Infant and Young Child Feeding

DR ANMOL K GUPTA

MBBS,MD,PGDMCH,FIMSA

WHO FELLOW KKU-THYLANDASSOCIATE PROF COMMUNITY MEDICINE

IGMC SHIMLA

INFANT AND YOUNG CHILD FEEDING

LEARNING OBJECTIVES

• Enumerate components of Optimal Feeding

• Define Exclusive BF/Predominantly BF/ Replacement Feed/Mixed Feeding

• Describe process of Breast Feeding

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LEARNING OBJECTIVES

• List advantages of breast milk and breast feeding

• Enumerate dangers of artificial feeding

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Infant feeding

• Feeding the fetus –

Feeding the pregnant mother

• Feeding the infant 0-6 months- Exclusive breast feeding

• Feeding beyond 6 months-

Complementary feeding +BF

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What is Optimal Infant and What is Optimal Infant and Young Child Feeding?Young Child Feeding?

• Optimal feeding is defined as exclusive breastfeeding from birth to six months of age and there after continued breastfeeding for 2 years or beyond

with adequate and safe complementary feeds to meet nutritional needs of a young child

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Definitions for Infant FeedingDefinitions for Infant Feeding

Exclusive breastfed

Predominantly breastfed

Only breastmilk is given . No other food or drink,Not even water is given

The main source of nutrition is breastmilk but the child is also receiving other fluids (non-nutritive) or water

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Definitions for Infant FeedingDefinitions for Infant Feeding

• Mixed feeding – the child receives animal milk, formula or cereal based foods in addition to breast milk

• Replacement feeding

Is the process of feeding a child who is not receiving any breast milk – with a diet that provides all the nutrients the child

needs until the child is fully fed on family foods

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Breast Anatomy - StructureBreast Anatomy - Structure

fat 7

How Milk is Produced

• First few days after delivery- the breast feel soft and empty- only small amount of yellowish first milk (colostrum) is secreted

• After few days (may vary from 2 days to one week)-the breast begins to feel full , and sometimes hard- Milk has “come in”

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Prolactin ReflexProlactin ReflexSecretion continues AFTER feed to produce NEXT feed

Frequent Suckling Increases Milk Production 9

Oxytocin ReflexOxytocin Reflex

For milk ejection 10

For milk ejection 11

Helping and Hindering the Oxytocin Reflex

Inhibitor in BreastmilkInhibitor in Breastmilk

Frequent emptying of breast maintains lactation 12

Feeding ReflexesFeeding ReflexesRooting reflex

When somethingtouches lips,baby opens mouthputs tongue downand forward

Sucking reflex

When something touches palate baby sucks

Swallowing reflex

When mouth fills with milk,baby swallows

SkillMother learns to position babyBaby learns to take breast

Gag reflex

When something touches anterior part of the tongue, baby pushes it out.

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Formation of Teat

• For effective suckling the baby does not take just the nipple but a mouthful of the areola and the breast tissue beneath, which contains the lactiferous sinuses

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Mechanism of Mechanism of ‘Suckling Cycle’‘Suckling Cycle’

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Remember

o Baby needs mother’s help initially to take the breast into his mouth

o Keeping baby and mother together makes breastfeeding successful

o More suckling makes more milk

o For sustained milk secretion, it is essential to breastfeed frequently

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Advantages of BreastfeedingAdvantages of Breastfeeding to infant to infant

Breastmilk Perfect nutrients

Easily digestible

Ready to serve

Protects against

infection

Protects against

adult onset diseases

Breastfeeding Helps bonding and

development

Helps in adequate

growth and

development

Enhances brain &

visual development

Prevents hypothermia

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Nutrients in Human & Animal MilkNutrients in Human & Animal MilkWhat are the differences between these milks?

