3.1. Feeding - pediatrics ppt on feeding for infants.

Medics

1. Infant and Young Child
Feeding
associate professor Kantemirova
M.G.

2. •Appropriate feeding are essential for the
nutrition, growth, development and
survival of infants and young children.
Types of infant feedings (upto 4-6 months)
I. Breastfeeding(natural or exclusive
breastfeeding feeding > 80% )
II. Mixed-breast feeding
(complementary feeding20%-80%)
III. Artificial feeding (> 20%)

3. Breast-feeding(natural or exclusive
breast-feeding )
•Exclusive breast-feeding means that
except for breastmilk, no other food or
fluids should be given to a child from birth
up to 4-6 months of age. Initiate
breastfeeding within first hour of birth;
•Natural breast-feedingmeans more than
80% of breastmilk (less than 20% of milk
formula or substituters) are given to infants
up to 4-6 months

4. Mixed-breast feeding (complementary
feeding)
•It means that infants receive:
20% < breastmilk < 80%
20% < milk substitutes < 80%
Milk substitutes: cow’s-milk, goat's milk,
diluted or powdered milk formula, acidic
milk preparations

5. Artificial feeding
•It means that an infant doesn't receive
breastmilk at all or less than 20%; more
than 80% of milk substitutes

6. Stages of lactation
•I. 1
st
-4
th
day –colostrum
•II. 5
th
-18
th
day –immature breast milk
•III. After 18
th
day –mature breast milk
(more watery)

7. Colostrum
•Content: high content of proteins, less lipids and
carbohydrates compared with mature breast
milk; active leucocytes –phagocytic bodies, IgA,
lactoferrin; amino acid-taurine, vitamins A,E.
•Protection from infection and prevention of
allergy, stimulation of defecation and growth.

8. The composition of breast milk
•Water(87-90%)
•Proteins(1%) –albumin>casein ; essential
amino acids:histidine, cysteinetaurine(brain
development)
•Lipids(4%) –rich with unsaturated fatty acids
(linoleic, linolenic, arachidonic)
•Carbohydrates (7%) –β-lactose (80-90%),
bifidus-factor
•Minerals: Ca:P 2:1 ( blood serum proportion),
Cu, Zn, Fe
•Vitamins -A, D, E

9. composition of breast milk
•Protein 0,9-1,3 g/100
ml
•Lipids 4,0-5,0 g/100
ml
•Carbohydrates 7,2-
7,5 g/100ml

10. Biological active components of
breast milk
•Ig A,M,G
•Secretary Ig A
•Lactoferin
•Lysozime
•Interferon
•C3, C4
•Bifidus-factor
•B-lymphocytes
•Neutrophils
•Macrophages
•Lactoperioxidase
•RNA-factor

11. Benefits to breastfeeding for the
infant.
•Bm less proteins (compared with Cm),
albumin:casein3:2 (Cm-2:8)
•Albumin is absorbed better, Bm casein is more
easily digested
•Cm proteins –foreign antigens caused allergy
•Cm higher protein content –excessive load on
the kidneys and immature membrane of
intestines of 2-3 months aged infants
•Bm –prevent IDDM, obesity

12. Benefits to breastfeeding for the infant.
•Active Bm lipase promotes digestion of fats and
provides free fatty acids, help in absorption of Ca
•Bm higher content of essential and unsaturated fatty
acids
•Bm is sterile
•Bm can decrease the risk of development of infectious
and other diseases.
•HigherIQ later in life?
•Close physical and emotional contact between
mothers and child

13. Bm can decrease the risk of development of
infectious and other diseases
•Viral infections (secretary IgA, specific inhibitory
substances, interferon, IgM,G)
•Intestinal infections (secretary IgA, lysozyme,
antistaphylococcal factor, lactoferrin, bifidus factor,
macrophagocytes)
•Amoebicinfections (bile salt stimulated lipase)
•Less chance of developingdiabetes mellitus type 1
•Less childhood obesity
•Less tendency to develop allergic diseases
•Less necrotizing enterocolitis in premature infants
•Less chanceof deficient diseases

