Transcript 25.10.2006-вигод.дітей_1_року_життя

Вигодовування дітей
першого року життя.
Природне, штучне та
змішане вигодовування.
Лектор: Галіяш Наталія Богданівна
Існує узгодженість між лікарями,
працівниками охорони
здоров’я, виробниками
продуктів дитячого харчування
та матерями про те, що грудне
молоко є найкращою і, бажано,
єдиною їжею для немовлят
протягом перших 4-6 місяців
життя.
Можливі причини відмови від
грудного вигодовування:
1.
Медичні протипокази чи інші
проблеми, пов’язані з станом здоров’я
матері.
2. Діти з вродженою непереносимістю
грудного молока.
3. Певні соціальні чи психологічні
проблеми, які перешкоджають
годуванню виключно грудним
молоком.
Абсолютні протипокази
до грудного вигодовування
1.
2.
3.
4.
Гіпергалактоземія.
Фенілкетонурія [PKU].
Гіпо- та алактазія.
Справжня алергія до казеїну.
Медичні протипокази,
пов’язані з станом здоров’я
матері
1. Хронічні захворювання в стані
декомпенсації (СН ІІВ чи ІІІ ст., ДН
ІІІ ст., захворювання нирок чи
печінки, ВІЛ інфекція тощо).
2. Психічні проблеми: шизофренія,
епілепсія, депресивний психоз,
післяпологова депресія.
3. Прийом певних ліків (Див. табл. 1, 2).
4. Наркотична залежність (алкоголь,
наркотики, маріхуана, інші) (Див.
табл. 3).
Табл. 1. Ліки, прийом яких є
протипоказом до грудного годування
No.
Назва ліків
Бромвмісні
1.
препарати
Вплив на немовля чи на лакт ацію
Пригнічують лактацію
Кокаїнове отруєння або
2. Кокаїн
залежність
Імуносупресія, пригнічення
Циклофос3.
росту, нейтропенія,
фамід
стимуляція карциногенезу
Імуносупресія, пригнічення
4. Циклоспорини росту, нейтропенія,
стимуляція карциногенезу
Знаходять від ⅓ до ½ терапевтичної
крнцентрації в крові немовлят
5.
Солі літію
6.
Імуносупресія, пригнічення росту,
Метотрексат нейтропенія, стимуляція
карциногенезу
7.
Фенциклідин Галюциноген, викл. збудження
8.
9.
Феніндіон
Антикоагулянт; загроза
геморагічного синдрому
Ерготамін
Блювота, діарея, судоми (при вжив. в
дозах, які використ. при мігренях)
Табл. 2. Ліки, що призначаються
годуючим матерям із значною
пересторогою
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 weaning
3. Phenolbarbitol from milk containing phenolbarbitol,
methemoglobinemia
4. Primidone
Sedation; feeding problems
5. Sulfasalazine
Bloody diarrhea
Table 3. Drugs of abuse that
are contraindicated during
breast-feeding
No.
Drug
Reported sign or symptom in infant or
effect on lactation
1. Amphetamine Irritability, poor sleep pattern
2. Cocaine
Cocaine intoxication
3. Heroin
Irritability, Heroin intoxication
Nicotine
4.
(smoking)
Shock, vomiting, diarrhea, rapid
heart rate, restlessness;
decreased milk production
5. Phencyclidine Potent hallucinogen
Other reasons why a mother
may not breastfeed her
baby:
•
•
Working outside the home makes it more
difficult to breastfeed exclusively,
especially if there is no support at her
workplace for her to either bring her
baby or to express and store her milk.
Choosing not to breastfeed for personal
reasons, either from the birth of the
baby or after breastfeeding for a short
while, is a mother's prerogative.
Recommendations for
Working Women:
• The mother who goes back to work can usually
continue breast-feeding without problems.
The milk supply adjusts itself to the demand.
If the mother is working at least 8 hours a
day, it is sometimes prudent to pump the
breasts once during her work day in order to
stay comfortable and maintain a good milk
supply. Each woman is different in what is
required to maintain a supply. Some women
can work for a long time without pumping and
without compromising the supply. Others have
a supply that is more responsive to decreased
feeds. A woman will rarely “dry up” becayse
she has returned to work.
• Working mothers, however, can easily breastfeed part-time and formula-feed part-time.
Breast pumps and
storage of milk
• Hand expression is superior if the mother
can learn the technique.
• Several pumps are available if the mother
is unable to express by hand.
• It is good if the woman can borrow a pump
from a friend before she decides which
pump to purchase. Another alternative is
to rent an electric pump.
• Milk should be stored in clean containers
and immediately refrigerated or frozen.
– If refrigerated, it will stay good for 48 hours.
– If frozen at 0°F, it wiil keep for months.
Recommendations for
mother’s diet:
• To drink approximately 64 oz of fluids per
day.
• The nursing mother requires an additional
500 calories and 20-30 g of protein a day.
• She has to take her prenatal vitamins with
iron.
• The mother need not to avoid certain foods
unless she observes consistent increased
fussiness in the baby in association with the
mother ingestion such foods.
Foods commonly incriminated:
• Garlic
• Onions
• Cabbage
• Chocolate
• Great quantities of caffeine.
Nursing mother may drink small amounts of
alcohol: a glass of sherry or wine may be
beneficial in late afternoon if she is having
let-down reflex problems.
