Transcript INFANT NUTRITION. BREAST

Child nutrition. The alimentary
factors & developments of
teeth system and development
of diseases
Nykytyuk S.O
Human milk is uniquely superior for
infant feeding and is species-specific;
all substitute feeding options differ
markedly from it. The breastfed
infant is the reference or normative
model against which all alternative
feeding methods must be measured
with regard to growth, health,
development, and all other shortand long-term outcomes
Epidemiologic research shows that human milk
and breastfeeding of infants provide advantages
with regard to general health, growth, and
development, while significantly decreasing risk
for a large number of acute and chronic diseases.
Research in the United States, Canada, Europe,
and other developed countries, among
predominantly middle-class populations, provides
strong evidence that human milk feeding
decreases the incidence and/or severity of
diarrhea, lower respiratory infection, otitis media,
bacteremia, bacterial meningitis, botulism,
urinary tract infection, and necrotizing
enterocolitis
There are also a number of studies that indicate possible
health benefits for mothers. It has long been acknowledged
that breastfeeding increases levels of oxytocin, resulting in
less postpartum bleeding and more rapid uterine involution.
Lactational amenorrhea causes less menstrual blood loss
over the months after delivery. Recent research
demonstrates that lactating women have an earlier return
to prepregnant weight, delayed resumption of ovulation
with increased child spacing, improved bone
remineralization postpartum with reduction in hip fractures
in the postmenopausal period, and reduced risk of ovarian
cancer and premenopausal breast cancer. In addition to
individual health benefits, breastfeeding provides significant
social and economic benefits to the nation, including
reduced health care costs and reduced employee
absenteeism for care attributable to child illness. The
significantly lower incidence of illness in the breastfed infant
allows the parents more time for attention to siblings and
other family duties and reduces parental absence from
work and lost income
RECOMMENDED
BREASTFEEDING PRACTICES
Human milk is the preferred feeding for all
infants, including premature and sick newborns,
with rare exceptions. The ultimate decision on
feeding of the infant is the mother's. Pediatricians
should provide parents with complete, current
information on the benefits and methods of
breastfeeding to ensure that the feeding decision
is a fully informed one. When direct breastfeeding
is not possible, expressed human milk, fortified
when necessary for the premature infant, should
be provided. Before advising against
breastfeeding or recommending premature
weaning, the practitioner should weigh
thoughtfully the benefits of breastfeeding against
the risks of not receiving human milk.
Breastfeeding should begin as soon
as possible after birth, usually within
the first hour. Except under special
circumstances, the newborn infant
should remain with the mother
throughout the recovery period.
Procedures that may interfere with
breastfeeding or traumatize the
infant should be avoided or
minimized
Newborns should be nursed whenever
they show signs of hunger, such as
increased alertness or activity, mouthing,
or rooting. Crying is a late indicator of
hunger. Newborns should be nursed
approximately 8 to 12 times every 24
hours until satiety, usually 10 to 15
minutes on each breast. In the early
weeks after birth, nondemanding babies
should be aroused to feed if 4 hours have
elapsed since the last nursing
No supplements (water, glucose
water, formula, and so forth) should
be given to breastfeeding newborns
unless a medical indication exists.
With sound breastfeeding knowledge
and practices, supplements rarely
are needed. Supplements and
pacifiers should be avoided whenever
possible and, if used at all, only after
breastfeeding is well established
When discharged <48 hours after delivery, all
breastfeeding mothers and their newborns should
be seen by a pediatrician or other knowledgeable
health care practitioner when the newborn is 2 to
4 days of age. In addition to determination of
infant weight and general health assessment,
breastfeeding should be observed and evaluated
for evidence of successful breastfeeding behavior.
The infant should be assessed for jaundice,
adequate hydration, and age-appropriate
elimination patterns (at least six urinations per
day and three to four stools per day) by 5 to 7
days of age. All newborns should be seen by 1
month of age.
