Developmentand

Infant and young child feeding practices

Revision class

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)

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

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

2 important maternal reflexes

• Prolactin reflex

• Oxytocin reflex

NEUROENDOCRINE REFLEX- Prolactin

3 reflexes helpful in baby

• While accepting BM

1. Rooting reflex

2. Sucking reflex

3. Swallowing reflex

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

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.

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

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)

Exclusive replacement feeding

• AFASS (A – Affordable F – Feasible A –Acceptable S – Sustainable S – Safe) criteria

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

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

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

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

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.

Problems

• Adequate?

• Latchment?

Mother c/o “NOT ENOUGH MILK”

• Passes urine 6 times a day

• Sleeps well after feeds atleast for 1 hour

• Gaining weight normally

Incorrect way- leads to Nipple sores and pain

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

• “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..”

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

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

• Developmental sequence is the same for all children

• The rate of attainment may be different in different children

• General actions give way to more specific actions- disappearance of primitive reflexes

• Simple movements give way to more complex actions