Infant and Young Child Feeding

1. Infant and Young Child Feeding DR ANMOL K GUPTA MBBS,MD,PGDMCH,FIMSA WHO FELLOW KKU-THYLAND ASSOCIATE PROF COMMUNITY MEDICINE IGMC SHIMLA

2. INFANT AND YOUNG CHILD FEEDING

3. LEARNING OBJECTIVES • Enumerate components of Optimal Feeding • Define Exclusive BF/Predominantly BF/ Replacement Feed/Mixed Feeding • Describe process of Breast Feeding 1

4. LEARNING OBJECTIVES • List advantages of breast milk and breast feeding • Enumerate dangers of artificial feeding 2

5. Infant feeding • Feeding the fetus – Feeding the pregnant mother • Feeding the infant 0-6 months- Exclusive breast feeding • Feeding beyond 6 months- Complementary feeding +BF 3

6. What is Optimal Infant and Young Child Feeding? • Optimal feeding is defined as exclusivebreastfeeding from birth to six months of age and there after continued breastfeeding for 2 years or beyond with adequate and safe complementaryfeeds to meet nutritional needs of a young child 4

7. Definitions for Infant Feeding Exclusive breastfed Only breastmilk is given . No other food or drink, Not even water is given Predominantly breastfed The main source of nutrition is breastmilk but the child is also receiving other fluids (non-nutritive) or water 5

8. Definitions for Infant Feeding • Mixed feeding – the child receives animal milk, formula or cereal based foods in addition to breast milk • Replacement feeding Is the process of feeding a child who is not receiving any breast milk • with a diet that provides all the nutrients the child needs until the child is fully fed on family foods 6

9. fat Breast Anatomy - Structure 7

10. How Milk is Produced • First few days after delivery- the breast feel soft and empty- only small amount of yellowish first milk (colostrum) is secreted • After few days (may vary from 2 days to one week)-the breast begins to feel full , and sometimes hard-Milk has “come in” 8

11. Prolactin Reflex Secretion continues AFTER feed to produce NEXT feed Frequent Suckling Increases Milk Production 9

12. Oxytocin Reflex For milk ejection 10

13. Helping and Hindering the Oxytocin Reflex For milk ejection 11

14. Inhibitor in Breastmilk Frequent emptying of breast maintains lactation 12

15. Feeding Reflexes Rooting reflex When something touches lips, baby opens mouth puts tongue down and forward Sucking reflex When something touches palate baby sucks Skill Mother learns to position baby Baby learns to take breast Swallowing reflex When mouth fills with milk, baby swallows Gag reflex When something touches anterior part of the tongue, baby pushes it out. 13

16. Formation of Teat • For effective suckling the baby does not take just the nipple but a mouthful of the areola and the breast tissue beneath, which contains the lactiferous sinuses 14

17. Mechanism of ‘Suckling Cycle’ 15

18. Remember • Baby needs mother’s help initially to take the breast into his mouth • Keeping baby and mother together makes breastfeeding successful • More suckling makes more milk • For sustained milk secretion, it is essential to breastfeed frequently 16

19. Breastmilk Perfect nutrients Easily digestible Ready to serve Protects against infection Protects against adult onset diseases Breastfeeding Helps bonding and development Helps in adequate growth and development Enhances brain & visual development Prevents hypothermia Advantages of Breastfeeding to infant 17

20. Nutrients in Human & Animal Milk What are the differences between these milks? 3.5 gm/dL 1.1gm/dL 3.5gms/dL 7gm/100ml Lower protein content puts lower solute load on kidney 18

21. Differences in the Quality of the Proteins in Different Milks Anti-Infective Proteins 35% Casein 19

22. Proteins in human milk • Higher proportion of lactalbumin and lactoglobulin in breast milk form finer curds and are easily digested • Human milk proteins have a suitable quality of anti-infective protein • Contains taurine and cysteine necessary for brain development 20

23. Differences in the Fats COW`S HUMAN Essential Fatty Acids, PUFA Enzyme Lipase No Essential Fatty Acids No Enzyme Lipase 21

24. Fats in human milk • Higher content of PUFA promotes brain growth and protects against atherosclrosis • Active lipase promotes fat digestion • Contains Omega 2 and omega 6 (VLCFA) • Facilitates absorption of calcium 22

25. Minerals • Ca/P (2:1) ratio promotes Ca absorption • High water content, Low Na+, low osmolality → low solute load to kidneys • Adequate Zn 23

26. Vitamins in Different Milks 24

27. Breastmilk composition • Colostrum • milk secreted during the first three days after delivery • Yellow in color & thick • Rich in antibodies, vitamin A, D,E,K • Transitional Milk • Milk secreted during the first two weeks • Immunoglobulin and protein contents gradually decreases and the fat & sugar contents increases 25

28. Variations in the Composition of Breastmilk What differences do you notice here? COLOSTRUM Mature Milk 26

29. Property Antibody rich Many white cells Purgative effect Growth factors Vitamin A rich Importance protects against infection and allergy protect against infection clears meconium helps to prevent jaundice help intestine to mature prevents allergy, intolerance reduces severity of infection Advantages of Colostrum 27

30. Composition of human milk is Tailor made for infant’s Nutritional requirements, maturity and rate of growth ! 28

31. Advantages of Breastfeeding to mother • Reduces post delivery bleeding and anemia • Delays next pregnancy • Protects breast and ovarian cancer • Prevent obesity • Convenient 29

32. Society Eco-friendly Human resource development Family Low cost involved Less illnesses Family bonding Other Advantages 30

33. Anti-infective properties • secretory IgA, IgM, Lysozymes • Antistaphylococcal factor • Lactoferrin less saturated with iron and prevents growth of enterobacteria •  Bifidus factor protects from infection with E.coli •  PABA protects from malaria 31

34. More diarrhoea, ARI and other infections Requires preparation Not easy to digest Lacks balance of nutrients More likely to die from infection & malnutrition Interferes with bonding More allergy and milk intolerance Increased risk of some chronic diseases Overweight babies Disadvantages of Artificial Feeding Baby • May become pregnant sooner • Increased risk of anemia, osteoporosis, ovarian and breast cancer Mother 32

35. Risk of Death from Diarrhoea with Different Milks CG Victora et al, Brazil, Lancet 8/8/87 33

36. 6 5 4 3 2 1 0 <2 2-3 4-5 6-8 9-11 12-13 Relative Mortality Risk in Absence of Breastfeeding Age in months The LANCET 2000; 355:451-5 34

37. U-5 Child Deaths (%) Saved with Preventive Interventions Breastfeeding is defined as exclusive breastfeeding for first 6 months and continued breastfeeding during 6-11 months Source: Jones et al. LANCET 2003; 632:65-71 35

38. KEY MESSAGES • EXCLUSIVE BREAST FEEDINGis complete food and fluids for the baby till 6 months of age • It prevents malnutrition and infants death • Artificial feeding & bottle feedingare harmful to the baby, family and society. 36