Exclusive breastfeeding is ideal nutrition
and sufficient to support optimal growth
and development for approximately the
first 6 months after birth. Infants weaned
before 12 months of age should not
receive cow's milk feedings but should
receive iron-fortified infant formula.
Gradual introduction of iron-enriched solid
foods in the second half of the first year
should complement the breast milk diet. It
is recommended that breastfeeding
continue for at least 12 months, and
thereafter for as long as mutually desired.
In the first 6 months, water, juice, and other
foods are generally unnecessary for breastfed
infants. Vitamin D and iron may need to be given
before 6 months of age in selected groups of
infants (vitamin D for infants whose mothers are
vitamin D-deficient or those infants not exposed
to adequate sunlight; iron for those who have low
iron stores or anemia). Fluoride should not be
administered to infants during the first 6 months
after birth, whether they are breast- or formulafed. During the period from 6 months to 3 years
of age, breastfed infants (and formula-fed
infants) require fluoride supplementation only if
the water supply is severely deficient in fluoride
(<0.3 ppm
Breastfeeding for the first year of
life with the supplementation
Breastfeeding for the first year of life with the supplementation
of Vitamin D from birth and iron supplementation as ferrous
sulfate drops or iron-fortified cereal after 4 months of age.
Fluoride supplementation may be required after 6 months of
age depending on the fluoride content of the city water supply.
Feeding of iron-fortified commercial infant formula for the first
year as an alternative to breastfeeding.
Delaying the use of whole cow milk until after one year of age.
Early introduction of whole cow milk protein during infancy may
contribute to iron-deficiency anemia by increasing
gastrointestinal blood loss. Whole cow milk has an increased
renal solute load compared to infant formulas.
Reduced fat milks should be delayed until after the second year
of life. Adequate fat intake is important for the developing brain
and milk is usually the primary source of fat for toddlers.
Delaying the introduction of semi-solid foods until 4 to 6
months of age or until the infant demonstrates signs of
developmental readiness, such as head control and ability to sit
with support.
There is an agreement among
healthcare professionals,
infant food manufacturers and
mothers that breastfeeding is
the best choice for feeding
infants during their first four
to six months of life
There are several reasons why a
mother may not breastfeed her
baby:
1. Medical or other health reasons
may prevent a mother from
breastfeeding.
2. The baby with special
requirements may not tolerate
breast milk.
3. Some social or psychological
reasons can make it more
difficult to breastfeed exclusively.
Table 1. Drugs that are contraindicated
during breast-feeding
No.
Drug
Reported sign or symptom in infant
or effect on lactation
1. Bromocriptine Supresses lactation
2. Cocaine
Cyclophos3.
phamide
4. Cyclosporine
Cocaine intoxication
Possible immune supression;
unknown effect on growth or
association with
carcinogenesis; neutropenia
Possible immune supression;
unknown effect on growth or
association with
5.
Doxopubicin
Possible immune supression; unknown
effect on growth or association with
carcinogenesis
6.
Ergotamine
Vomiting, diarrhea, convulsions (doses
used in migraine medication)
7.
Lithium
⅓ to ½ therapeutic blood
concentration in infants
8.
Possible immune supression; unknown
Methotrexate effect on growth or association with
carcinogenesis; neutropenia
9.
Phencyclidin
e (PCP)
10. Phenindione
Potent hallucinogen
Anticoagulant; increased prothrombin
and partial thromboplastin time in
infant
Table 2. Drugs that have caused
significant effects on some nursing
infants and should be given to nursing
mothers with caution
No.
Drug
Reported sign or symptom in infant or
effect on lactation
Aspirin
1. (salicylates)
Metabolic acidosis (dose related); may
affect platelet function; hemorrhagic
rash
Drowsiness, irritability, refusal to feed,
2. Clemastine
high-pitched cry, neck stiffness
Sedation; infantile spasms after
Phenolbarbito
3.
weaning from milk containing
l
phenolbarbitol, methemoglobinemia
4. Primidone
Sedation; feeding problems
Table 3. Drugs of abuse that are
contraindicated during breast-feeding
No
.
