PRINCIPLES OFARTIFICIAL

FEEDING

Draw attention to the role of the Ten Steps in improving breastfeeding rates.

By-V.JanarthananPre-final year,M.B.B.S

INDICATIONS

“HIV”“HTLV-1”MOTHER TAKING “ANTIMETABOLITE

DRUGS”MOTHER TAKING “THERAPEUTIC DOSES OF

RADIO PHARMACEUTICALS”MOTHER TAKING “DRUGS OF ABUSE”

Draw attention to the role of the Ten Steps in improving breastfeeding rates.

OTHER INDICATIONS

• "Infectious (contagious) tuberculosis: Breastfeeding is safe after the mother has undergone treatment and is no longer contagious.

• Hepatitis A: Breastfeeding is safe after the mother receives a dose of gamma globulin.

• Hepatitis B: Breastfeeding is safe after the baby receives a dose of Hepatitis B immune globulin (HBIG). The baby should also be started on the first of three doses of Hepatitis B vaccine.

• Herpes simplex: Breastfeeding is safe if there are no lesions on the breast.• Chicken pox: Breastfeeding is safe as soon as the mother is non-infectious,

meaning all spots are crusted over.• Lyme disease: Breastfeeding is safe as soon as the mother initiates

treatment.“

Renew action by health systems, health care providers and communities to makebreastfeeding the easy choice for women.

OTHER INDICATIONS

• CMV (Cytomegalovirus): Low birth weight premature infants may have problems with CMV in their mother's milk and heat treatment and/or freezing and re-warming may help - very preliminary research on this.

• Recommendations are often different in developing countries, where the risk of infant mortality is higher if the baby does not breastfeed.

• Although certain prescribed drugs can preclude breastfeeding, the vast majority of moms on meds don't even need to interrupt breastfeeding.

• If the mother has a common illnesses such as a cold or flu or mastitis she should continue to breastfeed her infant. Such illnesses are not passed through breast milk and breastfeeding continues to provide immunities to the infant.

Inform people everywhere of the risks of artificial feeding, and the role of breastfeeding for children’s development and lifelong health and the health of mothers.

INFANTS’ NEEDS

• ENERGY : 100 kcal/kg body wt./day• PROTEINS : FIRST 6 MONTHS – 2g/kg body wt./day END OF 1 YEAR – 1.5g/kg body wt./day• 8 – 10 % energy from proteins• -CHO requirement : 10g/kg body wt./day• After 4 months – undiluted, boiled &cooled milk• Frequency : 6 – 8 times/day (5 times/day : older children)• Increased calorie need during illness

Enable mothers to enjoy full support for breastfeeding in health care systems and beyond.

COMMERCIAL PRODUCTS

• Dried milk• Cow’s milk• Infant feeding formulas

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

DRIED MILK

• Scientifically prepared for infant feeding• Free from bacteria• Little danger from flies• Does not become sour• Simple to reconstitute• Fortified with vitamins• Expensive

2. Train all health care staff in skills necessary to implement this policy.

COW’S MILK

• Cheaper alternative• Widely used• Diluted milk during first 2 months – WHO and

Govt. of India recommendation• Hazardous in poor homes - risk of contamination - risk of overdilution

3. Inform all pregnant women about the benefits and management of breastfeeding.

DILUTION

CONSTITUENTINFANT’S WEIGHT

3 4 5 6

COW’S MILK (ml) 70 100 150 180

WATER (ml) 20 20 0 0

SUGAR (g) 5 10 10 10

kcal 64 103 135 153

PROTEIN (g) 2.1 3.0 4.5 5.4

- PLACE MILK, WATER AND SUGAR IN PAN

- BRING TO BOIL AND COOL

- POUR INTO FEEDING UTENSIL

Breast milk Vs Cow’s milk

CONSTITUENT BREAST MILK(g/l)

COW MILK(g/l)

Proteins 11 33

Casein 4 28

Soluble proteins 7 5

Lactalbumin 3.5 1.5 -1.8

Beta - lacto globulin 0 3.7

Lactotransferrin 1-2 0.2-0.5

Immunoglobulin 1-2 0.5

Lysozyme 0.5 Traces

Breast milk Vs Cow’s milk

CONSTITUENT BREAST MILK(g/l)

COW MILK(g/l)

Non – protein nitrogenous substances 0.32 0.32

Lipids 35 35

Linoleic acid 3.5 1

Carbohydrates 70 50

Lactose 62 50

Nitrogenous oligosaccharides 8 0

Breast milk Vs Cow’s milk

CONSTITUENT BREAST MILK(_/l)

COW MILK(_/l)

Minerals 2 g 8 g

Ca 0.33 g 1 g

P 0.15 g 1 g

Fe 0.4-1.5 mg 0.3-0.5 mg

Vitamins

C 60 mg 20 mg

D 50 IU 25 IU

Energy 640-720 kcal2670-3000 kJ

650 kcal2717 kJ

BREAST MILK - PROTEINS

• Lower than in most animals• More cystine• Less methionine• Rich in taurine• Immunoglobulins • Cow’s lactalbumin maybe immunogenic• Cow’s casein – large curdles

4. Help mothers initiate breastfeeding within a half hour of birth.

BREAST MILK - FATS

• 35-50 % total energy value• Essential PUFA are higher• Easier to digest and absorb• Cow’s milk – volatile fatty acids produces GIT

disorders• Cow’ milk – larger fat globules in emulsion

delays gastric emptying and induces digestive upsets (common cause)

5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.

BREAST MILK - CARBOHYDRATES

• More lactose• Promotes Lactobacillus bifidus growth

6. Give newborn infants no food or drink other than breast milk unless medically indicated.

BREAST MILK - VITAMINS

• Vit D as water soluble form• More Vit A & Vit C

7. Practise rooming in - allow mothers and infants to remain together - 24 hours a day.

BREAST MILK - MINERALS

• Iron has high bio-availability• Appropriate zinc and copper• Richer in copper, selenium and cobalt• Less sodium• Calcium/phosphorus ratio is high

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

THANK YOU