Infant Feeding

1. Infant Feeding

2. Breast is best. • Contains all the nutrients an infant needs in the right amounts and in an easily absorbable form. Its composition changes as the baby grows. • Contains growth factors and hormones to assist development • Anti infective properties: Macrophages, lymphocytes and polymorphs, Secretory IgA, Lyzozyme, Lactoferrin (inhibits growth of E.coli.), anti-viral agents.

3. Long term benefits to infant • Reduced risk of atopy • Better dental health • Reduced incidence of later obesity. • Improved neurological development • Reduced risk of SIDS

4. Maternal benefits • Reduced risk of premenopausal cancer. • Promotes weight loss after pregnancy • Lactational amenorrhoea • Cheaper, easier more convenient and portable. • No other equipment to prepare.

5. Breast milk • Varies greatly according to: • Hindmilk vs foremilk • Duration of lactation (reducing protein concentration) • Gestational age of baby • Maternal diet.

6. Composition of breast milk vs formula milk • Colostrum: For 2-4 days post delivery. Has high protein and mineral content but less carbohydrate and fat. Mature breast milk established by 4th week. • Water: Equal amounts • Calories: Approx 67kcal/100ml. • Protein: Human milk 1-1.5% protein(70% whey protein)Cows milk 3.3% protein due to greater content of casein

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

9. 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.

10. 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.

11. 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.

12. Dangers of Unmodified Cows Milk High renal solute load: • Hypernatraemia • High blood urea and acidaemia • Hyperosmolality • Hypocalcaemia

13. Contraindications to breast feeding • Galactosaemia • Maternal HIV infection in the UK • Anti-neoplastic drugs • Tetracyclines • Lithium

14. Baby Milks • Infant formulas are suitable from birth and are usually based on cows milk. Composition controlled by EC and UK legislation. • Whey based milks are usually first choice if not breast feeding. • Casein based milks are suggested for hungrier babies • Soya infant milks • Follow on formulas: Higher iron content than cows milk. Composition less controlled • Specialised formulas for those who are preterm or have medical conditions

15. Soya Infant Formula • Recommended for use on medical advice but should not be the first choice for the management of CMP intolerance. • Similar to cows milk but protein derived from soya with lactose replaced with other carbohydrates (glucose syrups).

16. Preterm Requirements • The aim of feeding premature babies is to achieve a rate of growth which is similar to intra-uterine growth at the same gestational age. Preferably the feed should be of constituents that do not load the metabolism and promote development of gastrointestinal function. • Special Needs • 1)Glycogen stores are small. Minimal fat stores. Reduced response to hypoglycaemia. • 2)Increased energy requirements (100-120 kcal/kg/day) • 3)Higher protein synthesis than term infants. • 3)Nervous system potentially at risk if inadequate nutrition provided.(LCPs)

17. Bottle feeding • Start with small amounts 20-60ml/kg/day • Increase to 150ml/kg/day by day 4-5. Usually given 3-4 hourly. • Follow instructions: risk of hypernatraemia • Hygiene issues.

18. Weaning • For the first 6 months babies cannot properly digest solid food. • Commence weaning at 6months old and increase so that by 12 months solids are the main part of the diet with milk to drink along side. • Do not rush or force-feed. • Full fat cows milk can be used from 12 months.

19. Serious nut allergy affects less than 1% of the population. Those most at risk have FH of atopy. Avoid giving peanuts and peanut products until the child is 3 yrs old if FH of atopy. Foods to avoid in weaning • Salt • Sugar • Tea • Honey • Nuts: Do not give any type of whole nut to children under 5 yrs due to risk of choking.

20. Weaning • Finger foods promote chewing practice and independence. • Soft lumps are often manageable from 6 months. Chewing encourages development of speech muscles. • Feeding should always be supervised. • Approx 1 pt of milk should be given plus clear fluids with meals. The bottle should be phased out by 1 yr of age. Avoid fruit juice until >6months.

21. Breast Milk • Rule of 5s • Room temp for 5 hrs • Frig. For 5 days • Freezer for 5 months • Formula • Rule of 1s • Room temp for 1 hr. • Frig for 1 day • Never frozen

22. THANK YOU.