INFANT FEEDING

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INFANT FEEDING

• Dr. Hussein Bamashmous
• Consultant Pediatrician
• King Abdulaziz University Hospital

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WHY?

• Provides nutritional requirements
• Successful feeding promotes infants and
  mothers emotional well-being
• Successful feeding needs
• Confidence
• Comfort
• Appropriate guidance and support
• Maintains normal metabolism and growth from fetal
  to extra-uterine life
• Decreases risk of
• Hypoglcaemia
• Hypokalaemia
• Hyperbilirubinaemia
• Azotaemia

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AFTER BIRTH

• Infants tolerate Enteral Feeds judged by
• Normal Activity
• Alertness
• Good Sucking
• Crying
• MISTAKES IN FEEDING
• Too much Obesity
• Too little (In hot weather)
• Dehydration fever
• Feeding of infant is guided by self-regulation
• By the end of the first month 90 on
  infants have a suitable and reasonably regular
  schedule

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PHYSIOLOGY OF BREAST FEEDING

• PROLACTIN
• Breast Development anterior pituitary
• Milk Secretion estrogen progesterone
  neuroendocrine pathway
• night time sucking
• drugs
• emotions
• OXYTOCIN
• Ejection of Milk posterior pituitary
• let down reflex
• Sensory contact
• Emotional responses
• Areola contact

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• ESTROGENS
• Proliferation of the Mammary Ducts
• (enlargement of lobules and alveoli)
• PROGESTERONE
• Development of Lobules and Alveoli

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BREAST FEEDINGBREAST IS THE BEST

• ADVANTAGES OF BREAT FEEDING
• For the MOTHER
• Easy, needs no preparation
• Cheap
• Available
• Involution of the uterus
• Emotional satisfaction
• lower incidence of breast cancer
• Birth spacing

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• For the BABY
• Natural, balance, meets nutritional needs
• Self regulated
• Available
• Fresh, proper temperature
• Easy digestion and absorption
• Bonding
• Anti infective properties
• Incidence of allergy
• Incidence of rickets
• Incidence of iron deficiency
• Lower renal solute for Vit. A C
• Giardia antibodies in breast milk

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ANTI INFECTIVE PROPERTIES OF BREAST MILK

• HUMORAL FACTORS
• Antibodies ( antibacterial / antiviral)
• Secretory IgA
• IgG, IgM, IgD
• Lyzosomes
• Bacteriolytic for enterobacteria Gram
  positive
• Lactoferrin
• Fe binding protein
• E. coli

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Interferon (anti virals)5. Lactobacillus
Bifidus 6. Stool pH

• CELLULAR FACTORS
• Macrophages ( esp. colostrum)
• Synthesize lactoferrin, lysozymes and
  complements
• B and T cell Lymphocytes
• Epithelial cells

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FACTORS INFLUENCING MILK PRODUCTION AND SECRETION

• ENDOCRINE
• PROLACTIN, OXTOCIN, THYROXIN
• ANATOMICAL
• SENSORY NERVE SUPPLY OF CHEST
• MECHANICAL
• GOOD SUCKLING AND COMPLETE EMPTYING

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• PHYCHOLOGICAL
• LET DOWN REFLEX
• MATERNAL NUTRITION
• DRUGS
• CHLORPROMAZINE
• METACHLOPRAMIDE
• BROMOCRIPTINE

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CONTRAINDICATION TO BREAST FEEDING

• MATERNAL CAUSES
• INFECTIONS Septicaemia Malaria
  Typhoid Fever Active TB HIV

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• MENTAL NEUROLOGIC ILLNESS Severe
  Neurosis Postpartum psychosis Insanity
  Epilepsy
• OTHERS Allergens in breast milk Eclampsia
  Nephritis Profuse haemorrhage Chroni
  c malnutrition Debility Severe inverted
  nipple Drugs

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• INFANT CAUSES
• INBORN ERRORS OF METABOLISM PKU
  Galactosaemia
• SEVERE CONGENITAL ANOMALIES Severe
  cleft palat Severe micrognathia

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SOME PROBLEMS WITH LACTATION

• Mastitis
• Acute Infection
• Resumption of Menstrual with breast feeding
• Pregnancy with breast feeding
• Breast feeding Give Vit. K
• Haemolytic disease of newborn and breast feeding
• No contraindication

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PREPARATION OF THE PROSPECTIVE MOTHER

• Very Successful breast feeding
• Sufficient Encouragement Reassurance S
  upport Over persuasion
• Advantages of breast feeding (from mid-trimester)
• Good health, Rest, Exercise
• No Worry
• Adequate Nutrition
• Treatment of Retracted nipples

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ESTABLISHING AND MAINTAINING THE MILK SUPPLY

• Psychological Factors
• Fatigue
• Hygiene of Breast
• Diet No dieting Milk is important for
  MOM OR 1 gram calcium / day

