ARTIFICIAL FEEDING:indication for artificial feeding, different artificial formulas, methods of artificial feeding, problems associated with artificial feeding

This informative PowerPoint presentation covers the aspects of artificial feeding including-
Definition and types of artificial feeding
Indications for artificial feeding
different artificial feeding formulas
Different methods of artificial feeding.
Risks and potential complications associated with artificial feeding

1. ARTIFICIAL FEEDING BY : MS. Ujjwala Mundhe MSc (Child Health Nursing)

2. At the end of the lesson plan students will be able to:. Introduce Artificial feeding Enlist indication for Artificial feeding. Explain different artificial feeding formulas. Describe the different method of artificial feeding. Illustrate the problems associated with artificial feeding.

3. ARTIFICIAL FEEDING INTRODUCTION: Choosing whether to breastfeed or formula feed the baby is one of the first decisions expectant parents will make. Although experts believes that breastmilk is the best nutritional choice for infants , breast feeding may not be possible for all women., decision to breastfeed or formula feed is based on their comfort level, life style and specific medical considerations that they might have. For mothers who are unable to breast feed or who decides not to breast feed , infant formula is a good alternative .

4. MEANING: Feeding the child milk other than breast milk is known as “ Artificial feeding”.

5. INDICATIONS FOR ARTIFICIAL FEEDING The main indications for artificial feeding are: Death or absence of mother. Prolonged maternal illness. Failure of breast milk production. Mothers who have active TB and HIV positive mothers. Working mothers. The baby is adopted and mother who has adopted the baby is not lactating .

6. ARTIFICIAL FORMULAS/FEED A baby who is not breastfeed is fed on artificial formulas , most infants are fed on cow’s milk , buffalo’s milk and commercially available dried milk. Cow’s milk: It is a cheap alternative which is well within the reach of many Indian families. Cow’s milk contains three times more protein than breast milk . but the protein in cow’s milk is not fully digested and used. The carbohydrate content of human milk is higher as compared to cow’s milk. The amount of fat is same in both cow’s milk and breast milk.

7. The fat in breast milk is better emulsified and digested than cow’s milk fat. Cow’s milk may cause strain on infant’s kidneys because of its high sodium content.it is therefore recommended by the paediatricians and WHO to dilute cow’s milk for first 6-8 weeks in ratio of 3 or 4:1 (three or four parts of milk and 1 part of water). on an average, an infant requires 150ml of milk /kg body weight per day to get about 100 kcal energy per kg body weight. After 3-4 months of age, undiluted milk should be given.

8. Buffalo’s milk: Buffalo’s milk can also be used in place of cow’s milk. It should be skimmed and then given in same proportion as cow’s milk for first 6-8 weeks. b)Dried milk formulas: The commercially available dried milk formulas are either cow’s milk -based or soy protein based. It must be reconstituted according to the recommendations of the manufacturer.

9. The general principle of manufacturing powdered milk is to reduce proteins to 1.5-2.5 g/100ml, increase lactose content to 6gm /100ml, reduce minerals like sodium and phosphates and modify fats by homogenization and substituting part of saturated animal fat with unsaturated vegetable oil. Inspite of all these changes, this milk is biologically inferior to breast milk

10. DIFFERENCE IN CONSTITUENTS OF HUMAN AND COW’S MILK: Protein: Protein content of human milk is three times less than cow’s milk . Human milk contains more cystine and lactalbumin and less methionine and casein than cow’s milk. Breast milk protein is completely digested and utilized for growth whereas much of cow’s milk protein is excreted by infant , undigested producing whitish curdy stool.

11. Fat: Although total content of fat in cow’s and human milk is almost same , there are differences in types of fatty acids contained in fat which renders cow’s milk a bit irritating and less easily digestible . b)Carbohydrates: The same form of carbohydrate is present in both milk (i.e. lactose )but its concentration is higher in breastmilk which is good for growing brain.

12. METHODS OF ARTIFICIAL FEEDING: Babies can be fed artificially by following ways : Bottle feeding Katori and spoon feeding Cup feeding Gavage or nasogastric feeding.

13. BOTTLE FEEDING: Bottle feeding is a common practice in India, to which babies become addicted. A prolonged bottle feeding may lead to ‘ baby bottle tooth decay’ also it is difficult to wean bottle fed babies. At times bottle is contaminated or inadequately cleaned resulting in gastrointestinal infection causing diarrhoea. Despite of these negative factors, if bottle feeding is practiced, it must be done cautiously .

