Approach to Breastfeeding and Infant nutrition

1. Infant Feeding & Nutrition
By:-
Jwan Ali Ahmed AlSofi

2. Objectives
• To know the types & definitions of breast feeding.
• To understand the physiology of lactation.
• To know the important problems that are associated with breast
feeding.

3. Infant Feeding & phases of growth
• Proper nutrition is crucial in promoting the normal growth &
development for children.
• Phases of growth
1. Infancy growth period –rapid.
2. Childhood growth period –decelerating growth.
3. Puberty phase –rapid again.

4. Energy Value of food
• Macronutrients :
1. Fat:-
- 1gram of fat = 9 kcal
- Are the main dietary energy source for infants
- account for up to 50% of energy in human milk.
2. Proteins:-
- 1gram of proteins = 4 kcal
- Liver plays a central role in a. a. metabolism.
- Total protein requirement increasing rapidly in the first year of life and then decrease to be
constant at 1.5gm/kg/day until school age.
- Illness & physical stress leads to negative nitrogen balance .
- This should be replaced after illness otherwise clinical malnutrition occurs.
3. Carbohydrates :-
- 1gram of carbohydrates = 4 kcal
• Micronutrients : Vitamins & trace minerals

5. Infants are more vulnerable to poor nutrition because of:
1. Poor stores of fat and protein
2. Extra nutritional demands for growth (the weight of a term
infant doubles by 4 months and triples by one year of age)
3. Periods of reduced food intake and increased nutritional
demands during illnesses or surgery.

6. Breast Feeding

7. Breast Feeding
‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
ِ‫ن‬ْ‫ي‬َ‫ل‬ِ‫ام‬َ‫ك‬ ِ‫ن‬ْ‫ي‬َ‫ل‬ ْ‫و‬َ‫ح‬ َّ‫ن‬ُ‫ه‬َ‫د‬ َ
‫َل‬ ْ‫و‬َ‫أ‬ َ‫ن‬ْ‫ع‬ ِ
‫ض‬ْ‫ر‬ُ‫ي‬ ُ‫َات‬‫د‬ِ‫ل‬‫ا‬َ‫و‬ْ‫ل‬‫ا‬َ‫و‬
‫هللا‬ ‫صدق‬
‫العظيم‬

8. Breast feeding:-
•Infant has received any breast milk expressed or from
breast.
Exclusive breast feeding:-
•Infant had received only breast milk no other liquids
or solids except vitamins ,minerals & medicines.
•Exclusive breastfeeding for the first 6 months is the
current (WHO) recommendation.

10. Components of Human Milk
• Main dietary energy source for infants  fat
• Main dietary component of breast milk  Carbs
Main components of human milk include:
1. Proteins
2. Lipids
3. Carbs:- Lactose & HMOS

11. HMO ( Oligosaccharides )
• Human milk oligosaccharides (HMO, also known as human
milk glycans):-
- are sugar molecules, that are part of the oligosaccharides group and
which can be found in high concentrations exclusively in human
breast milk.
- Oligosaccharides (HMO), the complex sugars in milk that are not
digested by the infant.
1. help establish the microbiota
2. Stimulate the maturation of the immune system
3. Protect against pathogenic infections
4. Promote the development of intestine

12. Pre & Probiotics
Prebiotics:-
• are fiber found exclusively in plant material
• are the fiber that feeds the best bacteria in the intestinal tract.
• These all come from plant food, except in mother’s milk.
Probiotics:-
• are live microorganisms that may be able to help prevent and treat some
illnesses.
• Promoting a healthy digestive tract and a healthy immune system are their
most widely studied benefits at this time.
• These are also commonly known as friendly, good, or healthy bacteria.
• Probiotics can be supplied through foods, beverages, and dietary supplements.

13. Breast Feeding

14. Anatomy of the breast

15. Physiology & Phases of Lactation

17. Establishing breastfeeding
• Colostrum, rather than milk, is produced for the first few days.
• Colostrum differs from mature milk in that the content of protein and
immunoglobulin is much higher.
• Volumes are low, but water or formula supplements are not required
while the supply of breast milk is becoming established.
• The first breastfeed should take place as soon as possible after birth.
• Subsequently, frequent suckling is beneficial as it enhances the
secretion of the hormones initiating and promoting lactation.

18. Colostrum
• The earliest milk to be secreted ,
• low in volume
• is produced for the first few days
• It is yellow-lemon in colour.
• Alkaline
• high specific gravity 1040-1060
• Very rich in protein which rapidly falls.
• Contains more electrolytes .
• Contains less amount of fat & lactose.
• It has unique immunological factors as IgA , lysosomes & lactoferrin.