14. Rules of successful breast-feeding
•Early breastfeeding-in the half hour after birth
the baby's suckling reflex is strongest, and the baby is
more alert, so it is the ideal time to start breastfeeding
•Breastfeeding at least every two to three
hours-helps to stimulatemilk production
•Avoid any bottles

15. Mixed-breast feeding
Additional foods
Milk substitutes:cow’s-milk, goat's milk, diluted or
powdered milk formula, acidic milk preparations
Adopted and non-adopted milk preparations.
Non-adopted milk preparations –different dilutions
of cow’s-milk, goat's milk(1:1-1
st
month, 2:1 –
1
st
-3d month)
Adopted: powdered milk formula( Nan, Nutrilon,
Frisolac , Humana …)

16. formula for premature babies
•"NAN" -Switzerland.
•"Nutrilak" -Russia.
•"Nutrilon" -The Netherlands.
•"Humana" -Germany.
•"Friso" –Netherlands

17. General principles of mixed-breast
feeding
•Additional food is given after Bm
•Small volume of additional food is given by
a spoon
•If additional food is given in a bottle with a
small hole on its nipple (milk flow out by
drops)
•Every feeding should be combination of
breast milk and milk formula (it stimulates
lactation)

18. Free breast-feeding (on demand)
•Put to the breast on baby’s demand when
hungry (not often than in 2-2,5 hours -10-
12 times, Bm is evacuated from stomach
after 2 hours)
•Don’t confuse –hungry or exited. Babies
may also nurse(sucking) when they are
lonely, frightened or in pain
•Without bottles or other supplements and
additional food (even water)

19. Free breast-feeding (on demand)
•Night feeding
•Don’t wash the breast nipples before and after
feeding
•Without pumping after feeding
•Duration of sucking is determined by a baby (not
more than 15-20 minutes)
•Weigh the child, not more than 1 time per week

20. Indications to pumping
•Lactostasis
•Lack of breast milk –stimulation of
lactation
•If mother have to leave the baby fore more
than 3-4 hours
•Additional food for sick baby, premature,
tired of sucking

21. pumpingbreast milk
•When direct breastfeeding is not possible,
a mother canpump(artificially remove and
store) her milk. With manual massage or
using abreast pump, a woman can pump
her milk and keep it in freezer in storage
bags.
•Breast milk may be kept atroom
temperaturenot more than six hours,
refrigerated not more than eight days or
frozen from four to six months.

22. Expressing breast milk
•Manual breast pump

23. 1) Optimal nutrition -breast milk

25. Breastfeeding
•Calculation of milk volume
Newborns 1-10 days of age
1.Zaitsev’s method: daily milk volume= 2%Mbxn;
Mb-birth weight in gram, n-day of age
2. Philkenshtain’s method: one-time volume of
milk=10xn; n-day of age
3. Daily milk volume= 70xn if Mb<3200 g
=80xn if Mb>3200g
n-day of age

26. Breastfeeding
•Calculation of milk volume
1. Volume method for infants above 2 weeks
2 weeks –2 months = 1/5 body weight
2 months –4 months = 1/6body weight
4 months –6 months = 1/7body weight
6 months –9 months = 1/8body weight
Daily volume of food for infants –not more
than 1 liter (1000 ml)

27. Breastfeeding
•Calculation of milk volume
2. Callorie method: 1 litre of milk provides
about 700 kcal
daily milk volume=
(M×daily energy requirements):700 kcal
M-infant’s weight

28. Breastfeeding
•The frequency of feeding
1. Up to 3 months of age –7 times a day with 3
hours intervals and 6-hours night interval: 6.00-
9.00-12.00-15.00-18.00-21.00-24.00
2. 3 –5 (6) months of age –6 times a day with
3,5 hours intervals and 6,5-hours night
interval:6.00-9.30-13.00-16.30-20.00-23.30
3. above 5 (6) months -5 times a day with 4.0
hours intervals and 8-hours night interval:6.00-
10.00-14.00-18.00-22.00

