4-infant feeding-M-Med07.pdf
Transcript of 4-infant feeding-M-Med07.pdf
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INFANT
FEEDING
Dr. Hussein BamashmousConsultant Pediatrician
King Abdulaziz University Hospital
°
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WHY?
Provides nutritional requirements
Successful feeding promotes infant’s and mother’s emotional well-being
Successful feeding needs:
Confidence
Comfort
Appropriate guidance and support
Maintains normal metabolism and growth from fetal to extra-uterine life
Decreases risk of:
Hypoglcaemia
Hypokalaemia
Hyperbilirubinaemia
Azotaemia
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AFTER BIRTH:
Infants tolerate “Enteral Feeds” judged by:
Normal Activity
Alertness
Good Sucking
Crying
MISTAKES IN FEEDING
Too much Obesity
Too little (In hot weather)
Dehydration fever
Feeding of infant is guided by self-regulation:
By the end of the first month 90% on infants have a suitable and reasonably regular schedule
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PHYSIOLOGY OF BREAST FEEDING1. PROLACTIN
A. Breast Development anterior pituitary
B. Milk Secretion estrogen & progesterone neuroendocrine pathway
night time sucking
drugs
emotions
2. OXYTOCIN
Ejection of Milk posterior pituitary
let down reflex
Sensory contact
Emotional responses
Areola contact
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3. PROGESTERONE
Development of Lobules and Alveoli
4. ESTROGENS
Proliferation of the Mammary Ducts
(enlargement of lobules and alveoli)
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BREAST FEEDING“BREAST IS THE BEST”
ADVANTAGES OF BREAT FEEDING
A. For the MOTHER
• Easy, needs no preparation
• Cheap
• Available
• Involution of the uterus
• Emotional satisfaction
• lower incidence of breast cancer
• Birth spacing
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B. For the BABY
• Natural, balance, meets nutritional needs• Self –regulated • Available• Fresh, proper temperature• Easy digestion and absorption• Bonding• Anti infective properties• Incidence of allergy• Incidence of rickets• Incidence of iron deficiency• Lower renal solute for Vit. A & C• Giardia antibodies in breast milk
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ANTI INFECTIVE PROPERTIES OF BREAST MILK
HUMORAL FACTORS
1. Antibodies ( antibacterial / antiviral):
– Secretory IgA
– IgG, IgM, IgD
2. Lyzosomes:– Bacteriolytic for enterobacteria & Gram
positive
3. Lactoferrin:– Fe binding protein
– E. coli
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4. Interferon: (anti virals)
5. Lactobacillus Bifidus:
6. Stool pH
CELLULAR FACTORS
1. Macrophages ( esp. colostrum)
2. Synthesize : lactoferrin, lysozymes and
complements
3. B and T cell Lymphocytes
4. Epithelial cells
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FACTORS INFLUENCING MILK PRODUCTION AND SECRETION
1. ENDOCRINE:
PROLACTIN, OXTOCIN, THYROXIN
2. ANATOMICAL:
SENSORY NERVE SUPPLY OF CHEST
3. MECHANICAL:
GOOD SUCKLING AND COMPLETE EMPTYING
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4. PHYCHOLOGICAL:
LET DOWN REFLEX
5. MATERNAL NUTRITION:
6. DRUGS:
CHLORPROMAZINE
METACHLOPRAMIDE
BROMOCRIPTINE
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CONTRAINDICATION TO BREAST FEEDING
MATERNAL CAUSES:
1. INFECTIONS:
Septicaemia
Malaria
Typhoid Fever
Active TB
HIV
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2. MENTAL & NEUROLOGIC ILLNESS:Severe NeurosisPostpartum psychosisInsanityEpilepsy
3. OTHERS: Allergens in breast milkEclampsiaNephritisProfuse haemorrhageChronic malnutritionDebilitySevere inverted nippleDrugs
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INFANT CAUSES:
1. INBORN ERRORS OF METABOLISM:
PKUGalactosaemia
2. SEVERE CONGENITAL ANOMALIES:
Severe cleft palatSevere micrognathia
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SOME PROBLEMS WITH LACTATION
1. Mastitis
2. Acute Infection
3. Resumption of Menstrual with breast feeding
4. Pregnancy with breast feeding
5. Breast feeding Give Vit. K
6. Haemolytic disease of newborn and breast feeding
No contraindication
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PREPARATION OF THE PROSPECTIVE MOTHER
»Very Successful breast feeding
Sufficient Encouragement
Reassurance
Support