19. Factors affecting initiation & continuation
of BF
• Happy relaxed mother.
• Good nutritional health of mother.
• Education about BF
• Hospital practices & policies.
• Follow-up care.
• Family & social support

20. Rules of Breast Feeding
• Feeding should be initiated soon after birth.
• At each feeding each breast should be nursed.
• Empty the 1st breast before offering the 2nd .
• Breast should be washed at least once a day.
• Instructions to the mother about: Infant hunger cues , correct nipple
latch , feeding frequency
• Neither breastfed nor formula –fed infants require additional water
unless dictated by high environmental temperature.
• Begin vitamin D drops ( 400 IU/ day ) at hospital discharge.
• Do not give glucose water, water, or formula unless indicated.
• Avoid pacifiers.
• Infant appetite varies from 1 feeding to another.
• Rooming in.

21. • Breast milk should be refrigerated & used within 48hours.
• Expressed breast milk can be frozen & used for up to 6 months.
• Milk should be thawed rapidly by holding under running tepid water & used
completely within 24 hours after thawing.
• Milk should never be microwaved.

22. Supplements to breast fed infants
400 IU/ day
6 mg/kg in two divided doses

23. Breast Feeding Technique
First step :
• Baby should be hungry, dry
• neither cold nor warm.
Second step :
• Baby should be in semi-sitting position,
• using arm-rested moderate low chair ,
• raising her knee.
• Baby face is held close to the mother breast by 1 arm & hand.
• The other hand supports the breast to avoid nasal obstruction.
Third step :
• Burping

24. Positions of Burping
• Position " 1 "
Position " 2 "

25. Proper Latch

26. • All breast fed infants should be seen by a pediatrician within 48-72hours
1. Evaluate hydration status
2. Evaluate body weight
3. Observe feeding

27. Collecting breast milk
Manual Breast Collection Mechanical Pump Electrical Breast Collection

28. Problems Associated with Breast Feeding
Baby
• Inadequate milk intake
• Jaundice
Mother
• Nipple pain
• Engorgement
• Mastitis
• Milk leakage

29. Maternal Problems Associated with Breast Feeding:
1. Nipple pain: it is caused by:
• Poor positioning of infant ,
• improper latch.
2. Engorgement :
• Physiological fullness of breast.
• O/E: firm , overfilled & painful.
• Cause: incomplete removal of milk.
• Treatment:
• Hot compresses with :
• 1.Frequent BF
• 2.Manual milk expression.

30. 3.Mastitis :
• After the 2nd week of life.
• C/F: breast pain, myalgia, fever, fatigue, nausea , vomiting
&headache.
• O/E: localized warmth, tenderness, edema & erythema
• Organisms: Staph aureus ,E.coli Group A streptococcus klebsiella ,
H.influenzae
• Treatment:
• Oral Abs & analgesia.
• Promoting BF or emptying the affected breast
4.Milk leakage.

31. Left Breast Mastitis

32. Problems Related to Infant
1. Inadequate milk intake:
• Infant: lethargic/might cry
• Dehydrated
• Delayed stooling
• Decreased urine output
• Weight loss > 7%
• Increased hunger
2. Jaundice:
• Breast feeding jaundice: It is due to insufficient fluid intake.
• Breast milk jaundice: It is due to
• Breast milk contains inhibitors of glucoronyl transferase.
• Breast milk enhance bilirubin absorption from gut.

33. Causes of Inadequate milk intake:
1. Insufficient milk production.
2. Improper technique.
3. Infant illness.
4. Preterm infant(poor sucking &swallowing/ medical problems).

34. Advantages of Breast Feeding
• Less prevalence of
- NEC
- meningitis ,
- Septicemia
- botulism.
- OM
- Pneumonia
- Diarrhea
- UTI
- colic ,
- cow milk intolerance
- celiac disease, Crohn 's disease,
- cancer,
- DM, obesity,
- mortality & hospitalizations
- Atopic eczema
• Free of contaminating bacteria
• Always available, fresh .
• Requires no preparation.
• Lower risk of breast cancer.
• Psychological support for both
baby & mother.

35. Anti-Infective Properties of Breast Milk

36. Disadvantages of breastfeeding
• Unknown intake
• Nutrient inadequacies
• Deficient in vitamin K & D ,iron & florid
• Transmission of drugs
• Transmission of infection
• Less flexible
• Emotional upset

37. Contraindications of Breast Feeding
- Hepatitis B virus , Hepatitis C virus , CMV infections
are not contraindications.
- Smoking & alcohol drinking should be discouraged.

41. Summary
• Breast feeding is the preferred feeding for all infants.
• Breast feeding is not a choice , it’s a responsibility”
• Breast milk is the best source of nutrition for the first 6 months
of life.
• All the nursing mothers should have information about
technique, frequency ,advantages ,problems of breast feeding.

