Formula Feeding of Infants

1. Formula Feeding of Infants

2. There is an agreement among healthcare professionals, infant food manufacturers and mothers that breastfeeding is the best choice for feeding infants during their first four to six months of life

3. There are several reasons why a mother may not breastfeed her baby: • Medical or other health reasons may prevent a mother from breastfeeding. • The baby with special requirements may not tolerate breast milk. • Some social or psychological reasons can make it more difficult to breastfeed exclusively.

4. The absolute contraindications to breast-feeding • Hypergalactosaemia. • Phenylketonuria [PKU]. • Lactose intolerance.

5. Medical contraindications to breast-feeding connected with mother • Decompensated chronic diseases like blood circulation insufficiency, kidney or liver problems, respiratory insufficiency of III grade, HIV-infection, etc. • Psychical disorders as epilepsy, schizophrenia, depressive phychosis, postpartum psychosis. • Taking certain medications (See tables 1, 2). • Substance-abuse (drugs, alcohol, marijuana, cocaine, heroin, ets)(See table 3).

6. Table 1. Drugs that are contraindicated during breast-feeding

8. Table 2. Drugs that have caused significant effects on some nursing infants and should be given to nursing mothers with caution

9. Table 3. Drugs of abuse that are contraindicated during breast-feeding

10. Other reasons why a mother may not breastfeed her baby: • Working outside the home makes it more difficult to breastfeed exclusively, especially if there is no support at her workplace for her to either bring her baby or to express and store her milk. • Choosing not to breastfeed for personal reasons, either from the birth of the baby or after breastfeeding for a short while, is a mother's prerogative.

11. Recommendations for Working Women: • The mother who goes back to work can usually continue breast-feeding without problems. The milk supply adjusts itself to the demand. If the mother is working at least 8 hours a day, it is sometimes prudent to pump the breasts once during her work day in order to stay comfortable and maintain a good milk supply. Each woman is different in what is required to maintain a supply. Some women can work for a long time without pumping and without compromising the supply. Others have a supply that is more responsive to decreased feeds. A woman will rarely “dry up” becayse she has returned to work. • Working mothers, however, can easily breast-feed part-time and formula-feed part-time.

12. Breast pumps and storage of milk • Hand expression is superior if the mother can learn the technique. • Several pumps are available if the mother is unable to express by hand. • It is good if the woman can borrow a pump from a friend before she decides which pump to purchase. Another alternative is to rent an electric pump. • Milk should be stored in clean containers and immediately refrigerated or frozen. • If refrigerated, it will stay good for 48 hours. • If frozen at 0°F, it wiil keep for months.

13. Recommendations for mother’s diet: • To drink approximately 64 oz of fluids per day. • The nursing mother requires an additional 500 calories and 20-30 g of protein a day. • She has to take her prenatal vitamins with iron. • The mother need not to avoid certain foods unless she observes consistent increased fussiness in the baby in association with the mother ingestion such foods.

14. Foods commonly incriminated: • Garlic • Onions • Cabbage • Chocolate • Great quantities of caffeine. Nursing mother may drink small amounts of alcohol: a glass of sherry or wine may be beneficial in late afternoon if she is having let-down reflex problems.

15. Common problems encountered with brest-feeding • Poor Let-Down (Milk ejection reflex) • Poor Weight Gain • Mastitis • Cracked Nipples • Jaundice From Breast- Feeding

16. Artificial feeding • This is the feeding of infant when he gets cow’s or buffalo’s milk or formula from first days till 4th to 6th month of his life.

17. Formula milks are humanized, i.e., they come very close to the composition of breast milk. • However, they are more expensive, so cow’s or buffalo’s milk are quite often used.

18. Composition of cow’s milk versus breast milk.(in 100 ml)

20. Other advantages of breast milk versus cow’s milk: • Breast milk is available all the time and is practically free from pathogenic bacteria. • It needs no time for preparation • It is available at the optimum temperature. • It contains antibodies as IgG and IgA and protects against certain infections such as E.Coli, cholera, polio, tetanus, measles etc. IgA antibodies prevent the microorganisms to adhere the intestinal mucosa and provide local GIT immunity.

21. β-lactose is called Bifidus factor, which promotes the growth of lactobacillus and helps to lower the gut pH, thus inhibiting the growth of E.Coli and yeasts. • Breast milk contains lactoferrin (an iron-binding whey protein), which inhibits bacterial growth by depriving them of iron, which is necessary for growth. • Breast milk contains cystine and tyrosine, which are not synthesized by infants but they are essential for proper growth and development. • Breast milk contains taurine that is synthesized in inadequate amounts in infants. It is important for normal differentiation of CNS.

22. Breast milk contains nonspecific factors of immune difence: lisozyme, macrofagocytes, neutrofiles, lymphocytes, complement system. • There are 5 times more essential fatty acids (polyunsaturated: arachidonic, docosahexacnoic, linoleic, and α-linolenic) in breasts milk than in cow’s milk. • Breast milk contains ferments (lipase, lactase) and mothers hormones. • Breast milk is ‘species specific’ and therefore allergy to breast milk is rare.

