3. Infant Feeding.pptx

Infant Feeding And Feeding Problems in Infancy Introduction  Feeding is an important part of the everyday life of infants and young children  Much of parent-child interaction occurs at feeding times  optimal infant and young child feeding practices rank among the most effective interventio...

Infant Feeding And Feeding Problems in Infancy Introduction  Feeding is an important part of the everyday life of infants and young children  Much of parent-child interaction occurs at feeding times  optimal infant and young child feeding practices rank among the most effective interventions to improve child health  Under-nutrition is associated with at least 35% of child deaths. It is also a major disabler preventing children who survive from reaching their full developmental potential.  Around 32% of children less than 5 years of age in developing countries are stunted and 10% are wasted.  It is estimated that sub-optimal breastfeeding, especially non-exclusive breastfeeding in the first 6 months of life, results in 1.4 million deaths and 10% of the disease burden in children younger than 5 years. Learning Objectives  To discuss breastfeeding  exclusive breast feeding  Compare the composition of human milk and cow’s milk  To discuss artificial feeding  Differentiate the various milk formulas  Formula feeding techniques To discuss weaning and introduction of solids Define weaning  State when to start solid feedings and why  Enumerate the recommended solid feedings  To define and demonstrate a “healthy” diet for children tO Learn about Feeding problems in infancy Breast Feeding  Breast milk is the ‘Best Milk’ for babies  Ideally initiated within 1 hour after birth in a healthy term neonate  Preterm milk is ideal for preterm babies which can be given as tube feeding or paladay feed  “Colostrum” is rich in immunoglobulins Exclusive breast feeding  Feeding  No only breast milk upto 6 months of life artificial feeds or pacifier , water or sugar solution  Only medicines or vitamins can be given if prescribed Determining Adequacy of Breast Milk  If infant is satisfied after each nursing period  Contented and sleeps 2-4 hours between feedings  Urine 8-10 times a day, stools 2-3 times a day  Regularly and adequately gaining weight i.e 20 to 30g/day  The “let-down” or milk ejection reflex in the mother is an important sign Advantages of Breast Milk Proper quality & quantity of nutrients Rates of growth better in the 1st 3-4 months Anti-infective properties Prevents allergy due to high IgA preventing antigen absorption 5. Contraceptive property, high levels of prolactin inhibit synthesis of ovarian steroids causing delay of ovulation & pregnancy 1. 2. 3. 4. Advantages Psychological advantages a. Fosters mother-child relationship b. Tactile contact makes babies more secure, emotionally stable c. A sense of fulfillment, satisfaction & joy for the mother 7. Protective against a. Necrotizing enterocolitis b. Otitis media c. Dental caries 8. Others: a. Safe, contains no pathogens b. Always at the right temperature c. Convenient & always available 6. Anti Infective Factors of Breast Milk a. Breast milk esp. colostrum contains plenty of b. c. d. e. f. antibodies E. coli antibodies present High % of lactose stimulates Lactobacillus bifidus Lactoferrin binds iron & inhibits growth of E. coli, staphylococci & Candida albicans Lysozyme bacteriostatic against enterobacteriaceae & staphylococcus species Anti-staphylococcus factor Anti Infective factors g. Lactoperoxidase kills streptococci & enteric bacteria h. Secretory IgA against intestinal bacteria i. Macrophages involved in phagocytosis & synthesis of bacteriostatic proteins: lactoferrin, lysozyme & complements C3, C4 j. B-Lymphocytes responsible for synthesis of IgA k. T-lymphocytes against E. coli, rubella, CMV & mumps viruses COMPARISON OF BREAST MILK v/s COW MILK CONTRAINDICATIONS OF BREAST FEEDING  ABSOLUTE:  HIV INFECTION  OPEN CASE OF TB  CHEMOTHERAPY  SEVERE ILLNESS IN MOTHER  RELATIVE:  ANTIMALARIALS  ANTI EPILEPTICS  ANTI PSYCHOTICS  LOCAL INFECTION  HEART DISEASE. BREAST FEEDING