back positive. And again twice more over the next few months. The boy’s mother was free of disease.
Upon probing, the mom noted that while her son was 9 to 14 months old, the two had lived with a great-aunt who helped care for the boy. And this aunt had a habit of feeding pre-chewed food to the youngster. The great-aunt’s gums were bleeding, the child’s mom recalled. Moreover, on at least one occasion the mom witnessed “blood mixed with the prechewed food.” What mom didn’t know until her relative died a month before the boy’s symptoms set in: That great-aunt had been HIV positive.
In a second Miami case, doctors had repeatedly tested a boy born to an HIV-infected woman. And through the age of two he remained free of the virus. But in 1995, when the child was a little over three, a pediatrician diagnosed the boy with anemia and a fungal assess in his jaw bone. Because of the mom’s disease and her history of cocaine abuse, the doctor performed another test of the boy’s blood. It not only came back positive, this time, but further analysis would show he had the same strain of virus as his mother did.
Mom admitted to feeding her son pre-chewed foods but couldn’t remember whether her gums might have been bleeding at that time.
In the last case, a nine-month-old Memphis girl was rushed to an emergency room in 2004 with a fever, nosebleed, oral thrush (a fungal disease) and “failure to thrive.” Owing to her mother’s diagnosis of HIV infection nine years earlier, the child had been screened shortly after birth and come up HIV-free. Moreover, the mom administered antiviral HIV treatment to her baby for six weeks after the girl was born and never breastfed the baby.
By the time the child was eight-months old, she was lethargic, developing rashes and running a low-grade fever. Records showed the mom had offered her daughter pre-chewed meats from the time the girl was three months old. And mom’s oral health: Throughout, she chronically experienced gum bleeding and mouth sores. The strain of virus cultured from her daughter’s blood matched her own.
So why did it take so long for these three cases to make it into the research literature?
Until now, no one had reported any evidence that pre-chewing could spread HIV and “ample data [in the mid-90s] indicated that routine household contact and kissing were not associated with a significantly increased risk of oral HIV transmission,” Gaur’s team notes. There was also little published data on how widespread pre-chewing baby food might be.
However, the new paper's authors recently turned up several reports indicating that the pre-chewing of baby's foods may be surprisingly common. In one study of Alaskan Native children up to three years old, some 86 percent of caregivers said they routinely pre-chewed food for their babies. A survey from the late ‘80s in Nebraska found that 45 of 68 adult caregivers reported having fed their infants pre-chew fare — and nearly all of these adults knew of others who did also.
The new paper also cites unpublished data indicating that perhaps 10 percent of U.S. babies may be fed pre-chewed food, with the prevalence especially high among black families, where up to half may periodically receive pre-chewed entrees. Data from China suggest pre-chewing may be even more widespread there.
The researchers don’t argue against pre-chewing baby’s food, especially among families where there is a long cultural history of it — unless moms or other caregivers have HIV. But where parents are infected, the researchers recommend that doctors point out the apparent newfound risks that they might unwittingly seed a baby’s food with their bloodborne germs.
Gaur, A.H., et al. 2009. Practice of Feeding Premasticated Food to Infants: A Potential Risk Factor for HIV Transmission. Pediatrics 124(August):658. DOI: 10.1542/peds.2008-3612
Centers for Disease Control and Prevention. HIV/AIDS Fact Sheets. [Go to]