FORMULA FEEDING and WEANING

1. FORMULA FEEDING andWEANING

2. Introduction Breast-feeding for all infants is the best, however when breast milk is unsuccessful or unavailable a formula, as compositionally close to breast milk as possible is desirable.

3. Indications of formula feeding • Substitutive: • Death or absence of the mother. • Institutes and nurseries. • Mother unwilling to breast-feed. • All contraindications to breast feeding. • Failure of lactation: no or very little milk • Supplemental: • Employed mothers • Twin delivery • Inadequate breast milk

4. Technique of formula feeding • The baby should be hungry, comfortable • The mother should be comfortable • Care of Feeding bottles and teats. • Preparation of Calculated amount of boiled water • Adjust milk temperature • Proper positioning of the bottle • Prubing after feeding • Washing the bottle after feeding

5. Number of feeding • It varies from baby to the other, also varies from day to day. • According to the needs of the baby is the best method. • schedule feeding according to the age and weight is as follow • Quantity of feed is also according to the baby needs • According to weight • Age method • Caloric method

6. Quantity of feed According to weight 150mlof formula*weight(kg)=daily requirement According to age: 1st week:10 ml per feed increased by 10 ml per feed every day End of the 1st week to the end of the 1st months: start by 70 ml per feed in creased by 10 ml every week

7. Quantity of feed After the 1st months : stat by 110ml per feed increased by 10 ml per feed every month Caloric methodThe daily caloric requirement is approximately 80-110 Kcal/Kg for the first year of life, with subsequent decrease by about 10 Kcal/kg/ 3 years until adolescence

8. Quantity of feed Quantity per feed=total calories required in 24 hours/calories in 100 cc of milk*number of feeds in 24 hours=*100 Infant weighs 6 kg= 6*110/67*7=1.4*100=140 cc per feed

9. Fresh animal milk • Raw Cow’s milk :high protein and mineral content results in high renal solute load, Shouldn’t be introduced before the end of the first year , it is deficient in vitC,and D and in iron • Buffalo milk :+high fat content

10. Fresh animal milk Goat milk :easily digested, less allergic but leads to electrolyte disturbance and megaloblastic anemia dt low folic acid content

11. unmodified cows milk is unsuitable for feeding in infancy as it contains too much protein and electrolytes and inadequate iron and vitamins

12. COW MILK PROTEIN–BASED FORMULAS cow milk–based formulas contain a protein concentration 1.5 – 1.9 g/100 ml slight higher than in mature breast milk (1.3 g/100 ml). Plant or a mixture of plant and animal oils are the source of fat in infant formulas;

13. COW MILK PROTEIN–BASED FORMULAS fat provides 40-50% of the energy in cow milk–based formulas. All infant formulas are supplemented with long-chain PUFAs that have positive effects on visual acuity and neurocognitive development.

14. Formula feeding pasteurized cows may be given from 1 year age it is deficient in vitC,and D and in iron and needs good weaning food with it. Alternatively Follow on formulae can be used after 1 year of age they contain more protein and sodium than infant formulae and are fortified by iron and vitamins

15. Lactose free formulas Indications Transient lactose intolerance after gastroenteritis Galactosemia Hereditary lactase deficiency

16. Soya protein formulas Indications Transient lactose intolerance after gastroenteritis Galactosemia Hereditary lactase deficiency Suspected intolerance to cow milk protein, infants with documented IgE mediated allergy to cows milk protein usually do well on soya formula NOT USED BEFORE 6 MONTHS OF AGE

17. PROTEIN HYDROLYSATE ( Semi-elemental) FORMULA Semi elemental formulas contain protein hydrolysate (casein hydrolysate)or (whey hydrolysate) with LCT, MCT, EFA from vegetable oils. CARBOHYDRATES ARE GLUCOSE POLYMERS. Used for infants with wide variety of malabsorption syndromes, cow milk and soya protein intolerance

18. AMINO ACID (elemental) FORMULAS Amino acid formulas are peptide-free formulas that contain mixtures of essential and nonessential amino acids. They are designed for infants with dairy protein allergy who failed to thrive on extensively hydrolyzed protein formulas

19. Premature formula contain greater calories , more protein, and higher levels of vitamins and minerals than formula meant for full term babies. Special formulas: for the dietary management of a specific inborn error of metabolism (phenylketonuria)

21. Disadvantage Of Artificial Feeding • Inadequate composition and quality • No antibody content • Bacterial contamination • Expensive and difficult availability. • More technique difficulty • Increase frequency of certain diseases .