1
.
2
.
3
.
Drug
Reported sign or symptom in infant
or effect on lactation
Amphetamin
Irritability, poor sleep pattern
e
Cocaine
Cocaine intoxication
Heroin
Irritability, Heroin intoxication
4 Nicotine
. (smoking)
Shock, vomiting, diarrhea,
rapid heart rate,
restlessness; decreased milk
Common problems encountered
with brest-feeding
Poor Let-Down (Milk ejection
reflex)
Poor Weight Gain
Mastitis
Cracked Nipples
Jaundice From Breast- Feeding
Artificial feeding
This is the feeding of infant when he
gets cow’s or buffalo’s milk or
formula from first days till 4th to 6th
month of his life.
Formula milks are humanized, i.e.,
they come very close to the
composition of breast milk.
However, they are more expensive,
so cow’s or buffalo’s milk are quite
often used.
Composition of cow’s milk versus
breast milk.
(in 100 ml)
Human milk
Cow’s milk
67
67
Water
87 %
87 %
Carbohydrate
7.4 %
4.4 %
β-lactose
α-lactose
3.5 %
3.5 %
Calories
Lactose
isomer
Fat
Protein
Lactalbumin:Cas
ein ratio
Human milk
Cow’s milk
1.5 %
3.5 %
60 : 40
20 : 80
Sodium
15 mg
Phosphorus
15 mg
Calcium
30 mg
Iron
0.5 mg
60 mg
(4 times)
90 mg
(6 times)
120 mg
(4 times)
0.1 mg
Other advantages of breast milk
versus cow’s milk:
Breast milk is available all the time and is
practically free from pathogenic bacteria.
It needs no time for preparation
It is available at the optimum
temperature.
It contains antibodies as IgG and IgA and
protects against certain infections such as
E.Coli, cholera, polio, tetanus, measles etc.
IgA antibodies prevent the
microorganisms to adhere the intestinal
mucosa and provide local GIT immunity.
β-lactose is called Bifidus factor, which
promotes the growth of lactobacillus and
helps to lower the gut pH, thus inhibiting
the growth of E.Coli and yeasts.
Breast milk contains lactoferrin (an ironbinding whey protein), which inhibits
bacterial growth by depriving them of iron,
which is necessary for growth.
Breast milk contains cystine and tyrosine,
which are not synthesized by infants but
they are essential for proper growth and
development.
Breast milk contains taurine that is
synthesized in inadequate amounts in
infants. It is important for normal
differentiation of CNS.
Breast milk contains nonspecific factors
of immune difence: lisozyme,
macrofagocytes, neutrofiles,
lymphocytes, complement system.
There are 5 times more essential fatty
acids (polyunsaturated: arachidonic,
docosahexacnoic, linoleic, and αlinolenic) in breasts milk than in cow’s
milk.
Breast milk contains ferments (lipase,
lactase) and mothers hormones.
Breast milk is ‘species specific’ and
therefore allergy to breast milk is rare.
Dilution of Cow’s Milk:
Child’s Age
Cow’s Milk
Water
First 10 days
1 part
2 parts
10 to 20 days
1 part
1 part
Up to 2 mo
2 parts
1 part
If dilution of cow’s milk is required,
add 1 TSF of sugar to each ounce of
water (5 %) – isocaloric formula)
Advances in nutritional
modifications of infant formulas
Proteins: their amount is adopted to the
needs of infant’s organism. Almoust all
formulas contain whey:casein ratio as
60:40 and adopted amino acid content.
Amino acid Breas Cow’s “Vitalact” “Similac”
t milk milk
Valine
Lysine
Trypto-
8.2
%
10.9
5
6.6
4.6 %
6.8 %
7.8
9.7 %
8.4 %
Fats: long-chain polyunsaturated
fatty acids are added in amounts
similar to those in human milk.