42. FORMULA FEEDING

43. •Infants who are not breastfed require a formula feed.
•Most formulas are based on cow’s milk.
•Unmodified cow’s milk is unsuitable for feeding in infancy as
1. it contains too much protein and electrolytes
2. inadequate iron and vitamins.
• Whole cow’s milk should not be introduced until 12 months of age.
• Pasteurized cow’s milk given before 12 months of age is associated with
increased risk of iron deficiency, but may be given from 1 year of age.
• It is deficient in vitamins A, C, and D and in iron, and supplementation
will be required unless the infant is having a good diet of mixed solids.

44. FORMULA FEEDING
• It produces
• 20 kcal /30 cc
• 1 oz=30 cc = 20 kcal
• 67kcal/dl
• Feeding interval ranging 3-5 hrs during 1st year of life (average 4hrs).
• Lactose is the major CHO in formula as well as in breast milk.
• Cow’s milk -based formulas contain a protein concentration varying from
1.45 to 1.6 g/dL.
• The predominant whey protein is B-globulin.
• The whey : casein ratio varies from 18 : 82 to 60 : 40 ratio.

46. Preparation of Formula

47. Sterilization of Bottles
1. Separate bottle parts.
2. Wash bottle & teet with soap & hot water.
3. Submerge the bottle & all parts into a pot of boiling water
4. Bottle ---10 min , teet------5min.
5. Remove bottle & its parts from boiling water.

48. Technique of Formula Feeding

49. Therapeutic
Formulas
Soy based formulas :
• free of cow milk protein & lactose.
• It is indicated in :
• Galactosemia
• Lactase deficiency
CHO free formula : (lactose free milk) , used in:
• Galactosemia
• Lactase deficiency
Protein hydrolysated formula : used in :
• Cow milk intolerance
• Soya protein intolerance
• Preventing atopic diseases
Phenylalanine free formula : used in
• PKU
Amino acid formula.

50. Complementary Feeding

51. Complementary Feeding
• Definition :
• Introduction of complementary foods(all solid &liquid foods)
other than breast milk or formula starting at 6 months of age.

52. Rules of Weaning
• Introduce 1 food at time.
• Energy density should exceed that of breast milk.
• Iron containing food (meat, iron-supplemented cereals) are required.
• Zinc intake should be encouraged.
• Breast milk should be continued to 12 months.
• Not >4-6 oz of fruit juice.
• No soda.
• Give not more than 24 oz/day of cow milk.
• Foods high in salt& sugar should be avoided.
• Honey should not be given until one year of age .
• Use of cup at proper age.

53. Feeding Problems During the 1st Year of Life
• 1. Under feeding:
• Suggested by crying ,restlessness ,failure to gain weight ,faluire to sleep,
constipation & irritability.
• It may result from insufficient food intake.
• 2. Overfeeding:
• Is manifested as discomfort after feeding with nausea & vomiting.
• 3 .Regurgitation:
• Return of small amounts of swallowed food during or shortly after feeding.
• 4 .Loose stool:
• Stool of breast fed infants is softer than that of formula fed infants.
• 5.Constipation
• 6.Colic
• It is a complex of paroxysmal abdominal pain (of intestinal origin)&severe crying.

55. Mcqs

58. 1. Vitamin D mandatory 400 IU till one year if only breastfeeding
2. Vitamin k prophylactic 1mg IM at birth
3. Iron maybe given depend on nutrition 6mg/kg/day in two doses
4. Floride from 6 month to 3 year
All THESE FOUR ARE DEFECIENT IN breast-MILK

62. • has full, firm& painfull right breast. O/E: the breast is firm ,overfilled
but neither tender nor erythematous.
What is the problem that facing that mother??
e. Right sided breast carcinoma
c. Right sided mastitis.
a. Breast engorgement.
d. Simple nipple pain.
b. Breast abscess
a. Breast engorgement.
Response:
correct

63. • lWhole cow’s milk can be introduced at age of :
• a.12-month.
• b. 9-month.
• D. At 6-month when breast feeding should be stopped.
• C. With starting of weaning.
• e. When teething started, cow’s milk can be introduced.
a.12-month.
Response:
correct

64. • Exclusive breast feeding can be defined as :
d. Infant had received only breast milk with water.
b.Feeding directly from the breast for the first 6- month of age.
a. Infant had received only breast milk no other liquids or solids except vitamins
,minerals & medicines.
c. Infant had received only breast milk.
e. In exclusive breast feeding baby should receive formula feeding as
complementary feeding.
Your answer : a. Infant had received only breast milk n
other liquids or solids except vitamins ,minerals &
medicines.
Response:
correct