Baby A was born at term by caesarean section due to fetal distress. Her birthweight was 3.1 kg, length (L) 45 cm, head circumference (HC) 36 cm. The mother was HIV positive. Baby A was abandoned at six weeks, with a bag of clothing and a tin of infant formula and her birth record. Unable to trace the mother, she was placed in care and arrived at ITL on 21 September 2006 when she was eight months old. She weighed 8.18 kg, was HIV positive, Mantoux positive and negative for syphilis. Her eczema was severe, as is commonly associated with HIV positive children. She was started on DHM immediately. She was placed on treatment for tuberculosis from October 2006 until May 2007. In June 2007, her CD4 count was 18 and she was started on ARV. She had a severe dose of chicken pox and mumps at two years of age, but other than that had no repeated infections commonly associated with HIV positive children. Her milestones were appropriate for her age. She continued to receive DHM until she was three years old. The decisions were made to continue for a longer period than normal as whenever the DHM was stopped, her eczema was exacerbated. She was a happy, confident, intelligent little girl who enjoyed good health despite her medical status and ongoing treatment. She was adopted in July 2011 aged five years (Fig. 1).