Infant feeding
Dr.Hussein alatabi MBChB,DCH,FICMS,CABP Senior lecturer-Alkindy college of medicine-university of Baghdadبسم ألله ألرحمن ألرحيم ((وصينا ألانسان بوالديه احسانا حملته أمه كرها ووضعته كرها وحمله وفصاله ثلاثون شهرا)) صدق الله العضيم
Infant feeding
In first 4-6 months of life human milk or, often, various infant formulas can provided complete nutrition to the growing infants. However,breast milk is the recommended sourse of nutrition for almost all children. Every effort should be made to encourege and promopt feeding.The alternate to human milk is iron-fortified formula. And cow’s milk (fresh) should not be introduced untile after 1st year of life.After 4-6 months of life,solid food and juices are introduced.Most term infants may start feeding by 6 hours of life or earliar
Breast feeding or formula usully provided every 2-4 hr/day. By the end of the 1st month 90% of infants have established aregular schedule By the end of 1st wk most term infants wants 6-9 feeding/day and have increased their intake from 30ml to 80-90ml every 3-4 hour Feeding is satisfactory if the infant is no longer losing weight by 4-5 days and gaining weight by 12-14 days. Infants cry from many reasons aside from hunger as being uncomfortably hot or cold or cold,soiled wet or ill.breast feeding
Phsiology; -milk synthesis begins in the 6th or 7th month of pregnancy. -with delivery of placenta at birth estrogen and progestrone levels fall and prolactin levels rise,lead to increase milk synthesis. -when neonate placed to the breast and begins sucking, the neuroendocrine reflex is triggered causing oxytoxin to be released ,oxytoxin causes the cells that line the breast ducts to contract, expelling milk from alveoli into ducts and subareolar sinuses that empty into anipple pore,this known as the milk ejection or ((let down)) reflex -Breast milk during first several days after birth is primairly composed of ((colostrum)),mature milk usully begins at the end of the 1st week after birth.Colostrum & mature milk
Colostrum : contains high protein and mineral and low fat and carbohydrate.It has very potent immunological and maturational properties. Mature milk is composed of ((foremilk)), which is the milk that first drawn during feeding,which is low in fat and more in protein.*and ((hind milk)) which follow foremilk,it contains more fat and higher caloric contents. So foremilk for infant thirst while hindmilk for growth. Breast milk from mothers of premature infants contains greater amount of antibodies and nutrients than breast milk from mother of full term.Advantages of breast milk
1-Anti-infective properties which include: *A-It contain Ig A which play arole in respiratory and GIT mucosal proliferation. *B-It contain a lot of macrophages and T-lymphocytes which produce lysozymes. *C-It contain some substances protecting from viral infection. *D-Contain bile salt stimulated lipase which has aprotective function against some infection as giardiasis 2-Breast milk is fresh and aviable at any time and needs no preparation and cost nothing to the family.3-It has proper temp.(body temp.). 4-More attachement and bonding between mother and her baby. 5-Studies show that breast fed babies have ahigher IQ than bottle fed babies. 6-For mother,breast feeding may provides protection against breast,ovarian and endomaterial malignancies.,also can be amethod of contraception with help to decrease post partum bleeding. 7-In future breast fed infant are less liable to develop Coranory artery disease and ciliary disease.
Drugs that should avoided during lactation by mother;
*-Alcohol *-Chloramphenicol *-Cimetidine*-Clindamycine *-Codeine *-Diazepam? *-Ergotamine *-Marijuana *oral cotraceptive*-Salfonamides *- Iodine *Tetracycline *-Radionuclide material *-Lithium *-Cyclosporin *-……..How to assess the adequacy of milk intake ?
Babies should look satisfied after feeding, with aperiod (1-2 hr) of sleep. Adequate weight gaining (2o-30 g/day) Yellow seedy stool passed at least 4 times dialy,which increase in frequency gradually,so that parents think that is diarhea. Infant void(urinate) 6-8 times dialy. Note;-the mother must be physically and mentally at rest with adequte nutrition. Expressed breast milk : means expressed breast milk in abottle and giving it to ababy in absence of mother, usully can be given in 2nd month age.Contraindication to breast feeding:
Related to mother:A-HIV infectionB-Infectious tuberculosis (untill they have received 2 or more weeks of treatment.C-Other relative C.I.((HF,RF.psychosis))Related to infants:Galactossemia, phenylketonuria(PKU),…Thank you
Formula feeding
Dr.Hussein k.Alatabi MBChB,DCH,FICMS,CABP
Formula feeding (Artificial feeding )
Whole cow’s milk or amodified commericial form of it,is the basis of most formula.Other animal milks and milk substitute are avilable for infants who cannot tolerate cow’s milk Sterilization,refrigeration and processing of formula make it more digestable and reduce risk of GIT infection.Cow’s milk has ahigher protein content than human milkHomogenized milk: has smaller globules and smaller less tough protein curd.Milk substitutes and hypoallergenic milk: include goats milk,milk consisting of amino acid mixtures or protein derived from soybeans and those not cotaining lactose.Artificial feeding should be followed to insure aquirecy and insure:-
Adequate fluid intake 150 ml/Kg/day. Adequate calories intake 110 Kcal/kg/day Adequate sterilization by mechanical (washing) or chemical (medication) methods Adequate quantity of feeding {each scoop (4-4.5 gm) should be reconstituted in 30 ml of water( 1 line ). Adequate number of feeding:feed baby 4 hourly and each time not more than 210 ml ( 7 lines) Additions of iron, minerals and vitamines.Problems with artificial feeding:
Infection:gastroenteritis,O.M.+pneumonia Convulsion: as it contain phosphate 7 times more than breast milk which lead to hypocalcaemia and convulsion. Hypernatremic dehydration Gastric upset due to formation of thick curds in stomach becouse the ratio of whey/casein is lower in artificial milk than breast milk. Diluted milk lead to malnutrition Obesity if concentrated milk given Allergy as lactose intolerance. Costy and economic problems to family.First year feeding probleme:
Under feeding: may be caused by inadequate technique,abnormal “bonding” or systemic disease,suggested by crying, restlessness,failure to gain weight,poor sleep and constipation.tratment by increasing fluid and caloric intake and treating the cause.Over feeding: lead to regurgitation and vomiting and may be weight gain.Diet adjustment is indicated.Regurgitation: return of small amount of swallowed food during or shortly after eating.Loose ormildly diarheal stool: may be secondary to dietary disturbance rather than infection,stools of breast-fed infants tend to be softer than those of artificialy feeding ifants.Constipation:insufficiant food or fluid,anal fissures,high fat or protein diet and aganglionic megacolon may be causes.Colic: is frequent symptom complex of sudden paroxysmal abdominal pain and sever crying,occuring in infants under 3 mo. ageConstituent of human milk versus cow’s milk Cow’s milk Human milk
Constituent (gm/100ml)Same
20 kcal/30 ml
Calories
88
88
Water
3.3 ( increase)
0.9
Protein
18 :82
78 : 30
(whey : casein)
4.8
7.0
Carbo.(lactose)
2.o
8.0
Fat(%polyunsa.
22 (inc. 3)
7
Na+ ( meq/L )
117(inc. 7)
34
Ca (mg/100ml)
92(increase about 7 times
15Phosphate( mg/100ml)
4.0 : 5.0
1.1 : 2.0
Ca:phosphate
27.7(increase about 3 times)
9.4
Osmolality( m osmol/100 ml)
same
0.5
Iron (meq/L)
low
adequate
Vitamin C&D