TECHNIQUE  Breast-feeding maybe started about 30 min after NVD & 1 hr after C/S  The baby should be comfortable, in semi-sitting position with lips engaging considerable areola & breast not obstructing breathing  The mother should be seated comfortably & relaxed  ADEQUATE Attachment and Latching must be ensured  Burping after feeds Positioning Attachment and Latching Formula Feeding Commercial formula:  Modified from cow’s milk base  Protein levels decreased  Saturated fatty acid of cow’s milk is replaced by vegetable unsaturated fatty acid  Vitamins are added. Formula Feeding Special Milk Formulas Where either the carbohydrate, protein, fat or all these components have been altered to address specific needs  Preterm formula milk  Phenylalanine-free Milk formula for phenylketonuria  Lactose-free Formulas- For lactose intolerance or galactosemia  Soy formulas/Protein Hydrolysates - For infants with cow’s milk allergy Technique of formula feeding  Mother & baby comfortable  Infant hungry, warm, dry, awake  Sterile techniques and hygiene  Avoid bottle feeding-Increased risk for aspiration, Increased incidence of otitis media, diarrhea  Time for feeding: 5 – 25min Formula Feeding  Calorie requirement: 80 – 120kcal/kg, 100kcal/kg at one year  Protein: 2.3g/kg to 1.5g/kg  Fluid: 130 – 190ml/kg Frequency of Feeds No. of feeds:  First week 6 – 10  One week to 1month  1mo to 3 months 5–6  3mo to 7 months 5–6  4mo to 9 months 4–5  8mo to 12months 3 6–8 Amount of Feeds Age Amount per feeding  2 weeks 60-90ml  3 wks to 2 months 120-150ml  2mo to 3 months 150-180ml  3mo to 4 months 180-210ml  5mo to 12 months 210-240ml Not recommended in infants Whole Cow’s Milk  Protein content much higher than in breast milk increasing solute load  Low in iron  Use may result in occult blood loss in stools Skimmed Milk & Low Fat Milk  Very low fat content  Deficient in vitamin C & iron Goat’s Milk  Just as antigenic as cow’s milk  High protein content may result in increased renal solute load  Deficient in folic acid & iron Complementary Feeding (WEANING)  Introduction of Semisolid food after 6 months of life along with breast feeding  To meet growing nutritional requirement  Initially liquid and runny in consistency  1 feed per day, one ingredient to start with  Water can be given with feeds  Needed in order for children to get accustomed to solid food later Complementary feeding Introduction of solids usually done at about 4-6 months of age because:  Milk supply may no longer meet the nutrient requirements for growth  Intestinal tract better able to handle foreign proteins  Kidneys are able to tolerate increased protein loads  The infant exhibits developmental readiness Complementary feeds  Wheat , ragi gruel  Banana, apple juice or pulp  Rice gruel  Mashed potatoes  Boiled vegetables Problems in Infant Feeding A) STRUCTURAL ABNORMALITIES  Abnormalities of the naso-oropharynx: choanal atresia,cleft lip or palate, Pierre Robin sequence, macroglossia,Tongue tie  Abnormalities of the larynx and trachea: laryngeal cleft, laryngeal cyst, subglottic stenosis, laryngo-tracheomalacia  Abnormalities of the esophagus: tracheoesophageal fistula,congenital esophageal atresia or stenosis,stricture, vascular ring B) NEURODEVELOPMENTAL DISABILITIES  • Cerebral palsy  • Arnold-Chiari malformation  • Myelomeningocele  • Familial dysautonomia  • Muscular dystrophies and myopathies  • Möbius syndrome  • Congenital myotonic dystrophy  • Myasthenia gravis  • Oculopharyngeal dystrophy C) BEHAVIOURAL FEEDING DISORDERS  • Infantile anorexia (6 months–3 years)  • Sensory food aversions  • Feeding disorder associated with concurrent medical condition  • Post traumatic feeding disorder Feeding problems  Preterms babies  Sick neonates  Galactosemia  Maternal death Conclusion  Breast milk is the best milk  Initiate early breast feeding and support exclusive breast feeding upto 6 months of life  Continue breast feeding upto 2 years age  Start Complementary feeding after 6 months  Maintain hygiene and prepare healthy food  Address feeding problems early to prevent malnutrition and growth retardation