Infant feeding 1

Infant feeding

Dr.Noor Sameer Yahya
2019

The aim of infant feeding 1.is to achieve optimal physical ,neural ,and mental growth as the maximum brain growth occur in the first two years of life .

2.Good nutrition prevents acute and chronic illnesses results from macro and micro nutrients deficiency or excess

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Nutritional requirements

Water :Forms about (70-75 )% of body weight ,and the daily consumption of fluid by the healthy infant is equivalent to (10-15 )% of body weight .

The daily requirements of calories in infants is (80-120 )Kcal for the first year of life with subsequent decrease of about 10 Kcal /Kg for each succeeding 3 years period .
Approximately (9-15 )% are derived from protein ,(35-45) % from fat ,(45-55 )% from carbohydrate
As 1gm of protein and carbohydrate give 4 Kcal and 1gm of fat give 9 Kcal

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Proteins
It constitute about 20% of body weight ,it’s amino acids are essential in forming cell protoplasm ,we have 24 amino acids 9 of them are essential for infants ,those are (Threonine ,valine ,leucine ,isoleucine ,lysine ,Tryptophan ,phenyl alanine ,Methionine and Histidine ) .

Arginine ,Cystine ,and Taurine are essential for low birth wt.infants .

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Carbohydrates

It constitute about 1% of body weight ,it is stored as glycogen in the liver and muscle, it is the major source of calories (45-55 )%,it has 3 various forms :

1.monosaccharides (glucose ,fructose ,galactose )

2.Disacchrides (lactose ,sucrose ,maltose ,isomaltose)
3.Polysaccharides (glycogen ,starches ,gums,cellulose and dextrin's )
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Fats

fats form 30-40% of the total energy intake for children
Dietary fats are composed of a various mix of saturated fats, monounsaturated fat, PUFA, trans fat, and cholesterol.
cholesterol moieties are precursors for cell membranes, hormones, and bile acids. Fat intake also facilitates absorption of the fat-soluble vitamins A, D, E, and K.
Humans are incapable of synthesizing the precursor (α–linolenic; ALA) and (linoleic; LA) PUFAs and are dependent on dietary sources for these essential fatty acids.
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Micronutrients
1.Minerals :the cations are (calcium,magnesium ,potassium and sodium ) and anions are (phosphorus ,sulphur and chloride ).Iron,iodine and cobalt appear in important organic complexes,and the trace element floride,copper,zink ,manganese ,and chromium have important metabolic rule .

2.Vitamines :are organic compounds required in minute amounts to catalyze cellular metabolism ,there are 3vitamines synthesized by the intestinal flora which are (vit.K,pantothenic acid andBiotin )
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Feeding of infants

Feedings should be initiated soon after birth unless medical conditions preclude them.

The American Academy of Pediatrics (AAP) and World Health Organization (WHO) strongly advocate breast-feeding as the preferred feeding for all infants.

the AAP recommends exclusive breast-feeding for a minimum of 4 mo and preferably for 6 mo.
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Preparation of the lactating mother

The mother should be prepared from the mid trimester of pregnancy :
1.Psychologically

2.Physically :by promoting good health and nutrition and balanced rest and exercise with treatment of any illness ,and if the mother has retracted nipples she will benefit from manual or electric breast pump traction during latter weeks of pregnancy .
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Care to the nipples
Any pain and tenderness in the nipples should be prevented to promote successful and continuous breast feeding by :
1.exposing the nipples to air
2.Applying pure lanoline emollient (panthenol )
3.Avoiding soaps and shampoos for cleaning
4.Frequent changing of nursing pads
5.Nursing more frequently by proper position of the baby
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Physiology of breast feeding

1.Babies use rooting , sucking ,swallowing reflexes to locate the nipple and feed
2.Tactile receptor in nipples are activated
3.Hypothalamus sends efferent impulses to anterior and posterior pituitary
4.Anterior pituitary prolactin secretion stimulate milk secretion by cuboidal cells in the acini of the breast
5.Posterior pituitary oxytocin secretion result in contraction of myoepethelial cells in the alveoli forcing milk into the larger ducts the so called (let down reflex )
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Breast feeding Initiation

• The mother should be comfortable and the infant positioned =mouth-to-breast contact.
• The breast should be supported with the opposite hand, with the thumb and index finger above the nipple to allow the infant easy access it.
• The rooting reflex should be explained to make initiation of breast-feeding easier.
• The entire nipple and most of the areola should be placed in the infant's mouth.
• The infant "latches on" by compressing the lips.


• The mechanics of normal suckling include suction of 4 to 6 cm of the areola,
• compression of the nipple against the palate, stimulation of milk ejection by initial rapid non-nutritive sucking, and extraction of milk from the lactiferous sinuses by a slower suck-swallow rhythm of one per second.
• The infant is removed from the breast by placing a clean finger between the infant's gums and the areola to release suction.
• The mean feeding frequency during the early weeks postpartum is 8 - 12 times per day. decreases throughout the 1st yr of life to only 3-4 at 1 yr of age.

Burping procedure (eructation)

At the end of nursing the baby should be held erect over the mother shoulder or on her lap on his abdomen with gentle rubbing or patting the back to assist in expelling swallowed air ,it is necessary after each feeding for 5-10 minutes before putting the baby in his bed to prevent development of gases & colic .

Sufficiency of breast feeding

1.If the infant is satisfied after each feeding he will sleep (2-4 ) hours .
2.He will gain weight about 20- 30 gm /day
3.he will have 6-8 soakaed napkins(good urine out put )
4.The mother will have the let down reflex (milk ejection reflex) which occur either by sucking or psychological stimuli to the mother by hearing the crying ,thinking about her baby she will have ejection of milk from the breast(hormonal stimuli) .