7gm/100ml

1.1gm/dL3.5 gm/dL

3.5gms/dL

Lower protein content puts lower solute load on kidney18

Differences in the Quality of Differences in the Quality of the Proteins in Different Milksthe Proteins in Different Milks

Anti-Infective Proteins

35% Casein

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Proteins in human milk

Higher proportion of lactalbumin and lactoglobulin in breast milk form finer curds and are easily digested

Human milk proteins have a suitable quality of anti-infective protein

Contains taurine and cysteine necessary for brain development

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Differences in the FatsDifferences in the Fats

HUMAN COW`S

Essential Fatty Acids,

PUFA

Enzyme Lipase

No Essential Fatty Acids

No Enzyme Lipase

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Fats in human milk

• Higher content of PUFA promotes brain growth and protects against atherosclrosis

• Active lipase promotes fat digestion

• Contains Omega 2 and omega 6 (VLCFA)

• Facilitates absorption of calcium

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Minerals

• Ca/P (2:1) ratio promotes Ca absorption

• High water content, Low Na+, low osmolality → low solute load to kidneys

• Adequate Zn

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Vitamins in Different MilksVitamins in Different Milks

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Breastmilk composition

• Colostrum • milk secreted during the first three days

after delivery• Yellow in color & thick• Rich in antibodies, vitamin A, D,E,K

• Transitional Milk• Milk secreted during the first two weeks • Immunoglobulin and protein contents

gradually decreases and the fat & sugar contents increases

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Variations in the Composition Variations in the Composition of Breastmilkof Breastmilk

What differences do you notice here?

COLOSTRUM

Mature Milk 26

Advantages of ColostrumAdvantages of Colostrum

Property Antibody rich

Many white cells

Purgative effect

Growth factors

Vitamin A rich

Importance protects against infection and

allergy

protect against infection

clears meconium helps to

prevent jaundice

help intestine to mature

prevents allergy, intolerance

reduces severity of infection

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Composition of human milk isTailor made for infant’s

Nutritional requirements, maturity and rate of growth !

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Advantages of Breastfeeding Advantages of Breastfeeding to motherto mother

Reduces post delivery bleeding

and anemia

Delays next pregnancy

Protects breast and ovarian cancer

Prevent obesity

Convenient

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Other Advantages

Society Eco-friendly

Human resource

development

Family Low cost involved

Less illnesses

Family bonding

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Anti-infective properties

secretory IgA, IgM, Lysozymes

• Antistaphylococcal factor

• Lactoferrin less saturated with iron and prevents growth of enterobacteria

Bifidus factor protects from infection with E.coli

PABA protects from malaria

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Disadvantages of Artificial Disadvantages of Artificial FeedingFeeding

More diarrhoea, ARI

and other infections

Requires preparation

Not easy to digest

Lacks balance of

nutrients

More likely to die

from infection &

malnutrition

Interferes with bonding

More allergy and

milk intolerance

Increased risk of some

chronic diseases

Overweight babies

May become

pregnant sooner

Increased risk of anemia,

osteoporosis, ovarian and breast

cancer

Mother

Baby

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Risk of Death from Diarrhoea with Risk of Death from Diarrhoea with Different MilksDifferent Milks

Infants 8 days to 12 months

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16.3

11.6

4.5

3.4

1

0 5 10 15 20 25

Formula only (age less than 2 months)

Formula only

Cow's milk only

Breast & formula

Breast & cow's milk

Breast only

Relative risk of death

CG Victora et al, Brazil, Lancet 8/8/87 33

Relative Mortality Risk in Relative Mortality Risk in Absence of BreastfeedingAbsence of Breastfeeding

0

1

2

3

4

5

6

<2 2-3 4-5 6-8 9-11 12-13

The LANCET 2000; 355:451-5

Age in months

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U-5 Child Deaths (%) Saved with U-5 Child Deaths (%) Saved with Preventive InterventionsPreventive Interventions

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6

5

4

4

3

3

2

2

2

2

1

1

- 2 4 6 8 10 12 14 16

Percentages

*Br eastf eeding

Complementar y f eeding

Zinc

Hib vac

Clean del iver y

Water , sani tation, hygiene

Ante ster oids

Vit A

T T

NB temp contr ol

Nevir apine + no BF

Measles vac

Antibio f or P ROM

Breastfeeding is defined as exclusive breastfeeding for first 6 months and continued breastfeeding during 6-11 months

Source: Jones et al. LANCET 2003; 632:65-7135

KEY MESSAGES

• EXCLUSIVE BREAST FEEDING is complete food and fluids for the baby till 6 months of age

• It prevents malnutrition and infants death

• Artificial feeding & bottle feeding are harmful to the baby, family and society.

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