Over persuasion
Advantages of breast feeding (from mid-trimester)
Good health, Rest, Exercise
No Worry
Adequate Nutrition
Treatment of Retracted nipples
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ESTABLISHING AND MAINTAINING THE MILK SUPPLY
Psychological Factors
Fatigue
Hygiene of Breast
Diet : No dietingMilk is important for MOM
OR 1 gram calcium / day
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Drugs contraindicated with breast feeding: antithyroidsLITHIUMAnticancerINHPhenindione
Temporary cessation of B.F. with:Radiographic agents
ChloramphenicolMetronidazole
Sulfonamide
NO SMOKING- Sudden Infant Death Syndrome
NO ALCOHOL – FETAL Alcohol Syndrome
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SOME CHEMICALS SECRETED WITH BREAST MILK:
Aresenicals Iodides Salicylates
Barbiturates Lead Opium
Bromides Mercury Atropine
Most Antibiotics
ONE OR BOTH BREAST PER FEEDING:
• Early weeks both breast
• Late one will do, Unless milk secretion is
too great
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ADEQUACY OF BREAST FEEDING
• Infant calm and satisfied
• Sleeps well
• Normal Stools (frequent, yellow, soft, acidic)
• Normal amount of urine
• Normal weight gain
• Positive “LET DOWN” of milk ejection reflex
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CRITERIA OF UNDERFEEDING IN BREAST FED INFANT:
• Irritable baby
• Stays on breast for longer period
• Very short sleeps
• Oliguria
• Hunger diarrhea
• Slow gain Static weight loss
TREAT: SUPPLEMENTARY OR COMPLEMENT FEEDS
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FORMULA FEEDING
BY FORMULA FEEDING WE MEAN:
WHOLE COW’S MILK
MODIFIED COW’S MILK
MILK SUBSTITUTES
STERILIZATION & REFREGIRATION OF FORMULA
MORBIDITY & MORTALITY FROM GASTROINTESTINAL INFECTONS
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MILK PROCESSING :
( Alters CASEIN Small digested curds)
SIMPLE HOME BOILING
PASTEURIZATION
HOMOGENIZATION
EVAPORATION
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NOTE:
CHANGING CULTURAL & SOCIAL PATTERNFORMULA FEEDING
OBJECTIVE NUTRITIONAL STUDIES OF INFANTS SHOW LITTLE DIFFERENCE BETWEEN BREAST ED AND COW’S MILK FED INFANT
CONVENTIONAL FORMULAS OF WHOLE AND EVAPORATED COW’S MILK
3-4 gram PROTEIN/K/DAY
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HUMAN AND HUMANIZED MILK
3-4 gram /K/ DAY
COMMERCIAL FORMULAS ARE MODIFIED
FROM COW’S MILK BASE: THEIR PROTEIN
AND ASH CONTENT IS TO HUMAN MILK
LEVELS
1. OSMOLALITY
2. RENAL EXCRETORY LOAD
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SATURATED FAT OF COW’S MILK IS
REPLACED WITH SOME UNSATURATED
VEGETABLE FATTY ACIDS
VITAMINS ARE ADDED
SOME FORMULAS:
LACTOPROTEIN (WHEY) CYSTEIN
CASEIN AS IN BREAST MILK
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COMPARISON OF HUMAN MILK AND COW’S MILK
CONSTITUENT HUMAN COLOSTRUM COW
WATER 88 87 88
PROTEIN(G%) 1 2.7 3.3
CASEIN 0.4 1.5 2.7
WHEY:
Lactoalb
Lactoglob
0.4
0.2
-
1.2
0.4
0.2
FAT (G%)
% P.U.F.A
3.8
8%
2.9
7%
3.8
7%
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CONSTITUENT HUMAN COLOSTRUM COW
LACTOSE (G%) 7 5.3 4.8
CALORIES 67 - 67
CALCIUM (mg%)
34 30 117
PHOSPHATE 15 15 92
IRON (mg/L) 0.5 0.1 0.5
ZINC (mg/L) 4 6 4
VITAMIN A (IU) 1900 - 1025
VITAMIN C (mg) 43 - 11
VITAMIN D (IU) 22 - 14
VITAMIN E (mg) 2 - 0.4
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COLUSTRUM
FIRST 2-4 DAYS
LEMON YELLOW IN COLOUR
ALKALINE
S.G. 1.040 – 1.060 ( Mature Breast Milk=1.030)
DAILY PRODUCTION: 10-40 ml
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COLUSTRUM CONTAINS:
PROTEIN
MINERALS
CHO
FAT
SECRETORY IgA
MACROPHAGES
LACTOERRIN
LYSOZYMES
COLUSTRUM TRANSITIONAL MILK
BY THIRD OR FOURTH DAY MATURE MILK
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BACTERIAL CONTENT:
• MASTITIS - Pathogenic organism in breast milk
Infected Mothers Infected Milk with:
Tuberculosis
Thypoid Bacilli
Herpes Simplex
Hepatitis B Virus
Rubella Virus
Mumps Virus
HIV
CMV
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MILK-BORNE INFECTIONS:
STREPTOCOCCAL DISEASES
DIPHTERIA
TYPHOID FEVER
SALMONELLOSIS
T.B. & BRUCELLOSIS
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DIGESTABILITY
HUMAN MILK RAPID STOMACH
EMPTYING
GASTROINTESTINAL PASSAGE TIME
EQUAL IN BREAST MILK AND COWS MILK
IN THE FIRST 45 DAYS.