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:Casein
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 α-linolenic)
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
Breast Cow’s
milk
milk
“Vitalact”
“Similac”
Valine
8.2 %
6.6
4.6 %
6.8 %
Lysine
10.95
7.8
9.7 %
8.4 %
Tryptophan
2.29
1.4
2.4 %
1.4 %
• 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
Breast
milk
Fortified
Cow’s milk
formulas
•Vitamin E
0.63 mg%
0.18
0.4-0.6
•Vitamin C
4.2 mg%
1.5
4.5-5.0
•Potassium
55 mg%
140
70-95
2 to 8
µg/L
420
mosm/L
11 to 15
µg/L
320
mosm/L
15 to 20
•Selenium
µg/L
260
•Osmolality
mosm/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
270 mosm/L
• 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
• Hypergalactosaemia
• 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, Lhistidine, and taurine.
• Polyunsaturated fatty
acids (arachidonic,
docosahexacnoic,
linoleic, and αlinolenic) are present
• 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
Carbohydrate s.
Fat source
For full-term and premature infants with no special
nutritional requirements
SMA
(Wyeth)
Enfamil
(Mead
Johnson)
Nonfat cow's
milk, reduced
mineral whey:
whey/casein
ratio: 60:40
Nonfat cow's
milk, demineralized whey:
whev/casein
ratio: 60:40
Lactose
Oleo, coconut,
oleic (safflower) and
soy oils
Lactose
Soy, coconut
oils
Similac
(Ross)
Nonfat cow's milk;
whey/ casein ratio:
18:82
Lactose
Soy and coconut
oils, mono- and
diglycerides
Baby
formula
(Gerber)
Nonfat cow's milk;
whey/ casein ratio:
18:82
Lactose
Soy
FOR MILK PROTEIN-SENSITIVE INFANTS (‘MILK
ALLERGY’), LACTOSE INTOLERANCE, GALACTOSEMIA
Prosobee
(Mead
Johnson)
Soy protein isolate
Corn syrup
Soy and coconut
solids.
oils
Lactose and
sucrose free
Isomil
(Ross)
Soy protein isolate
Corn svrup,
Soy and coconut
sucrose
oils
Lactose free
Nursoy
(Wyeth)
Soy protein
isolate
Sucrose (liquid
Oleo, coconut,
formula). Corn syrup oleic, and soy
solids (powdered
oils
formula)
FOR INFANTS WITH MALABSORPTION SYNDROME
Soy protein
RCF (Ross
Carbohydrate isolate
Free) (Ross)
Absent
Portagen
(Mead
Johnson)
Sodium
caseinate
Corn syrup solids, MCT (coconut
sucrose, lactose
source) and
Pregestimil
(Mead
Johnson)
Casein
hydrolysate
and L-amino
acids
Corn syrup
solids,
modified
tapioca starch
Soy and coconut
oils
corn oil
Corn oil, MCT
For infants
with disaccharidase
deficiencies,
malabsorption
svndromes,
cystic
fibrosis.
Specialty formulas
Formula
(manufacturer)
Indication for use
Comments
For long-term
For children with
Lonalac
congestive cardiac management, additional
sodium must be given.
failure,
who
require
(Mead Johnson)
Supplement with
reduced sodium
vitamins C and D and
Powder
intake.
iron. Na = 1 mEq/L
Low calcium,
For newborns
potassium, and
Similac PM 60/ predisposed to hypocalphosphorus.
cemia and infants with
40 (Ross)
impaired renal,
Relatively low
digestive, and cardioPowder
solute load. Na — 7
vascular functions.
mEq/L
For infants and
Lofenalac
(Mead Johnson) children with
phenylketonuria.
111 mg
phenylalanine per
quart of formula
For children over 1 Phenylalanine free.
Phenyl-free
Permits increased
(Mead Johnson) year of age with
phenylketonuria.
supplementation
with normal foods.
PKU 1 (Milupa)
For infants with
phenylketonuria
(Available as PKU
2 for children over
1 year of age.)
Phenylalanine- and
fat-free. Contains
vitamins,minerals,
and trace
elements
Low Methionine
Diet Powder
(Product 3200K)
(MeadJohnson)
For infants with
homocystinuria
Nutritionally
complete, but
requires monitoring of amino acid
levels
Developmental milestones
associated with feeding
Age (months)
Development
• Birth
– Has sucking, rooting, and swallowing reflexes;
– Feels hunger and indicates desire for food by crying;
– Expresses satiety by falling asleep
• 1 - Has strong extrusion reflex
• 3-4
– Extrusion reflex is fading;
– Begins to develop hand-eye coordination
• 4-5- Can approximate lips to the rim of a cup
• 5-6- Can use fingers to feed self a cracker
• 6-7
– Chews and bites;
– May hold own bottle, but may not drink from it
(prefers for it to be held)
• 7-9
– Refuses food by keeping lips closed; has taste
preferences;
– Holds a spoon and plays with it during feeding;
– May drink from a straw;
– Drinks from a cup with assistance
• 9-12
– Picks up small morsels of food (finger foods) and
feeds self
– Holds own bottle and drinks from it
– Drinks from a household cup without assistance
but spills some
– Uses a spoon with much spilling
• 12-18
– Drools less
– Drinks well from a household cup, but may drop it
when finished
– Holds cup with both hands
• 24
–
–
–
–
• 36
Can use a straw
Chews food with mouth closed and shifts food in mouth
Distinguishes between finger and spoon foods
Holds small glass in one hand; replaces glass without
dropping
– Spills small amount from spoon
– Begins to use fork; holds it in fist
– Uses adult pattern of chewing, which involves rotary
action of jaw
• 48
– Rarely spills when using spoon
– Serves self finger foods
– Eats with fork held with fingers
• 54 Uses fork in preference to spoon
• 72 Spreads with knife