23. Dilution of Cow’s Milk: • If dilution of cow’s milk is required, add 1 TSF of sugar to each ounce of water (5 %) – isocaloric formula)

24. Advances in nutritional modifications of infant formulas • Proteins: their amount is adopted to the needs of infant’s organism. Almoust all formulas contain whey:casein ratio as 60:40 and adopted amino acid content.

25. Fats: long-chain polyunsaturated fatty acids are added in amounts similar to those in human milk.Infants fed these formulas or human milk have higher tissue concentrations of long-chain polyunsaturated fatty acids and reportedly have better visual acuity than do infants fed nonsupplemented formulas.

26. Carbohydrates: they are presented by β-lactose, sakcharose, dextrin-maltose, which improve the growth of Bifidum-bacteria. The total quantity of carbohydrates in formulas is 7.5 %

27. Nucleotides and their related products play key roles in many biological processes. Although nucleotides can be synthesized endogertously, they are considered "conditionally essential." Nucleotide concentrations in human milk are higher than in unsupplemented cow milk-based formulas, and studies in animals and human infants suggest that dietary nucleotides play a role in the development of the gastrointestinal and immune systems

28. Vitamins and minerals

29. For infants 0 to 12 months • Whey proteins:casein = 60:40 • Close to breast milk spectrum of amino acids • Contains taurine. • Milk fats – 74 % and plant fats – 26 % • Linoleic : α-linolenic ratio is optimal for absorption 9.9:1 • Osmolality is equal 270 mosm/L

30. The level of proteins is 2.2 % • Whey proteins:casein = 40:60 • Inriched with bifidum-bacteria • Fortified with vitamins

31. Biologically hydrolyzed casein and whey proteins • Biologically hydrolyzed lactose • Iron fortified (0.8 mg/100 ml) • Contains Bifidobacterium Lactis 2107/1 g • -6 : -3 = 7.9:1 • Osmolality 270 mosm/L

33. It doesn’t contain lactose • Only whey proteins are present, 20 % of them are amino acids • Contains nucleotides and selen • Iron and Iodine fortified • Contains taurine, inositol, L-karnitine.

34. For infants with • Hypergalactosaemia • Lactose intolerance • Strong allergy to cow’s milk proteins • Vegetarian babies

35. For premature and low-birth-weight (less than 2500 g) babies • Proteins – 2.3 % • Whey : casein ratio = 70:30 • Proteins are particly hydrolyzed (oligopeptids) • Contains lysine, cystine, tryptophan, L-histidine, and taurine. • Polyunsaturated fatty acids (arachidonic, docosahexacnoic, linoleic, and α-linolenic) are present

36. For ‘hungry’ babies • For infants with often regurgitation • Contains 77 % of casein • Iron, Iodine, Vit. D, A, E and C enriched.

37. NAN H.A.1 NAN H.A.2 For children with strong family allergy Contains 100 % of whey proteins, which are hydrolyzed to oligopeptids (80 %) and aminoacids (20 %) Alfaré Hypoallergenic elemental diet for children with malarbsorption syndrome, diarrhea, for tube feeding Contains hydrolyzed whey proteins: 80 % of oligopeptids and 20 % of aminoacids Hydrolyzed lactose Short-chain fatty acids

38. Other commercial infant formulas

41. Specialty formulas

43. Developmental milestones associated with feeding Age (months) Development • Birth • Has sucking, rooting, and swallowing reflexes; • Feels hunger and indicates desire for food by crying; • Expresses satiety by falling asleep • 1 - Has strong extrusion reflex • 3-4 • Extrusion reflex is fading; • Begins to develop hand-eye coordination • 4-5 - Can approximate lips to the rim of a cup • 5-6 - Can use fingers to feed self a cracker • 6-7 • Chews and bites; • May hold own bottle, but may not drink from it (prefers for it to be held)

44. 7-9 • Refuses food by keeping lips closed; has taste preferences; • Holds a spoon and plays with it during feeding; • May drink from a straw; • Drinks from a cup with assistance • 9-12 • Picks up small morsels of food (finger foods) and feeds self • Holds own bottle and drinks from it • Drinks from a household cup without assistance but spills some • Uses a spoon with much spilling • 12-18 • Drools less • Drinks well from a household cup, but may drop it when finished • Holds cup with both hands

45. 24 • Can use a straw • Chews food with mouth closed and shifts food in mouth • Distinguishes between finger and spoon foods • Holds small glass in one hand; replaces glass without dropping • 36 • Spills small amount from spoon • Begins to use fork; holds it in fist • Uses adult pattern of chewing, which involves rotary action of jaw • 48 • Rarely spills when using spoon • Serves self finger foods • Eats with fork held with fingers • 54 Uses fork in preference to spoon • 72 Spreads with knife