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INFANT FEEDING

INFANT FEEDING. “Nutrition” – “nutricus” – “to suckle at the breast” Critical window period for nutritional programming – first 1000 days of life 270 days in utero Upto 2 years of age Healthy baby into a healthy environment. By 2y of age Weight 20% of adults Height 50% of adults

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INFANT FEEDING

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  1. INFANT FEEDING

  2. “Nutrition” – “nutricus” – “to suckle at the breast” • Critical window period for nutritional programming – first 1000 days of life • 270 days in utero • Upto 2 years of age • Healthy baby into a healthy environment

  3. By 2y of age • Weight 20% of adults • Height 50% of adults • Brain growth 75-80% • Nutrition in this critical period is solely dependent on the health, nutrition, well-being and empowerment of the mother

  4. IYCN/IYCF • 5 key facts and 10 steps of IYCF proposed by UNICEF in 2002

  5. 5 key facts • Indian children have the growth & developmental potential as all children worldwide • Child malnutrition remains one of the greatest developmental challenges of India. • Stunted children have stunted bodies, stunted brains & stunted lives.

  6. Child undernutrition starts early in life to make a lifelong lasting difference. • No need to discover new vaccines or new drugs: ‘We know what works’

  7. 10 key interventions • Timely initiation of breast feeding within 1 hour of birth • Exclusive breastfeeding during the first 6mo of life • Timely introduction of complementary foods at 6mo • Age-appropriate foods for children 6mo to 2years. • Hygienic complementary feeding practices.

  8. Immunization & bi-annual vitamin A supplementation with deworming • Appropriate feeding during and after illness • Therapeutic feeding for children with severe malnutrition • Adequate nutrition & support for adolescent girls to prevent anemia • Adequate nutrition & support for pregnant & breastfeeding mothers.

  9. BFHI • WABA • BPNI • World Breastfeeding Week 1st – 7th August

  10. BFHI • “Baby friendly Hospital Initiative” 1992 • Global programme organised by UNICEF • Cochin – 1st baby friendly city in India • BFHI Plus - incorporates immunisation, antenatal care, ORT, ARI control program etc.

  11. Exclusive demand feeding is the only mode of early infant feeding • Breastfeeding is accepted as a human right, a right of the baby as well as the mother.

  12. 10 steps in BFHI • Have a written breastfeeding policy routinely communicated to all staff • Train all healthcare staff in skills necessary to implement this policy • Educate all pregnant women about benefits & management of breastfeeding • Help mothers initiate breastfeeding within 1 hour of delivery

  13. Show mothers how to feed, how to maintain lactation even when they are separated from their infants • Newborns should not be given anything besides breast milk unless medically indicated • Practice rooming-in 24h a day • Encourage breastfeeding on demand

  14. No artificial teats/pacifiers to breastfeeding infants • Foster the establishment of breastfeeding support groups and refer mothers to them on discharge

  15. Preparing Mother for Breastfeeding • Antenatal motivation and preparation • Primigravidas – more motivation required • Last trimester – check nipples & breast • Oiling, massaging, ‘inverted syringe’ technique

  16. Antenatal mother should take: • Extra 300kcal & 15g protein • Lactating mother should take: • Extra 400-500kcal & 25g protein • 2 extra helpings of family food • Green leafy veggies, seasonal fruits, fluids

  17. Initiation of Breastfeeding • Newborn baby must be put to the breast within half an hour after normal delivery and within 4hours after cesarean section. • Prelacteal feeds should not be given • “Biologically ready”

  18. First 2-4days, small quantity of colostrum (10-40ml) is secreted • Colostrum is rich in • Protein • Immunoglobulins • Followed by ‘transition milk’ then ‘mature milk’

  19. Average quantity: 500-800 ml/day • Gradual increase till 6mo then plateaus • Prolactin is secreted more at night • Night time feeding is crucial

  20. Prerequisites • Mother and baby should be relaxed and comfortable • Proper positioning & posture • Allow sucking for as long as the baby desires • “Foremilk” & “hindmilk” • Feed from both breasts each time; 20min

  21. Rooming in • Bedding in • Mothering in

  22. In case of twins – exclusive breastfeeding should be the choice • Might need supplementation • “Tummy to tummy, chest to chest, chin to breast and mouth to areola”