COW’S MILK CURD IS BY: BOILING
(Milk-Processing) ACID
ALKALI
HOMOGENIZATION
COW’S MILK FAT IS LESS READILY
DIGESTED
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MILK USED IN FORMULA
RAW MILK:
NOT ADVISED IN INFANTS
LARGE CURDS
SLOWLY DIGESTED
EASILY CONTAMINATED
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PASTURIZED MILK
DESTROS PATHOGENIC BACTERIA
MODIFIES CASEIN
PASTURIZATION:
HEATED MILK AT 63° C X 30 SEC.
HEATED MILK AT 72° C X 15 SEC.
THEN COOLING RAPIDLY TO 65° C OR 60 ° C
ALLOWED BACTERIAL CONTENT (NON-PATHOGENIC) UP TO 50,000/ml.
AVERAGE COUNT : 5,000 – 10,000/ml.
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HOMOGENIZED MILK
FAT GLOBULES BROKEN TO MINUTE PARTICLES & REMAIN DISPERSED
SMALLER LESS TOUGH CURD PRODUCED IN THE STOMACH
EVAPORATED MILK UNIVERSALLY AVAILABLE
MONTHS WITHOUT REFRIGERATION
CASEIN CURD: SOFT & SMALL
LACTOALBUMIN LESS ALLERGENIC
VITAMIN D IS ADDED
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PREPARED MILK:
ADDITION OF WATER IN 1:1 PROPORTION
MOST DERIVED FROM COW’S MILK
EITHER POWDER OR LIQUID
MAJORITY SIMULATES HUMAN MILK
ALL FORTIFIED WITH VIT. D
SOME HAVE ADDED IRON
MANY CONTAIN OTHER VITAMINS
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FORMULA WITH VERY LOW ELECTROLYTES
CONGENITAL HEART DISEASE
NEPHROGENIC D.I.
MARGINAL R.F.
SODIUM FORMULA = 1mmol/quart
(for C.H.D.)
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MILK PREPARED FROM HYDROLYZED WHEY OR CASEIN
FOR: MALABSORPTION
MILK ALLERGY
SPECIAL FORMULA WITH ELIMINATION OF SPECIFIC AMINO ACID
INBORN ERROR OF METABOLISM
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LACTOSE FREE FORMULA
FOR: LACTOSE INTOLERANCE
GALACTOSAEMIA
CONDENSED MILK
USED ONLY WHEN CALORIES ARE
NEEDED
ADDITION OF 45% CANE SUGAR
IN EVAPORATED FORM: 60% CHO
PROTEIN & FAT
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DRIED WHOLE MILK :
THE FAT CONTENT OF FLUID MILK ADJUSTED TO 3.5%.
DRIED SKIM MILK:
NON-FAT SKIM MILK ( FAT 0.5%)
HALF-SKIM MILK (FAT 1.5 %)
FOR: FAT INTOLERANCE
NOT FOR FIRST YEAR
PROTEIN & MINERALS
RENAL SOLUTE LOAD DEHYDRATION
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ACID AND FERMENTED MILK:
ACID BY : ADDING ACID
FERMENTED : LACTIC ACID PRODUCING ORGANISM
THESE MILKS REQUIRE:
1. HCL ACID IN STOMACH
2. CASEIN SMALL LESS TOUGH CURDS
ACIDS MILKS ACIDOSIS RARELY USED NOW
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GOAT’S MILK
BRUCELLOSIS
WIDELY USED
USED FOR COW’S MILK ALLERGY
GOAT’S MILK: Na
K
CL
LINOELIC &
ARACHIDONIC ACID
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FAT DIGESTABLELOWER CURD TENSION THAN COW’S MILK
VIT. D & IRON
FOLIC ACID MEGALOBLASTIC ANAEMIA
MILK PROTEINTO PROTEIN CONTENT OF SOME FORMULA
FED TO:
PRETERMS
DEBILITATED INFANTS
INFANTS WITH DIARRHEA SHOULD BE USED CAREFULLY , FOR SHORT DURATION
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MILK SUBSTITUED & HYPOALLERGENIC FORMULA:
SOYA BASED FORMULA
FOR: 1. VEGETARIANS
2. COW’S MILK PROTEIN
INTOLERANCE
LACTOSE FREE FORMULA
FOR: 1. GALACTOSAEMIA
2. LACTOSE INTOLERANCE
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PROTEIN HYDROLYSATE FORMULA
FOR: 1. COW’S MILK PROTEIN
INTOLERANCE
2. LACTOSE INTOLERANCE