29. Weaning
•TheWorld Health Organizationrecommends exclusive
breastfeeding for the baby's up to6 months of life.
•After 4-6 months, Bm alonecannot provides all energy
and proteins requirements of infants
•Weaningis the process of introducing the infant to
other food and reducing the supply of breast milk.
•Weaningfood -solid food for development chewing
organs and G-I-T

30. Weaningfoods
•1-st weaning: mashed vegetables (vegetable
soup; purees) -cabbage, cauliflower, squash,
dark green leafy vegetables, carrot, potatoes
(5-6 months)
•2-d weaning: porridge or gruel (5% than 10%)
rice, semolina, lentils, corn, buckwheat
porridge(gluten free) 6 months
•3-d weaning: meat -mashed, spam, meatballs
(beef, rabbit, turkey)/fish (7-8/9 months)
•4-th weaning: kefir, yogurt (10 month)

31. Corrections of microelements,
vitamins
•1-st -fruit juices, mashed fruits (3-4
months)
•2-d -vegetable oil (5 months)
•3-d -curd, butter, yolk egg (6-6,5
months)
•4-th -crackers, cookies(8-9 month)
All correction foods have to start by drops
or tea-spoon (10xn, n-month of age)

33. General principles of weaning
introducing
•Beginning with a single weaning food
•Beginning with a 5-10 ml
•Gradually increase the volume from 5-10
ml to the volume of one feeding (180-200
ml) during 2 weeks
•Between every weaning 1 month interval
•Weaning food is given before Bm

34. The approximate menu of4,5-5,5
months aged breast fed infant
•6.00–breast milk180 –200ml
•10.00-breast milk180 –200ml
•14.00–mashed vegetables–5 ml. to
200г+ breast milk (195 ml to 0 ml)
•18 -breast milk180 –200ml
•22 -breast milk180 –200ml
•Between main feeding–fruit juices–
1drop-to40-50ml, mashed fruits–1
tee spoon to40-50ml(V= 10 х n(n–
months of age)

35. The approximate menu of5,5-6,5
months aged breast fed infant
•6 –breast milk200ml
•10 –porridge rice 5%(than 10%)1 tee
spoon-150 ml+ breast milk till180 –200ml
•14-mashed vegetables180 –200g+
vegitabal oil3 –5 g+ yolk 1/4
•18-breast milk200ml
•22 -breast milk200ml
•Between feeding -fruit juices–50-60ml,
mashed fruits–50-60ml(V= 10 х n(n–
months of age)

36. The approximate menu of7-8 months
aged infant
•6 –breast milk200ml
•10 –porridge 5%-10% 200 g+ butter 5,0 g
•14 –mashed vegetables 200-150 g+
mashed meat–5gto50 g+ yolk½ +
vegitabel oil5.0 g
•18 –curd–40g+ breast milk
•22 –breast milk200ml
•Between feeding–fruit juices–60-70ml,
mashed fruits–60-70ml(V= 10 х n(n–
months of age) ,crackers, cookies

37. The approximate menu of8-12 months
aged infant
•6.00–breast milk200ml
•10.00–porridge 10% 200 g+ butter 5,0 g+yolk ½-
1,0
•14.00-mashed vegetables 200-150 g+ mashed
meator meat balls50 g+ + vegetebl oil5.0 g
•18.00–curd–50 + kefir (jogurt)150ml+
crackers, cookies5-10 g
•22.00-breast milk200ml
•Between feeding–fruit juices–80-120ml, mashed
fruits–80-120ml(V= 10 х n(n–months of age)
,crackers, cookies
•\

38. Algoritm
•Determination of body weight according
the age
•Determination of the needs in the P, F, C,
kcal/kg
•The definition of the daily volume of food
•Determination of the frequency of feedings
•Definition of a single volume of food
•The diet of the day based on the
introduction of weaning foods