Infants fed these formulas or
human milk have higher tissue
concentrations of long-chain
polyunsaturated fatty acids and
reportedly have better visual
acuity than do infants fed
nonsupplemented formulas.
Carbohydrates: they are presented
by β-lactose, sakcharose, dextrinmaltose, which improve the growth
of Bifidum-bacteria. The total
quantity of carbohydrates in formulas
is 7.5 %
Nucleotides and their related
products play key roles in many
biological processes. Although
nucleotides can be synthesized
endogertously, they are considered
"conditionally essential." Nucleotide
concentrations in human milk are
higher than in unsupplemented cow
milk-based formulas, and studies in
animals and human infants suggest
that dietary nucleotides play a role
in the development of the
gastrointestinal and immune
systems
Vitamins and minerals
E
C
Vitamin
Vitamin
Potassiu
m
Seleniu
m
Breast
milk
0.63
mg%
Cow’s
milk
Fortified
formulas
0.18
0.4-0.6
4.2 mg%
1.5
4.5-5.0
55 mg%
140
70-95
15 to 20
µg/L
2 to 8
µg/L
11 to 15
µg/L
For infants 0 to 12
months
Whey
proteins:casein =
60:40
Close to breast milk
spectrum of amino
acids
Contains taurine.
Milk fats – 74 %
and plant fats – 26
%
Linoleic : α-linolenic
ratio is optimal for
absorption 9.9:1
Osmolality is equal
The level of
proteins is 2.2 %
Whey
proteins:casein =
40:60
Inriched with
bifidum-bacteria
Fortified with
vitamins
Biologically
hydrolyzed casein
and whey proteins
Biologically
hydrolyzed lactose
Iron fortified (0.8
mg/100 ml)
Contains
Bifidobacterium
Lactis 2107/1 g
-6 : -3 = 7.9:1
Osmolality 270
mosm/L
It doesn’t contain
lactose
Only whey
proteins are
present, 20 % of
them are amino
acids
Contains
nucleotides and
selen
Iron and Iodine
fortified
Contains taurine,
inositol, Lkarnitine.
For infants with
Hypergalactosaemi
a
Lactose intolerance
Strong allergy to
cow’s milk proteins
Vegetarian babies
For premature and
low-birth-weight
(less than 2500 g)
babies
Proteins – 2.3 %
Whey : casein ratio
= 70:30
Proteins are particly
hydrolyzed
(oligopeptids)
Contains lysine,
cystine, tryptophan,
L-histidine, and
taurine.
Polyunsaturated
fatty acids
(arachidonic,
docosahexacnoic,
For ‘hungry’ babies
For infants with
often regurgitation
Contains 77 % of
casein
Iron, Iodine, Vit. D,
A, E and C
enriched.
NAN H.A.1
NAN H.A.2
For children with
strong family allergy
Contains 100 % of
whey proteins,
which are
hydrolyzed to
oligopeptids (80 %)
and aminoacids (20
%)
Alfaré
Hypoallergenic
elemental diet for
children with
malarbsorption
syndrome, diarrhea,
for tube feeding
Contains hydrolyzed
whey proteins: 80 %
of oligopeptids and
20 % of aminoacids
Hydrolyzed lactose
Short-chain fatty
acids
Other commercial infant formulas
Formula
Protein
source
CarbohyFat source
drate s.
For full-term and premature infants with no
special nutritional requirements
SMA
(Wyeth)
Enfamil
(Mead
Johnson)
Nonfat cow's
Lactose
milk, reduced
mineral whey:
whey/casein
ratio: 60:40
Nonfat cow's
Lactose
milk, demineralized whey:
whev/casein
ratio: 60:40
Oleo,
coconut,
oleic (safflower) and
soy oils
Soy, coconut
oils
Similac
(Ross)
Nonfat cow's milk;
whey/ casein ratio:
18:82
Lactose
Soy and
coconut oils,
mono- and
diglycerides
Nonfat cow's milk; Lactose
Soy
Baby
whey/ casein ratio:
formula
18:82
(Gerber)
FOR MILK PROTEIN-SENSITIVE INFANTS (‘MILK
ALLERGY’), LACTOSE INTOLERANCE,
GALACTOSEMIA
Prosobee
(Mead
Johnson)
Soy protein isolate
Corn syrup Soy and
solids.
