Transcript Infant and Young Child Feeding

Infant and Young Child
Feeding
associate professor Kantemirova
M.G.
• Appropriate feeding are essential for the
nutrition, growth, development and
survival of infants and young children.
Types of infant feedings (upto 4-6 months)
I. Breastfeeding (natural or exclusive
breastfeeding feeding > 80% )
II. Mixed-breast feeding
(complementary feeding 20%-80%)
III. Artificial feeding (> 20%)
Breast-feeding (natural or exclusive
breast-feeding )
• Exclusive breast-feeding means that
except for breastmilk, no other food or
fluids should be given to a child from birth
to 4-6 months of age. Initiate
breastfeeding within first hour of birth;
• Natural breast-feeding means more than
80% of breastmilk (less than 20% of milk
formular or substituters) are given to
infants upto 4-6 months
Mixed-breast feeding (complementary
feeding)
• It means that infants receive:
20% <breastmilk < 80%
20%< milk substitutes<80 cows
Milk substitutes: cow’s-milk, goat's milk,
diluted or powdered milk formular, acidic
milk preparations
Artificial feeding
• It means that an infant doesn't receive
breastmilk at all or less than 20%; more
than 80% of milk substitutes
Stages of lactation
• I. 1st-4th day – colostrum
• II. 5th-18th day – immature breast milk
• III. After 18th day – mature breast milk
(more watery)
Colostrum
• Content: the high content of proteins, less lipids
and carbohydrates as compared with mature
breast milk; active leucocytes – phagocytic
bodies, IgA, lactoferrin; growth factors
(fibroblast, epidermal, granulocyte-macrophagestimulating, vascular endothelia), amino acidtaurine, vitamins A,E.
• Protection from infection and prevention of
allergy, stimulation of defecation and growth.
The composition of breast milk
• Water (87-90%)
• Proteins (1%) – albumin>casein ; essential
amino acids: histidine, cysteine taurine (brain
development)
• Lipids (4%) – rich with unsaturated fatty acids
(linoleic, linolenic, arachidonic)
• Carbohydrates (7%) – β-lactose (80-90%),
bifidus-factor
• Minerals: Ca:P 2:1 ( blood serum proportion),
Cu, Zn, Fe
• Vitamins - A, D, E
The composition of breast milk
• Protein 0,9-1,3 g/100
ml
• Lipids 4,0-5,0 g/100
ml
• Carbohydrates 7,27,5 g/100 ml
Biological active components of
breast milk
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Ig A,M,G
Secretary Ig A
Lactoferin
Lysozime
Interferon
C3, C4
Bifidus-factor
B-lymphocytes
Neutrophils
Macrophages
Lactoperioxidase
RNA-factor
Benefits to breastfeeding for the
infant.
• Bm less proteins (compared with Cm),
albumin:casein 3:2 (Cm-2:8) Albumin is
absorbed better,Bm casein is more easily
degested
• Cm proteins – foreign antigens caused allergy
• Cm higher protein content – excessive load on
the kidneys and immature membrane of
intestines of 2-3 months aged infants. So up to
2-3 months Cm should be dilated: 1:1 up to 2
weeks; 2:1 – up to 3 months (5% cereal water)
Bm – prevent IDDM, obesity
Benefits to breastfeeding for the infant.
• Active Bm lipase promotes digestion of fats and
provides free fatty acids, facilitates absorption of Ca
• Bm higher content of essential and unsaturated fatty
acids
• Bm proportion Ca:P 2:1– better absorption of these
minerals
• Bm is sterile
• Bm can decrease the risk of development of infectious
and other diseases.