22. COMPLEMENTARY FEEDING & WEANING Definitions • The term weaning describes the process by which the baby gradually becomes accustomed to full adult diet. • Complementary feeding means the provision of foods or fluids to infants in addition to breast milk

23. Importance of weaning • Increasing needs for energy (calories). • Growing baby requires more minerals & vitamins • To train the child on spoon feeding, chewing, and swallowing of solid food • To train the gastrointestinal tract to digest starch and other solid foods. • To educate the child independence by using spoon and cup to feed himself

24. Principles Of Weaning • Introduction of food should be gradually • Do not start a new food when the baby is sick or not doing well. • Initially the new food should be introduced in small amount • Don’t introduce another food until the infant accustomed the previous one • Gradually replace milk by foreign food until all milk feeds are replaced at age of 2 years. • Amounts are determined by baby's appetite. • Never force the infant to take a new food.

25. Principles Of Weaning Introduction of weaning food at about 6 months Fortified cereals, fruits, vegetables, and meat should be complement to breast milk Meats provide an important dietary source of iron and zinc both of which are low in breast milk by 6 months, and pureed meats may be introduced as an early complementary food

26. Breast milk provides optimal intake of most nutrients including iron and zinc. Although they present in lower amounts than in infant formula, they are more bioavailable and sufficient to meet infant needs until ~4-6 mo of age. After 4-6 mo of age, iron and zinc are required from complementary foods, such as iron-fortified cereal and pureed meats.

27. Iron present in animal protein is more bioavailable than that found in vegetables and other foods because it is already incorporated into heme moieties in blood and muscle. Iron deficiency is the most common micronutrient deficiency and is associated with iron-deficiency anemia and neurocognitive deficits.

28. Zinc deficiency affects millions of children and is associated with increased risk for impaired linear growth (stunting) impaired immune function, and increased risk for respiratory and diarrheal diseases.

29. Weaning food

30. Weaning food

31. Weaning food

32. Disadvantage Of Early Weaning • Reduced production of breast milk • The risk of insufficient energy and nutrient intake by the infant. • Infants will benefit less of the protective factors in breast milk • Infants are exposed to microbial pathogens present in foods. • Increase the risk of diarrheal disease and consequently malnutrition. • The risks of food allergies are increased

33. Disadvantage Of Delayed Weaning • Infant may suffer from malnutrition • There is a universal agreement that complementary feeding: • Should not be started before the age of 4 months, and • Should not be delayed beyond the age of 6 months.

34. Foods to Avoid in Infancy • Foods that cause aspiration. • Common allergy inducing foods. • Food additives. • Salted foods. • Junk foods. • Foods hard to digest.

35. FEEDING PROBLEMS First Year Feeding Problems • Underfeeding • Overfeeding • Regurgitation • Loose or diarrheal stools • Constipation • Abdominal colic

36. Second Year Feeding Problems • Failure to gain weight due to: • Self selection of the diet • eating between meals especially sweets • self feeding which is usually insufficient and without hygiene or cleaning

37. Nutrition of the older children For the association of diet with the development of such chronic diseases as diabetes, obesity, and cardiovascular disease, learning a healthy eating behavior at a young age is an important preventive measure Features of the diet for children older than 2 years include the following:

38. Nutrition of the older children 3 meals per day with two snacks Balanced food Fats less than 35% of total calories Reduce cholesterol and trans-fatty acid intake Carbohydrates should provide 65% of daily caloric intake, with no more than 10% in the form of simple sugar

39. Nutrition of the older children • Limitation of eating while watching television • Limitation of sodium intake • Consumption of lean cuts of meats • low- fat milk and vegetable oils(olive oil) should be used

40. Nutrition of the older children Whole-grain bread and cereals and plentiful amount of fruits and vegetables are recommended Processed food, juice drinks, soft drinks and candies should be limited Regular physical activities and limiting sedentary life

41. Thank You