coconut oils
Lactose and
sucrose
free
Isomil
(Ross)
Soy protein isolate
Corn svrup, Soy and
sucrose
coconut oils
Lactose
free
FOR INFANTS WITH MALABSORPTION SYNDROME
RCF (Ross
Carbohydra
te Free)
(Ross)
Soy protein
isolate
Absent
Soy and
coconut oils
Portagen
(Mead
Johnson)
Sodium
caseinate
Corn syrup
solids, sucrose,
lactose
MCT (coconut
source) and
corn oil
Pregestimil
(Mead
Johnson)
Casein
hydrolysate
and L-amino
acids
Corn syrup
solids,
modified
tapioca
starch
Corn oil, MCT
For infants
with
disaccharidase
deficiencies,
malabsorptio
n svndromes,
Specialty formulas
Formula
(manufacturer)
Indication for use
Comments
Lonalac
(Mead
Johnson)
Powder
For children with
congestive cardiac
failure, who
require reduced
sodium intake.
For long-term
management,
additional sodium
must be given.
Supplement with
vitamins C and D and
iron. Na = 1 mEq/L
Similac PM
60/ 40 (Ross)
Powder
For newborns
predisposed to
hypocal-cemia and
infants with impaired
renal, digestive, and
cardio-vascular
functions.
Low calcium,
potassium, and
phosphorus.
Relatively low
solute load. Na —
7 mEq/L
Lofenalac
(Mead
Johnson)
For infants and
children with
phenylketonuria.
Low Methionine
For infants with
111 mg
phenylalanine
per quart of
formula
For children over Phenylalanine
Phenyl-free
1 year of age
free. Permits
(Mead
with
increased
Johnson)
phenylketonuria. supplementation
with normal
foods.
PKU 1 (Milupa) For infants with Phenylalaninephenylketonuria and fat-free.
(Available as PKU Contains
2 for children
vitamins,mineral
over 1 year of
s, and trace
age.)
elements
Nutritionally
Sunlight as a source of vitamin
D
Adequate supplies of
vitamin D3 can be
synthesized with sufficient
exposure to solar
ultraviolet B radiation
Melanin, clothing or
sunscreens that absorb
UVB will reduce cutaneous
production of vitamin D3
What are the causes for
deficiency of Vitamin D?
Reasons of vitamin D deficiency
Environmental conditions where
sunlight exposure is limited like indoor
confinement or working indoors during
daylight hours may reduce source of
vitamin D;
Inadequate daily consumption - a lack
of vitamin D, calcium and phosphorous
in the diet, have trouble digesting milk
products, people who are lactose
intolerant;
Reasons of deficiency vitamin D
Problem of malabsorption called
steatorrhea, in which the body is unable to
absorb fats. The result of this problem is
that Vitamin D, which is usually absorbed
with fat, and calcium are poorly absorbed.
This poor absorption can be a result of
digestive disorders.
Liver, kidney failure (congenital or acquired
disorders) - due to tubular acidosis in which
there is an increased amount of acid in the
body;
Etiology
1. Lack of sunshine due to:
1) Lack of outdoor activities
2) Lack of ultraviolet light in fall and
winter
3) Too much cloud, dust, vapour and
smoke
Etiology
2. Improper feeding:
1) Inadequate intake of Vitamin D
Breast milk 0-10IU/100ml
Cow’s milk 0.3-4IU/100ml
Egg yolk
25IU/average yolk
Herring
1500IU/100g
2) Improper Ca and P ratio
Etiology
3. Fast growth, increased
requirement (relative deficiency)
4. Diseases and drug:
Liver diseases, renal diseases
Gastrointestinal diseases
Antiepileptic
Glucocorticosteroid