Common Breast feeding Problems

□ Engorgement, one of the most common causes of lactation failure, should receive prompt attention because milk supply can decrease quickly if the breasts are not adequately emptied.
□ Applying warm or cold compresses to the breasts before nursing and hand expression or pumping of some milk can provide relief to the mother and make the areola easier to grasp by the nursling.
Supportive measures include:
nursing for shorter periods
beginning feedings on the less sore side
air drying the nipples well after nursing
Applying lanolin cream after each nursing session.

• □ Severe nipple pain and cracking

• usually indicate improper latch-on. Temporary pumping, which is well tolerated, may be needed.

• Mastitis

lactating woman + fever & chills + malaise
Organisms implicated in mastitis include Staphylococcus aureus
Treatment: frequent & complete emptying of the breast + antibiotics.
Breastfeeding should not be stopped because the mother's mastitis has no adverse effects on the infant, and abrupt weaning increase the risk of breast abscess.

• Breast abscess:

• if Untreated mastitis. Treated by: incision, regular drainage, antibiotics.
□ Nursing from the contralateral breast can be continued with the healthy infant.
If maternal comfort allows, nursing can continue on the affected side.

Advantages of breast feeding

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Available at the proper temperature and requires no preparation time.
less GIT disturbances as diarrhea, intestinal bleeding, occult melena, “spitting up,” colic, and atopic eczema.
less incidence or severity of respiratory illnesses, otitis media, bacteremia, bacterial meningitis, NEC.
Lower frequency of allergic and chronic diseases in later life than formula-fed infants.
Milk supply all the necessary nutrients except, Fluoride & after several months vit D.
The psychologic advantages of breast-feeding for both mother and infant



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Fresh and free of bacteria & protective effects of breast milk against pathogens as it:
Contains bacterial & viral antibodies, high secretory IgA that prevents microorganisms from adhering to the intestinal mucosa
↓Macrophages in human milk synthesize complement, lysozyme, and lactoferrin: lactoferrin, an iron-binding whey protein that is one-third saturated with iron and has an inhibitory effect on the growth of Escherichia coli in the intestine.
The lower pH of the stool of breast-fed favorable intestinal flora (i.e., more bifidobacteria and lactobacilli; fewer E. coli), which helps protect against infections.

Contains bile salt–stimulated lipase, kills Giardia lamblia & Entamoeba histolytica.
Transfer of tuberculin responsiveness by breast milk =passive transfer of T-cell immunity.
Decrease risk of leukemia, obesity & DM.
Better cognitive function.
Improve oral motor development and decrease orthodontic problems.

The composition of breast milk

Colostrum : Is the secretion of breast during the latter part of pregnancy & for 2-4 days after delivery,
it has deep lemon yellow color as it contain several times the protein of mature breast milk but less fat & more minerals,
it has important immunological (antibodies ) & maturational properties the total amount of colostrum secreted daily is (10-40) ml

After the first few days of lactation colostrum is replaced by secretion of transitional form of milk that assume gradually the characteristics of mature breast milk by the 3rd-4th weeks .

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Comparison between breast milk &cow milk
1.Both contain equal amounts of water.
2.The energy contents are equal approximately 20Kcal/oz ,as 1oz=30 ml of milk
3.Protein :cow milk contains higher protein approximately 3 folds, its contents of casein is about 6folds , while the human milk protein is mainly whey protein (lactalbumin & lactglobulin ) but 30% casein .
4.Carbohydates :human milk 7% which is lactose while cow milk is 4.5% .
5.Fat :contents are almost equal but there is qualitative differences ,as human milk contain twice of the more absorbable olein .

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6.Minerals :cow milk contains much more of all the minerals except iron &copper &although breast milk iron is low but better absorbed (bioavailable) and the infant will depend on the iron stores in the first 4-6 months .

7.Vitamines :

both has large amount of vit.A,
both milk contains adequate amount of vit.B complex
cow milk has low vit.C & D ,also human milk has low vit D and depends largely on the maternal nutrition and sun exposure .so breast fed infants should receive the daily requirements of vit.D which is 400 I.U / day .

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The stool of the breast fed infant is unformed yellow and seedy and is more frequent than formula fed infants and last 4-6 weeks ,few weeks later it become less frequent as every few days will pass a motion .
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CONTRAINDICATIONS TO BREAST-FEEDING.

• maternal contraindications to breast-feeding.

1. Mothers with septicemia, active tuberculosis, CMV, typhoid fever, breast cancer, or malaria should not breast-feed.
2. avoid infant nursing & contact on the breast with Herpetic lesions
3. Maternal HIV infection is a contraindication for breastfeeding in developed countries
4. Substance abuse and severe neuroses or psychoses are contraindications
5. Maternal drugs as radioactive iodine -131 & cytotoxic chemotherapy

• Infantile contraindications:
1. Metabolic diseases: galactosemia, maple serup urine disease, organic academia.
2. Anatomical reasons: cleft lip or cleft palate, extract the breast milk and put it in bottles with special nipple.
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Expressing breast milk

Indications for mothers to express breast milk:
• the most common reason for expressing breast milk was to manage difficulties in breastfeeding, usually due to breasts engorgement or mastitis
the infant is sick or preterm
mother and infant will be temporarily separated as the mother is returning to her work
the milk supply needs to be increased
Breast milk expression is either done manually ,manual or electric breast pump


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Length of time breast milk can be stored

Freshly expressed into sterile container:
-Storage in room temperature 26c for 6-8 hours
-Storage in refrigerator 5c or lower not more than 72 hours
-Storage in freezer :2weeks in freezer(-15c)
-3monthes in freezer (-18c )
6-12 months in deep freezer (-20c )

When the stored milk is needed it should be rewarmed either by special warmer or by warm water.
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