14. Principles of bottle feeding: The following principles must be kept in mind while bottle feeding the baby. After washing the bottle with brush and clean water , it should be boiled for about 10 minutes. The milk or cream sticking to nipple can be easily removed by rubbing with common salt. Hands should be washed thoroughly before touching the bottle and preparing the feed.

15. The hole of teat should be such that drip rate is one drop/ second . a hole smaller than this makes feeding difficult , exhausts the child and results in swallowing of air leading to vomiting and abdominal distension. A big hole, on other hand will result in choking , vomiting and abdominal distension. Technique of bottle feeding: After cleaning the teat and bottle , it should be sterilized and kept covered. Prepare the formula as per requirement, when the baby is hungry. Change the soiled diaper and make the baby comfortable.

16. Wash hands and test flow of milk and its temperature, by sprinkling a few drops of inner aspects wrist . Sit in comfortable position with baby in lap. Head of the baby should be higher than rest of the body.

17. If any medication to be administered, it should be given before feeding. The teat should be touched to the corner of baby’s mouth and when baby opens mouth, teat should be inserted in mouth. The bottle should be held at an angle that teat is completely filled and there is no air in the teat. The baby should be burped during and after feeds. After burping make the baby lie in right lateral position.

18. KATORI AND SPOON FEEDING: When the neonate cannot suck on the breast due to prematurity or any congenital malformation or when breast milk is obtained from sources other than mother, feeding with katori and spoon is the best method. Technique of katori and spoon feeding: The katori and spoon should be washed thoroughly and boiled for 10 mins. Take required amount of feed in the cup and keep it covered. Change soil diaper.

19. Wash hands and hold the baby semi-upright in lap and wrap a bib or soft cloth around the neck . Touch the spoon to the corner of the mouth and when the baby opens mouth , feed is given. The first bolus is allowed to swallow , before the next is given. Feed from corner of the mouth and constantly observe the baby to prevent aspiration and control feeding . After feeding burp the baby , wipe the mouth and make him/her lie in right lateral position

20. CUP FEEDING: Another good method of feeding the baby is directly by cup. A baby who is cup fed needs to be given 5 ml extra at each feed to allow for spillage from cup. Technique of cup feeding: Wash the cup thoroughly and boil it for 10 min. Take the required amount of feed with 5ml extra to allow for spillage from the cup. Hold the baby in lap after changing of soiled diaper , supporting his/her head and shoulders. Hold the cup of milk resting on the lower lip so that the rim of cup touches the baby’s upper lip .

21. Tilt the cup so that the milk just reaches baby’s lips. A term baby will suck the milk spilling some of it. Do not pour the milk into baby’s mouth; let him/her suck it. When the baby has had enough , he/she closes the mouth and stops taking feed. Wipe off the face and burp the baby. Make the baby lie in right lateral position

22. GAVAGE FEEDING: For gavage feeding size Fr.5 feeding catheter is required for nasogastric or orogastric placement. For nasogastric insertion, the catheter is measured from external nares to the tragus of the ear and from there to the xiphisternum. This length of tube should be inserted from nose. For orogastric insertion , distance is measured from angle of mouth to the tragus and from there to the xiphisternum.

23. During nasogastric or orogastric tube insertion , the head is slightly raised and a wet ( not lubricated) catheter is passed gently through the nose or mouth into the oesophagus and then to stomach. Position of the N.G tube is verified by aspirating the gastric contents. The tube is then fixed through an adhesive tape. At the time of feeding , a 5or 10 ml syringe without plunger is attached to the tube and milk is given through it .

24. After feeding place the baby in right lateral position. There is no need to burp the baby after gavage feed. A nasogastric or orogastric tube can be left in situ for up to 7 days.

25. PROBLEM ASSOCIATED WITH ARTIFICIAL FEEDING : The problem associated with artificial feeding are: Constipation due to undigested protein . this can be relieved by adding sugar to the milk. Underfeeding Overfeeding Aerophagy leading to distension of abdomen , colic and aspiration. Low PH formula may lead to acidosis.

26. Malnutrition , if feeds are over diluted. It is expensive and its preparation is tedious . High incidence of infection if hygiene is not maintained. Cow’s milk contains higher sodium and phosphorus leading to increased solute load on kidneys which predispose babies to hypertonic dehydration. Artificially fed infants are at higher risk for gastroenteritis , anaemia , hyperphosphatemia , hypocalcaemia and latent or clinical scurvy.