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• Drugs contraindicated with breast feeding
  antithyroids LITHIUM Anticancer
  INH Phenindione
• Temporary cessation of B.F. with Radiographic
  agents Chloramphenicol Metronidazole
  Sulfonamide
• NO SMOKING- Sudden Infant Death Syndrome
• NO ALCOHOL FETAL Alcohol Syndrome

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SOME CHEMICALS SECRETED WITH BREAST MILK

• Aresenicals Iodides Salicylates
• Barbiturates Lead Opium
• Bromides Mercury Atropine
• Most Antibiotics
• ONE OR BOTH BREAST PER FEEDING
• Early weeks both breast
• Late one will do, Unless milk secretion is too
  great

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ADEQUACY OF BREAST FEEDING

• Infant calm and satisfied
• Sleeps well
• Normal Stools (frequent, yellow, soft, acidic)
• Normal amount of urine
• Normal weight gain
• Positive LET DOWN of milk ejection reflex

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CRITERIA OF UNDERFEEDING IN BREAST FED INFANT

• Irritable baby
• Stays on breast for longer period
• Very short sleeps
• Oliguria
• Hunger diarrhea
• Slow gain Static weight loss
• TREAT SUPPLEMENTARY OR COMPLEMENT FEEDS

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FORMULA FEEDING

• BY FORMULA FEEDING WE MEAN
• WHOLE COWS MILK
• MODIFIED COWS MILK
• MILK SUBSTITUTES
• STERILIZATION REFREGIRATION OF FORMULA
• MORBIDITY MORTALITY FROM GASTROINTESTINAL
  INFECTONS

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MILK PROCESSING

• ( Alters CASEIN Small digested curds)
• SIMPLE HOME BOILING
• PASTEURIZATION
• HOMOGENIZATION
• EVAPORATION

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NOTE

• CHANGING CULTURAL SOCIAL PATTERN FORMULA
  FEEDING
• OBJECTIVE NUTRITIONAL STUDIES OF INFANTS SHOW
  LITTLE DIFFERENCE BETWEEN BREAST ED AND COWS
  MILK FED INFANT
• CONVENTIONAL FORMULAS OF WHOLE AND EVAPORATED
  COWS MILK 3-4 gram PROTEIN/K/DAY

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HUMAN AND HUMANIZED MILK 3-4 gram /K/ DAY

• COMMERCIAL FORMULAS ARE MODIFIED FROM COWS MILK
  BASE THEIR PROTEIN AND ASH CONTENT IS TO HUMAN
  MILK LEVELS
• OSMOLALITY
• RENAL EXCRETORY LOAD

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SATURATED FAT OF COWS MILK IS REPLACED WITH
SOME UNSATURATED VEGETABLE FATTY ACIDS

• VITAMINS ARE ADDED
• SOME FORMULAS
• LACTOPROTEIN (WHEY) CYSTEIN
• CASEIN AS IN BREAST MILK

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COMPARISON OF HUMAN MILK AND COWS MILK
CONSTITUENT HUMAN COLOSTRUM COW
WATER 88 87 88
PROTEIN(G) 1 2.7 3.3
CASEIN 0.4 1.5 2.7
WHEY Lactoalb Lactoglob 0.4 0.2 - 1.2 0.4 0.2
FAT (G) P.U.F.A 3.8 8 2.9 7 3.8 7
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CONSTITUENT HUMAN COLOSTRUM COW
LACTOSE (G) 7 5.3 4.8
CALORIES 67 - 67
CALCIUM (mg) 34 30 117
PHOSPHATE 15 15 92
IRON (mg/L) 0.5 0.1 0.5
ZINC (mg/L) 4 6 4
VITAMIN A (IU) 1900 - 1025
VITAMIN C (mg) 43 - 11
VITAMIN D (IU) 22 - 14
VITAMIN E (mg) 2 - 0.4
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COLUSTRUM

• FIRST 2-4 DAYS
• LEMON YELLOW IN COLOUR
• ALKALINE
• S.G. 1.040 1.060 ( Mature Breast Milk1.030)
• DAILY PRODUCTION 10-40 ml

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COLUSTRUM CONTAINS

• PROTEIN
• MINERALS
• CHO
• FAT
• SECRETORY IgA
• MACROPHAGES
• LACTOERRIN
• LYSOZYMES
• COLUSTRUM TRANSITIONAL MILK
• BY THIRD OR FOURTH DAY MATURE MILK

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BACTERIAL CONTENT

• MASTITIS - Pathogenic organism in breast milk
• Infected Mothers Infected Milk with
• Tuberculosis
• Thypoid Bacilli
• Herpes Simplex
• Hepatitis B Virus
• Rubella Virus
• Mumps Virus
• HIV
• CMV

