2. Must know
• To be covered:
– Breast feeding- physiology
– Benefits of breast feeding to child, mother and
community
– Composition of breast milk-anti-infective factors
– Complementary feeding principles
– Laws of development
• Not covered today: Important milestones at
various ages (important long question)
3. Why the stress on Infant nutrition?
• WHO/UNICEF have emphasized the first 1000
days of life i.e, the 270 days in-utero and the
first two years after birth as the critical
window period for nutritional interventions
4. Breast milk constitutents
BM is Nutritionally superior
• Lactose 7 gms%
• Protein 1 gms% (more lactalbumin)
• Fat – lipase, EFA
• Minerals: More calcium (2:1); Zinc
• Sodium less
• Iron
• Vitamins (except vitamin D and to some extent
vitamin K)
• Water- 88% is water
10. 3 reflexes helpful in baby
• While accepting BM
1. Rooting reflex
2. Sucking reflex
3. Swallowing reflex
11. Duration
• Exclusive breastfeeding for 6 months (180
days)
• Nutritionally adequate and safe
complementary feeding starting from the age
of 6 months with continued breastfeeding up
to 2 years of age or beyond
12. IYCF guidelines
• Practise exclusive breastfeeding from birth to 6 months of age, and
introduce complementary foods at 6 months of age while continuing to
breastfeed.
• Continue frequent, on-demand breastfeeding until 2 years of age or
beyond.
• Practise responsive feeding
• Practise good hygiene and proper food handling.
• Start at 6 months of age with small amounts of food and increase the
quantity as the child gets older, while maintaining frequent breastfeeding.
• Gradually increase food consistency and variety as the infant grows older,
adapting to the infant’s requirements and abilities.
• Increase the number of times that the child is fed complementary foods as
the child gets older.
• Feed a variety of nutrient-rich foods- non-vegetarian, fruits etc
• Use fortified complementary foods or vitamin-mineral supplements for the
infant, as needed
• During illness- increase fluid intake during illness, more frequent
breastfeeding, and soft, favourite foods. After illness, encourage the child
to eat more.
13. MTCT
• Counsel HIV-positive mothers during antenatal period-
infant feeding options, viz. exclusive breastfeeding or
exclusive replacement feeding. Exclusive breastfeeding
is superior to exclusive replacement feeding in
developing countries because it maximizes the
chances of survival of the infant
• Risk of transmission through breastfeeding is minimal
provided mother and the infant receive appropriate
antiretroviral prophylaxis
• No Mixed Feeding is to be done during the first 6
months
14. ART
• Those with condition warranting ART- Maternal ART during
pregnancy (in those who need it) and continued lifelong
• Not needing ART- Antepartum twice-daily AZT starting from
as early as 14 weeks of gestation (or as soon as possible
thereafter) and continued during pregnancy. At the onset
of labour, single-dose NVP (sd-NVP) with initiation of twice-
daily AZT + Lamivudine, which should be continued for 7
days postpartum
• For breastfeeding infants, maternal prophylaxis should be
coupled with daily administration of NVP to the infants
from birth (within 6−12 hours) or as soon as feasible
thereafter, until 1 week after all exposure to breast milk has
ended
• Replacement feeding- 4-6 weeks of infant prophylaxis with
daily NVP (or twice-daily AZT)
16. Benefits to baby
• Short-term and long-term benefits on both
child and mother
• Reduces infant mortality in the first few
months by 6- 10 times
• Deaths from diarrhea and pneumonia could
be reduced by one third if infants were
exclusively breastfed
• Reduced otitis media, UTI, HiB meningitis
17. Baby- Long term benefits
• Reduced asthma and other atopic conditions, type 1
• Diabetes, celiac disease, ulcerative colitis and Crohn
disease
• Artificial feeding is also associated with a greater risk of
childhood leukaemia.
• Obesity in later childhood and adolescence is less
common among breastfed children
• Artificial feeding linked with risks to cardiovascular
health, including increased blood pressure, altered
blood cholesterol levels and atherosclerosis in later
adulthood
• Better IQ
18. To mother
• Short-term benefits- reduces risk of
postpartum haemorrhage
• Reduced risk of breast and ovarian cancer
among women who breastfed
• Contraception, helps with recovery of pre-
pregnancy weight
19. BFHI 1992
• Hospitals become baby-friendly by
implementing the Ten Steps to Successful
Breastfeeding
• Criteria have been developed by WHO and
UNICEF and are used worldwide
20. BFHI- Ten Steps to Successful
Breastfeeding
1. Have a written breast feeding policy.
2. Train all health staff to implement this policy.
3. Inform all pregnant women about the benefits of breast feeding.
4. Help mothers to initiate breast feeding within ½ hour of birth.
5. Show mothers the best way to breast feed
6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
7. Practice “Rooming-in”
8. Encourage breast feeding on demand.
9. Give no artificial teats, pacifiers, dummies or soothers
10. Help start breast feeding support groups and refer mothers to them.
24. Despite knowing all these..
• Only 34.8% of infants are exclusively breastfed
for the first 6 months of life
• Most important intervention to bring down the
under 5 mortality rate
25. • “If a multinational company developed a food
product that was a nutritionally balanced and
delicious, a wonder drug that both prevented and
treated disease, cost almost nothing to produce
and could be delivered in quantities controlled by
the consumers‘ needs, the very announcement of
their find would send their shares rocketing to the
top of the stock market.. The scientists who
developed the product would win prizes and the
wealth everyone involved would increase
dramatically.. Women have been producing such a
miraculous substance, breastmilk, since the
beginning of human existence..”
26. Growth and development- definitions
• Growth: It is the increase in size as a result of
multiplication of cells associated with increase
in cytoplasmic and intercellular mass as per
genetic norms of an individual, influenced by
environment to achieve the optimum
• Development: Maturation of functions and
acquisition of skills
27. 7 principles of Development
• Development is a continuous process- diseases
may halt its continuity
• Development proceeds in the cephalo-caudal
direction
• Development proceeds from central axis to
peripheries
28. • Developmental sequence is the same for all
children
• The rate of attainment may be different in
different children
29. • General actions give way to more specific
actions- disappearance of primitive reflexes
• Simple movements give way to more complex
actions