  23. Reflexes involved in Breastfeeding • Rooting reflex • Milk Production reflex • Let down reflex

  24. Problems during Breastfeeding • Flat or inverted nipples: Normal – areola & the breast tissue beneath should be capable of being pulled out to form the teat

  25. Remedy: i. Inverted syringe technique

  26. ii. Double syringe technique

  27. Fullness & engorgement of the breast • Remedy: Feed frequently (2-2.5hourly for 20min) followed by expression of milk • Apply moist heat 3-5min before a feed, followed by gentle massage • Express enough milk to soften the areola • Paracetamol if required

  28. Sore and cracked nipples: • Remedy: proper latching on, proper technique to break the latch on • Treat oral thrush with 1% Gentian violet • ?Systemic antifungals to mother • Wash the nipple with water, exposure to air • Application of hindmilk after each feed

  29. Blocked duct: • Remedy: Proper technique, avoid tight clothes, warm compresses, massage • Mastitis & Abscess: • Continue breastfeeding! • Antibiotics & symptomatic treatment • Rest • I & D if abscess forms

  30. How often to feed? • Exclusive demand feeding • On an average, the baby should feed 8-10times, 15-20min per feed • Burping after feeds • Position after feed?

  31. How do you know if breast milk is sufficient or not? • Baby is gaining weight • Passing plenty of pale colored urine • Passing 1-6 liquid stools per day – golden yellow • Sleeps for about 2hours at a time

  32. Avoid ‘nipple confusion’ • EBM – palada (gokarnam), spoon, dropper

  33. Continue breastfeeding well into 2nd year of life • Continue even if baby is ill (unless contraindicated) • By 6mo complementary foods should be introduced • Most easily digestible food for the ill baby

  34. Benefits: Satisfies nutritional & fluid demands, provides anti-infective and immunological factors, good pacifier • If sucking is poor, offer more frequent feeds or EBM • Gut priming

  35. Do NOT stop breastfeeding if: • Mother has viral fever, UTI etc. • Open Pulmonary TB – start ATT, put baby on chemoprophylaxis • Hepatitis B – baby should get Hep B vaccine + Hep B Ig • Mastitis, breast abscess – stop temporarily from affected breast, continue to express • Postpartum psychosis – under supervision

  36. Contraindications to Breastfeeding • Congenital lactose intolerance • Galactosemia • Intake of: - Antimalarials - Antithyroid drugs - Antipsychotics - Anti cancer drugs - Radioactive drugs

  37. HIV? • Chance for perinatal transmission: 30% • LSCS, artificial feeds – if affordable • Mother should be on anti-retroviral treatment during pregnancy, continued during labor, 6wks after

  38. Fore milk Syndrome • Failure to thrive, colicky pain, diarrhoea with excoriation • High lactose content in foremilk

  39. Advantages of Breastfeeding • Optimum fluidity and warmth • Economical • Convenient • Physiological – sweetest milk with highest lactose content • Biochemically superior (Whey:casein = 80:20)

  40. Sterile • Immunologically safe and non-allergenic • Ensures mother-child bonding • Maternal benefits: Reduce PPH, helps in involution of uterus, reduce weight, reduce incidence of breast & ovarian cancers

  41. Options for a working mother

  42. Storage of EBM • Should be stored in freezer in clean, capped, glass or hard polypropylene plastic containers or special freezing bags • NOT in the door or in the feeding bottle

  43. How long? • Back of freezer – upto 12 months • Back of fridge – upto 5days • Room temperature – upto 6hours

  44. How to use? • Thaw – place in fridge the night before, place in bowl of warm water • DO NOT REFREEZE • Use within 24hours • Pasteurization (62.5oCx 30min) is acceptable, sterilization (120oC x 30min) is not

  45. “Breast milk for brain growth, Cow’s milk for body growth”

  46. Breast milk contents • Rich in sulphur containing amino acids • Essential fatty acids and LCPUFAs • Hormones & growth factors – TSH, GHRF, insulin....... • Better bioavailability of Cu, Mg, Co, Se, Zn

  47. Alternatives to Breastmilk • Cow’s milk • Formula milk

  48. Comparison • Cow’s milk – high protein and solute content • Equal quantities of calories – 67 kcal/100ml • Proteins in cow’s milk – biochemically different, less digestible • Whey:casein = 20:80 • Less vitamins than human milk

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