Ezy Barnita

Introduction

Nutrition

Poor Adequate

Morbidity & mortality ↑Directly or indirectly Ensure growth, health

and development ~ potential2006: ⅓ of 9,5

million deaths in children <5 yo,

Inappropriate

Obesity

…introduction

The first two years of life: a critical window of opportunity ensuring children’s appropriate growth and development through optimal feeding

Optimal breastfeeding prevent 13% of deaths in children <5 years of age, appropriate complementary feeding practices an additional 6% reduction in underfive mortality

Malnutrition during the 1st 2 yrs of life

Short stature (stunting)

Impaired intellectual performance (adult)

Reduced capacity for physical work

Affected reproductive capacity in ♀(LBW)

Implication of national development

Global strategy for infant and young child feeding (2002)

Exclusive breastfeeding for 6 months (180 days)

Complementary feeding starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond.

1

2

Definition

Infant receives only breast milk or expressed breast milk, and

no other liquids or solids, not even water, with the exception of oral rehydration solution, drops or syrups consisting of vitamins, minerals supplements or medicines

Exclusive breastfeeding

process starting when breast milk is no longer sufficient to meet the nutritional requirements of infants, and therefore otherfoods and liquids are needed, along with breast milk.

Complementary feeding

Evidence for recommended BF (1)

Mortality 6-10 times higher at 1st month of life

Diarrhea and pneumonia are more common and more severe even with adequate hygiene, as well as other acute infections (otitis media, Haemophilus influenzae meningitis, UTI)

↑ risk diseases with an immunological basis, (asthma and other atopic conditions, type 1 diabetes, celiac disease, ulcerative colitis and Crohn disease

No breastfeeding

Evidence for recommended BF(2)

Greater risk of childhood leukaemia

Obesity in later childhood and adolescence is less common among breastfed children dose response effect

↑risks to cardiovascular health (hypertension, cholesterol level, atheros-clerosis in later adulthood)

A meta-analysis of 20 studies: cognitive function on average 3.2 points higher among children who were breastfed

Exclusive and partial BF

Exclusive BF

Partial BF

Diarrhea : 8,6 times higher

Mortality: 4,2 times higher

Exclusive and no BF

Exclusive BF

No BF

Diarrhea : 25 times higher

Mortality: 14,2 times higher

Complementary feeding

After 6 month old:

It becomes increasingly difficult for breastfed infants to meet their nutrient needs from human milk alone

Most infants are developmentally ready for other foods at about 6 months

In many countries, the period of complementaryFeeding (6–23 months) peak incidence of growth faltering, micronutrient deficiencies and infectious illnesses

inadequate nutritional qualitygiven too early or too latein too small amounts or not frequently enoughpremature cessationlow frequency of breastfeeding

Ten guiding principles for complementary feeding of the breastfed child

1. Introduce complementary foods at 6 months of age (180 days) while continuing to breastfeed.Six months old doubled his or her birth’s weight and more active exclusive BF is no longer sufficient to meet baby’s energy and nutrient needs

Digestive system is mature enough to digest the starch, protein and fat in a non-milk diet.

Tongue thrust and rooting reflexes begin to disappear infants can receive and hold semi-solid food in their mouths

2. Continue frequent on-demand breastfeeding until 2 years of age or beyond

higher quality nutrients

protective factors

reduces the risk of acute and chronic diseases

3. Responsive feeding

Feed infants directly & assist older children feeding themselves. Feed slowly,patiently, and encourage children to eat, but do not force them

If children refuse experiment with different food combinations, tastes, textures and methods of encouragement.

Minimize distractions during meals

Feeding times are periods of learning &love

4. Practise good hygiene and proper food handling

5. Start with small amounts of food, increase the quantity as the child gets older

Amount of energy

Breastfeeding 0.7kcal/ml

Complementary feeding

0.6-1kcal/ml

Dilute food ~0.3kcal/ml

Complementary foods should have a greater energy density than breast milk, that is, at least 0.8 kcal per gram

Practical guidance of complementary food

6. Increase food consistency and variety gradually

The most suitable consistency for an infant’s or young child’s food depends on age and neuromuscular development

6 months

8 months

12 months

pureed, mashed or semi-solid foods

finger foods

family food

delayed beyond 10 months of age may ↑ the risk of feeding difficulties

7. Frequency of complementary food

How much energy the child needs to cover the energy gap

The amount that a child can eat at one meal stomach capacity (~30ml/kg)

The energy density of the food offered at least 0.8kcal/g (>BF) or need greater volume need to be divided into more meals

8. Feed a variety of nutrient-rich foods to ensure that all nutrient needs are met

such as:

Animal source

Pulses

Fats & oil

Fruit and veg

Dairy

There are no controlled studies that show that restrictive diets have an allergy-preventing effect

Vegetarian (plant-based) complementary foods do not by themselves provide enough iron and zinc to meet child’s needs

9. Fortified complementary foods or vitamin-mineral supplements as neededIn settings where little or no animal-source foods are available to many families, iron-fortified complementary foods or foods fortified at the point of consumption with a multinutrient powder or lipid-based nutrient supplement may be necessary

10. Increase fluid intake during illness

During illness the need of fluid often ↑

child’s appetite for food often decreases

desire to breastfeed increases

breast milk may become the main source of both fluid and nutrients

give more frequent, smaller meals

Take home message

After 6 months yo start complementary feeding due to energy gap along with maturity of digestive tract and

feeding skills development

Breastfeeding is the best

Thank you