• Higher intelligence later in life
• Close physical and emotional relations between
mothers and child
Bm can decrease the risk of development of
infectious and other diseases
• Viral infections (secretary IgA, specific inhibitory
substances, interferon, IgM,G)
• Intestinal infections (secretary IgA, lysozyme,
antistaphylococcal factor, lactoferrin, bifidus factor,
macrophagocytes)
• Amoebic infections ( bile salt stimulated lipase)
• Less chance of developing diabetes mellitus type 1
• Less childhood obesity
• Less tendency to develop allergic diseases
• Less necrotizing enterocolitis in premature infants
• Malaria (para-amino-benzoic acid)
• Less chance of deficient diseases
Rules of successful breast-feeding
• Early breastfeeding - in the half hour after birth
the baby's suckling reflex is strongest, and the baby is
more alert, so it is the ideal time to start breastfeeding
• Breastfeeding at least every two to three
hours - helps to maintain milk production
• Joint stay in the ward of mother and
newborn
• Exclusion of prelacteal feeding and water
• Avoid any bottles
Expressing breast milk
• When direct breastfeeding is not possible,
a mother can express (artificially remove
and store) her milk. With manual massage
or using a breast pump, a woman can
express her milk and keep it in freezer
storage bags, a supplemental nursing
system, or a bottle ready for use. Breast
milk may be kept at room temperature for
up to six hours, refrigerated for up to eight
days or frozen for up to four to six months.
Expressing breast milk
• Manual breast pump
Breast feeding
• Calculation of milk volume
Newborns 1-10 days of age
1. Zaitsev’s method: daily milk volume= 2%Mbxn;
Mb- birth weight in gram, n-day of age
2. Philkenshtain’s method: one-time volume of
milk=10xn; n-day of age
3. Daily milk volume= 70xn if Mb<3200 g
=80xn if Mb>3200g
n-day of age
Breast feeding
• Calculation of milk volume
1. Volume method for infants above 2 weeks
2 weeks – 2 months = 1/5 body weight
2 months – 4 months = 1/6 body weight
4 months – 6 months = 1/7 body weight
6 months – 9 months = 1/8 body weight
Daily volume of food for infants – not more
than 1 liter (1000 ml)
Breast feeding
• Calculation of milk volume
2. Callorie method: 1 litre of milk provides
about 700 kcal
daily milk volume =
(M×daily energy requirements):700 kcal
M- infant’s weight
Daily proteins, fats, carbohydrates, energy
requirements of infants
Nutrients
g/kg
Возраст, месяцы
0-3
3-6
6-12
Proteins
2.2
2,6
2.9
Fats
6.5
6,0
5.5
Carbohydrates
13
13
13
Energy kcal/kg
115
115
(100)
1 : 2,5 : 5
110
Proportion
P:F:C
1:3:6
1 : 2 : 4,5
Breast feeding
• The frequency of feeding
1. Up to 3 months of age – 7 times a day with 3
hours intervals and 6-hours night interval: 6.009.00-12.00-15.00-18.00-21.00-24.00
2. 3 – 5 (6) months of age – 6 times a day with
3,5 hours intervals and 6,5-hours night
interval:6.00- 9.30-13.00-16.30-20.00-23.30
3. above 5 (6) months - 5 times a day with 4.0
hours intervals and 8-hours night interval:6.0010.00-14.00-18.00-22.00
Weaning
• The World Health Organization recommends exclusive
breastfeeding for the baby's first 6 months of life.
• After 4-6 months of age Bm alone cannot provides all
energy and proteins requirements of infants
• Weaning is the process of introducing the infant to
other food and reducing the supply of breast milk.