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MILK-BORNE INFECTIONS

• STREPTOCOCCAL DISEASES
• DIPHTERIA
• TYPHOID FEVER
• SALMONELLOSIS
• T.B. BRUCELLOSIS

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DIGESTABILITY

• HUMAN MILK RAPID STOMACH EMPTYING
• GASTROINTESTINAL PASSAGE TIME EQUAL IN BREAST
  MILK AND COWS MILK IN THE FIRST 45 DAYS.
• COWS MILK CURD IS BY BOILING
• (Milk-Processing) ACID
• ALKALI
• HOMOGENIZATION
• COWS MILK FAT LESS READILY DIGESTED

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MILK USED IN FORMULA

• RAW MILK
• NOT ADVISED IN INFANTS
• LARGE CURDS
• SLOWLY DIGESTED
• EASILY CONTAMINATED

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PASTURIZED MILK

• DESTROS PATHOGENIC BACTERIA
• MODIFIES CASEIN
• PASTURIZATION
• HEATED MILK AT 63 C X 30 SEC.
• HEATED MILK AT 72 C X 15 SEC.
• THEN COOLING RAPIDLY TO 65 C OR 60 C
• ALLOWED BACTERIAL CONTENT (NON-PATHOGENIC) UP TO
  50,000/ml.
• AVERAGE COUNT 5,000 10,000/ml.

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HOMOGENIZED MILK

• FAT GLOBULES BROKEN TO MINUTE PARTICLES
  REMAIN DISPERSED SMALLER LESS TOUGH CURD
  PRODUCED IN THE STOMACH
• EVAPORATED MILK
• UNIVERSALLY AVAILABLE
• MONTHS WITHOUT REFRIGERATION
• CASEIN CURD SOFT SMALL
• LACTOALBUMIN LESS ALLERGENIC
• VITAMIN D IS ADDED

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PREPARED MILK

• ADDITION OF WATER IN 11 PROPORTION
• MOST DERIVED FROM COWS MILK
• EITHER POWDER OR LIQUID
• MAJORITY SIMULATES HUMAN MILK
• ALL FORTIFIED WITH VIT. D
• SOME HAVE ADDED IRON
• MANY CONTAIN OTHER VITAMINS

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FORMULA WITH VERY LOW ELECTROLYTES

• CONGENITAL HEART DISEASE
• NEPHROGENIC D.I.
• MARGINAL R.F.
• SODIUM FORMULA 1mmol/quart (for
  C.H.D.)

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MILK PREPARED FROM HYDROLYZED WHEY OR CASEIN

• FOR MALABSORPTION
• MILK ALLERGY
• SPECIAL FORMULA WITH ELIMINATION OF SPECIFIC
  AMINO ACID
• INBORN ERROR OF METABOLISM

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LACTOSE FREE FORMULA

• FOR LACTOSE INTOLERANCE
• GALACTOSAEMIA
• CONDENSED MILK
• USED ONLY WHEN CALORIES ARE NEEDED
• ADDITION OF 45 CANE SUGAR
• IN EVAPORATED FORM 60 CHO
• PROTEIN FAT

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DRIED WHOLE MILK

• THE FAT CONTENT OF FLUID MILK ADJUSTED TO 3.5.
• DRIED SKIM MILK
• NON-FAT SKIM MILK ( FAT 0.5)
• HALF-SKIM MILK (FAT 1.5 )
• FOR FAT INTOLERANCE
• NIT FOR FIRST YEAR
• PROTEIN MINERALS
• RENAL SOLUTE LOAD
  DEHYDRATION

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ACID AND FERMENTED MILK

• ACID BY ADDING ACID
• FERMENTED LACTIC ACID PRODUCING ORGANISM
• THESE MILKS REQUIRE
• HCL ACID IN STOMACH
• CASEIN SMALL LESS TOUGH CURDS
• ACIDS MILKS ACIDOSIS RARELY USED NOW

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GOATS MILK

• BRUCELLOSIS
• WIDELY USED
• USED FOR COWS MILK ALLERGY
• GOATS MILK Na
• K
• CL
• LINOELIC
• ARACHIDONIC ACID

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FAT DIGESTABLE

• LOWER CURD TENSION THAN COWS MILK
• VIT. D IRON
• FOLIC ACID MEGALOBLASTIC ANAEMIA
• MILK PROTEIN
• TO PROTEIN CONTENT OF SOME FORMULA FED TO
• PRETERMS
• DEBILITATED INFANTS
• INFANTS WITH DIARRHEA SHOULD BE USED CAREFULLY ,
  FOR SHORT DURATION

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MILK SUBSTITUED HYPOALLERGENIC FORMULA

• SOYA BASED FORMULA
• FOR 1. VEGETARIANS
• 2. COWS MILK PROTEIN INTOLERANCE
• LACTOSE FREE FORMULA
• FOR 1. GALACTOSAEMIA
• 2. LACTOSE INTOLERANCE