PHENYLALANINE FREE FORMULA
FOR: PKU
VALINE , LUCINE, ISOLUCINE FREE
FORMULA
FOR: MSUD
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MILK FORMULAS
CALORIC REQUIREMENTS:
FIRST FEW MONTHS:100-120 kcal/kg/day
BY ONE YEAR: 100 kcal/kg/day
FLUID REQUIREMENTS:
FIRST 6 MONTHS: 130-190 ml/kg/day
NUMBER OF FEEDINGS:
BIRTH - 1 WEEK 6-10 feeds/day
BY 8 – 12 MONTHS 3 feeds/day
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INTERVAL BETWEEN FEEDS:
• EARLY FEEDING THROUGHOUT 24 H
• GRADUALLY
• FULL TERM: EVERY 3-5 H 4 hourly
• SMALL / WEAK INFANTS: 2-3 hourly
INFANT ADJUSTS DEMAND TO THE FAMILY PATTERN OF DAYTIME ACTIVITY
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QUANTITY FORMULA / each feed
IT DIFFERS WITH:
DIFFERENT INFANTS OF THE SAME AGE
SAME INFANT AT DIFFERENT FEEDS
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AVERAGE AMOUNTS AT VARIOUS AGES / each feed
1ST and 2nd WEEK 60-90 ml/feed
3W - 2/12 120-150 ml/feed
2/12 - 3/12 150-180 ml/feed
4/12 - 5/12 180-210 ml/feed
6/12 - 1 YEAR 210-240 ml/feed
AFTER 6/12 OF AGE :
MILK INTAKE IS
MILK IS SUBSTITUTED WITH OTHER FOODS
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OTHER FOODS
VITAMINS
ORANGE & CITRUS NATURAL SOURCES
OF VIT. C
YOUNG INFANTS CAN NOT TOLERATE
LARGE AMOUNTS GIVE 50 milligrams/day
VIT. D IS SUPPLIED IF FORMULA IS DEVOID
OF IT START IT IN NEONATAL PERIOD AS
10 microgram/day
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IRON
START IT AT 6/52 OF AGE
IRON FORTIFIED FORMULA
OR 2 milligram/Kg ( UP TO 15 milligram/day)
CEREAL + IRON INSUFFICIENT
ABSORPTION
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SOLID FOODS
NOT BEFORE 4-6 MONTHS OF AGE
HIGH CALORIES FOOD AS:
EGG YOLK, CEREALS, MEAT, PUDDING
→OBESITY
SOLID FOOD WHEN:
MILK ALONE NO SATISFACTION(HUNGER)
WHEN THEY FIT INTO THE DAILY
SCHEDULE
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INFANT’S APPETITE BEST INDEX FOR
PROPER AMOUNT
RESPECT INFANTS WISHES
CEREALS
MOST CONTAIN IRON + FACTORS OF VIT. B
COMPLEX
FRUITS
MILD LAXATIVE EFFECT
INFANTS LIKE IT
RAW RIPE READILY DIGESTED
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VEGETABLES:
GOOD SOURCE OF VIT. C + IRON
SHOULD BE FRESHLY COOKED
STRAINED
ADDED BY 7 MONTHS OF AGE
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MEAT, EGGS, STARCHY FOOD:STARCHY FOOD IN THE SECOND 6/12 OF
LIFE
EGG YOLK COULD BE GIVEN EARLIER
EGG WHITE ALLERGIC MANIFESTATIONS
TOAST, CRACKERS 6- 8/12 ( GUMMING)
INFANTS LEARN TO CHEW + FEED
THEMSELVES
MEAT PROTEIN
IRON + VITAMINS
START BT 6/12 OF AGE
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DESSERTS
GOOD FOR OLDER INFANTS
BRIBE OR REWARD POOR EATING HABITS
SALT INTAKE
SHOULD BE DISCOURAGED
INTAKE FUTURE BP
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FOOD ADDITIVES
ARTIFICIAL FLAVOURS (3000) + COLOURS
ALLERGIC DISORDERS
URTICARIA & ANGIODEMA
LESIONS OF TOUNGE & BUCCAL MUCOSA
DIGESTIVE DISTURBANCES
ARTHRALGIA
HYDROARTHROSIS
HEADACHE
HYPERKINESIS
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FIRST YEAR FEEDING PROBLEMS
UNDERFEEDING
OVERFEEDING
REGURGITATION, VOMITING &
RUMINATIONS
LOOSE DIARRHEAL STOOLS
CONSTIPATION
COLIC
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THAN Q