• Weaning means accustoming the infant to the
products differ from milk
• Weaning foods provide solid food for development
chewing organs and G-I-T
Weaning foods
• Correction of minerals and vitamins needs: fruit juices,
mashed fruits (3-4 months)
• 1-st weaning: mashed vegetables (vegetable soup;
purees) - cabbage, cauliflower, squash, dark green leafy
vegetables, carrot, potatoes (5-6 months)
• 2-d weaning: porridge or gruel (5% than 10%) rice,
semolina, lentils, corn, buckwheat porridge (gluten free)
6 months
• 3-d weaning: meat - mashed, spam, meatballs (beef,
rabbit, turkey)/fish (7-8/9 months)
• 4-th weaning: kefir, yogurt (10 month)
Corrections of microelements,
vitamins
• 1-st - fruit juices, mashed fruits (3-4
months)
• 2-d - vegetable oil (5 months)
• 3-d - curd, butter, yolk egg (6-6,5 months)
• 4-th - crackers, cookies (8-9 month)
All correction foods have to start by drops
or tea-spoon (10xn, n-month of age)
General principles of weaning
introducing
• Beginning with a single weaning food
• Beginning with a 5-10 ml
• Gradually increase the volume from 5-10
ml to the volume of one feeding (180-200
ml) during 2 weeks
• Between every weaning 1 month interval
• Weaning food is given before Bm
The approximate menu of 4,5-5,5
months aged breast fed infant
• 6.00 – breast milk180 – 200 ml
• 10.00 - breast milk180 – 200 ml
• 14.00 – mashed vegetables– 5 ml. to
200г+ breast milk (195 ml to 0 ml)
• 18 - breast milk180 – 200 ml
• 22 - breast milk180 – 200 ml
• Between main feeding– fruit juices –
1drop - to 40-50 ml, mashed fruits– 1
tee spoon to 40-50 ml (V = 10 х n (n –
months of age)
The approximate menu of 5,5-6,5
months aged breast fed infant
• 6 –breast milk 200 ml
• 10 – porridge rice 5% (than 10%) 1 tee
spoon-150 ml + breast milk till 180 – 200 ml
• 14 - mashed vegetables 180 – 200 g +
vegitabal oil 3 – 5 g+ yolk 1/4
• 18 - breast milk 200 ml
• 22 - breast milk 200 ml
• Between feeding - fruit juices – 50-60 ml,
mashed fruits– 50-60 ml (V = 10 х n (n –
months of age)
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The approximate menu of 7-8 months
aged infant
6 –breast milk 200 ml
10 – porridge 5%-10% 200 g+ butter 5,0 g
14 – mashed vegetables 200-150 g+
mashed meat –5 g to 50 g+ yolk ½ +
vegitabel oil 5.0 g
18 – curd – 40 g + breast milk
22 – breast milk 200 ml
Between feeding– fruit juices – 60-70 ml,
mashed fruits– 60-70 ml (V = 10 х n (n –
months of age) ,crackers, cookies
The approximate menu of 8-12 months
aged infant
• 6.00 – breast milk 200 ml
• 10.00 – porridge 10% 200 g+ butter 5,0 g+yolk ½1,0
• 14.00 - mashed vegetables 200-150 g+ mashed
meat or meat balls 50 g+ + vegetebl oil 5.0 g
• 18.00 – curd– 50 + kefir (jogurt) 150 ml +
crackers, cookies 5-10 g
• 22.00 - breast milk 200 ml
• Between feeding– fruit juices – 80-120 ml, mashed
fruits– 80-120 ml (V = 10 х n (n – months of age)
,crackers, cookies
• \
Mixed-breast feeding
Additional foods
Milk substitutes: cow’s-milk, goat's milk, diluted or
powdered milk formula, acidic milk preparations
Adopted and non-adopted milk preparations.
Non-adopted milk preparations –different dilutions
of cow’s-milk, goat's milk (1:1-1st month, 2:1 –
1st-3d month)
Adopted: powdered milk formula( Nan, Nutrilon,
Frisolac , Humana …)
General principles of mixed-breast
feeding
• Additional food is given after Bm
• Small volume of additional food is given by
a spoon
• If additional food is given in a bottle the
nipple should be a small hole (milk flow
out by drops)
• Every feeding should be combination
breast milk and milk formula (it stimulates
lactation)
Free breast-feeding (on demand)
• Put to the breast on baby’s demand when
hungry (not often than in 2-2,5 hours -1012 times, Bm is evacuated from stomach
after 2 hours)
• Don’t confuse – hungry or exited. Babies
may also nurse (sucking) when they are
lonely, frightened or in pain
• Without bottles or other supplements and
additional food (even water)
Free breast-feeding (on demand)
• Night feeding
• If additional foods are necessary – to use
spoons, cup
• Don’t wash the breast nipples before and after
feeding
• Without pumping after feeding
• Duration of sucking is determined by a baby (not
15-20 minutes)
• Weigh the child, not more than 1 time per week
Indications to pumping
• Lactostasis
• Lack of breast milk – stimulation of
lactation
• If mother have to leave the baby fore more
than 3-4 hours
• Additional food for sick baby, premature,
tired of sucking
Algaritm the decision of tasks
• Determination of body weight according
the age
• Determination of the needs in the P, F, C,
kcal/kg
• The definition of the daily volume of food
• Determination of the frequency of feedings
• Definition of a single volume of food
• The diet of the day based on the
introduction of weaning foods