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PROTEIN HYDROLYSATE FORMULA

• FOR 1. COWS MILK PROTEIN INTOLERANCE
• 2. LACTOSE INTOLERANCE
• PHENYLALANINE FREE FORMULA
• FOR PKU
• VALINE , LUCINE, ISOLUCINE FREE FORMULA
• FOR MSUD

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MILK FORMULAS

• CALORIC REQUIREMENTS
• FIRST FEW MONTHS 100-120 KCAL/day
• BY ONE YEAR 100 KCAL/day
• FLUID REQUIREMENTS
• FIRST 6 MONTHS 130-190 ml/day
• NUMBER OF FEEDINGS
• BIRTH - 1 WEEK 6-10 feeds/day
• BY 8 12 MONTHS 3 feeds/day

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INTERVAL BETWEEN FEEDS

• EARLY FEEDING THROUGHOUT 24 H
• GRADUALLY
• FULL TERM EVERY 3-5 H 4 hourly
• SMALL / WEAK INFANTS 2-3 hourly
• INFANT ADJUSTS DEMAND TO THE FAMILY PATTERN OF
  DAYTIME ACTIVITY

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QUANTITY FORMULA / each feed

• IT DIFFERS WITH
• DIFFERENT INFANTS OF THE SAME AGE
• SAME INFANT AT DIFFERENT FEEDS

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AVERAGE AMOUNTS AT VARIOUS AGES / each feed

• 1ST and 2nd WEEK 60-90
• 3W - 2/12 120 150
• 2/12 - 3/12 150-180
• 4/12 - 5/12 180-210
• 6/12 - 1 YEAR 210-240
• AFTER 6/12 OF AGE
• MILK INTAKE IS
• MILK IS SUBSTITUTED WITH OTHER FOODS

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OTHER FOODS

• VITAMINS
• ORANGE CITRUS NATURAL SOURCES OF VIT. C
• YOUNG INFANTS CAN NOT TOLERATE LARGE
  AMOUNTS GIVE 50 milligrams/day
• VIT. D IS SUPPLIED IF FORMULA IS DEVOID OF IT
  START IT IN NEONATAL PERIOD AS
• 10 microgram/day

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IRON

• START IT AT 6/52 OF AGE
• IRON FORTIFIED FORMULA
• OR 2 milligram/Kg ( UP TO 15 milligram/day)
• CEREAL IRON INSUFFICIENT
  ABSORPTION

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SOLID FOODS

• NOT BEFORE 4-6 MONTHS OF AGE
• HIGH CALORIES FOOD AS
• EGG YOLK, CEREALS, MEAT, PUDDING
• OBESITY
• SOLID FOOD WHEN
• MILK ALONE NO SATISFACTION(HUNGER)
• WHEN THEY FIT INTO THE DAILY SCHEDULE

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INFANTS APPETITE BEST INDEX FOR PROPER
AMOUNTRESPECT INFANTS WISHES

• CEREALS
• MOST CONTAIN IRON FACTORS OF VIT. B COMPLEX
• FRUITS
• MILD LAXATIVE EFFECT
• INFANTS LIKE IT
• RAW RIPE READILY DIGESTED

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VEGETABLES

• GOOD SOURCE OF VIT. IRON
• SHOULD BE FRESHLY COOKED STRAINED
• ADDED BY 7 MONTHS OF AGE

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MEAT, EGGS, STARCHY FOOD

• STARCHY FOOD IN THE SECOND 6/12 OF LIFE
• EGG YOLK COULD BE GIVEN EARLIER
• EGG WHITE ALLERGIC MANIFESTATIONS
• TOAST, CRACKERS 6- 8/12 ( GUMMING)
• INFANTS LEARN TO CHEW FEED THEMSELVES
• MEAT PROTEIN
• IRON VITAMINS
• START BT 6/12 OF AGE

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DESSERTS

• GOOD FOR OLDER INFANTS
• BRIBE OR REWARD POOR EATING HABITS
• SALT INTAKE
• SHOULD BE DISCOURAGED
• INTAKE FUTURE BP

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FOOD ADDITIVES

• ARTIFICIAL FLAVOURS (3000) COLOURS
• ALLERGIC DISORDERS
• URTICARIA ANGIODEMA
• LESIONS OF TOUNGE BUCAL MUCOSA
• DIGESTIVE DISTURBANCES
• ARTHRALGIA
• HYDROARTHROSIS
• HEADACHE
• HYPERKINESIS

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FIRST YEAR FEEDING PROBLEMS

• UNDERFEEDING
• OVERFEEDING
• REGURGITATION, VOMITING RUMINATIONS
• LOOSE DIARRHEAL STOOLS
• CONSTIPATION
• COLIC

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T H A N K Y O U !