Nutrition chapter 2 that is nutritional consideration during lactation

Nutrition

1. Nutrition Laiba Tariq Topic: Nutrition in Lactation Nutrition in infancy

2. Nutrition during lactation Lactation is the period during which mother gives breast feed to the infant During first few months of life infant derives all nutrition from mothers milk so the mother milk should be able to meet the requirement of rapidly growing infant The quality and quantity of mothers milk is affected by types of diet consumed by her

3. Breastfeeding Energy intake To produce and adequate amount of milk a lactating mother should take extra energy of almost 2000 kJ a day above her regular need during the first 6 months of lactation Nutrients : Recommendations of protein and fats are the same for lactation as in pregnancy but increase in carbohydrates and fiber. Nursing mother needs additional carbohydrates to replace the glucose used to make the lactose in breast milk Fiber recommendations are 5gm higher than for general female population

4. Composition of mother’s milk Nutrient Amount /100ml Energy 65kcal Protein 1.1g Carbohydrates 7.7g Fat 3.4g Calcium 28mg Iron Vitamin A 1371retinol Thiamine 0.02mg Riboflavin 0.02mg Niacin Vitamin C 3mg

5. Nutritional requirements Energy During first six months of lactation energy requirements are increased by +550kcal and during next six months by +400kcal than the normal adult women. The additional energy is required for milk production.as milk production is decreased after six months so energy requirements also decreases. Protein Protein need also increases for milk production. As milk contain 1.15g of protein/100ml.since mother secretes on an average 85ml/day milk during first six months and 600ml/day during 6 to 12 months the additional protein requirement is 25g for 0 to 6 months and 18g for 6 to 12 months

6. Fat requirement Fats are required to fulfill the need of essential fatty acids linoleic acid 45g of fat has been recommended by ICMR Vitamins Requirements of B complex vitamins increases in proportion to increased calories and protein requirements because B complex are required for metabolism and energy production. Vit C also increased to 80mg/day. Vit A should also be included in diet so that breast milk also contain sufficient amount of Vit A Minerals Calcium requirements also increased during lactation as it is required for milk production. All other nutrients like iron, zinc, selenium and iodine must also be consumed in sufficient amount

7. Lactogogues Lactogogues are the substances which stimulate milk production so these must be included in diet e.g. garlic, milk, almonds etc.

8. Nutrient supplements Most lactating mothers can obtain all the nutrients from a well balanced diet without taking vitamin-mineral supplements. Some may need iron supplements. Childbirth has incurred blood loss so many woman may need iron supplements during lactation her iron requirement is half of the non pregnant women of her age. Water: Breastfeeding mother needs an additional of 500mL of fluids in which water is the major component Particular foods: Foods with strong or spicy flavors may alter the flavor of breast milk which can annoy some infants

9. Vitamins and minerals Studies reveal that if a lactating mother takes less quantity of vitamins and minerals it reduces quantity not the quality because mother’s milk contains enough amount of nutrients even if their own supplies are limited due to maternal stores Maternal bones can lose density due to less intake of calcium but no affect on quality of breast milk The nutrients in breast milk that are much likely to decline in response to less intake of mother are Vit B6,B12, A and D.

10. Practices incompatible with lactation Alcohol Medicines Smoking Caffeine

11. Infancy Infancy is the period from birth through the completion of 12 th month of life

12. NUTRTION DURING INFANCY As a period of rapid growth during first year of life, infants double their birth weight by the time when they are 6 months of age and weight gets triple by 1 year of age. Growth and development It includes in body size, body composition and mental development. Changes in body size First year of life i.e. infancy is a period of rapid growth. A normal infant doubles his birth weight by age of six months and triples by age of one year. According to national center for health and statistics a normal Indian babies weighs between 2.7 to 2.9kg. While well nourished women may give birth to baby weighing 3.2 to 3.3 kg .similarly increase in length of infant is approximately 50% by the end of first year

13. Changes in body composition Infants at birth has 75% of water in the body, 12 to 15% fat and poorly developed muscles. Water content starts decreasing as infant grows and reaches to 60%.muscle growth, growth of skeletal muscles, adipose tissues starts, fat content also increases. Bone mineralization starts in infancy Changes in gastrointestinal system Full term baby can digest simple proteins,carbohydtrates as well as fats. With the advancing age digestibility keeps on improving.

14. Changes in excretory system The filtration rate of kidneys is low during early months of life. Child is not able to excrete high concentration of solutes. Slowly by the end of first year kidneys functional capacity is fully developed. Mental development There is rapid increasing in number of brain cells (neuron) in first six months, this rate declines with age so proper diet is necessary for proper development of brain Changes in feeding behavior Rooting reflex: This is the feeding behavior of an infant during first three months, in which baby suckles with up and down movement of tongue. By the end of 4 th month tongue movement start changing and child is able to start swallow properly by the end of six months.

15. RDA of various nutrients for infants Age (months) Energy (kcal) Protein (g) Calcium (mg/dl) Thiamine mg/dl Riboflavin mg/kg Vitamin C mg/kg Folic acid mg/d 0-6 108/kg 2.05/kg 500 55mg/kg 65mg/kg 25 25 6-12 98/kg 1.65/kg 50mg/kg 60mg/kg

16. Nutritional requirement during infancy Energy Infancy is a period of rapid growth so energy requirement are higher nearly up to 5 months energy requirements of infants are met by mother’s breasts feed. As the child grows or by the age of 5 months mother should start supplementing the feeding regime of infant Protein As the growth rate of infants is very high, so protein requirements are also high. During early stages breast feed nearly meets protein requirements. But beyond 6 months breast milk cannot satisfy protein needs so supplementation should necessary

17. Fat requirements Well feed infant gets nearly 30g fat /day and breast milk meets to all essential fatty acid requirements. During weaning one should be careful that diet provides about 25% of energy as fat Mineral Calcium requirement of infant is calculated from calcium content of breast milk .As infant grows calcium need also increases because it is required for calcification. ICMR has recommended 500 mg of calcium during infancy Iron needs of infants are same as other age groups, during first 5 months infant have stores of iron but with advancing age supplementation becomes essential as iron store are depleting as breast milk does not contain iron.

18. Vitamins Vitamin A is essential for normal and healthy eyes. ICMR has recommended a daily allowance of 350mg of retinal up to age of 6 months. While Vit D which is essential for bone development can be obtained from sunlight thiamine 0.3mg/1000kcal riboflavin 2.5mg/1000kcal niacin 6.6mg/1000kcal

19. Advantages of breast feeding Natural method of feeding This method eases mother’s job of preparation of feed and sterilization of bottles. It is the best food as it satisfies infants nutritional needs Nutritionally balanced It is easily digested and absorbed. Breast feed also supports early immunity of infants. As breast milk is hygienic and it contains factors which enhances immunity. Clostrium is thick yellowish liquid secreted from mother’s breast for first 1-3 days.it contains antibodies which develops or enhances infants immunity. Breast feeding also have psychological advantages as it gives a sense of motherhood and security to infant.

20. Continue… It is most economical food for the baby Normally some infants show allergy to lacto globulin and serum bovine which are present in cow’s milk. While these are absent in breast milk .So there are no risk of allergies. Breastfeeding also act as natural contraceptive, as during feeding prolactin is formed which prevents ovulation. This prevents chances of another pregnancy so act as natural contraceptive Breast feeding have also shown positive impact in prevention of breast cancer.

21. Benefits of breast feeding Infant Decrease incidences of various infectious diseases Bacterial meningitis Bacteremia Diarrhea Respiratory tract infections Necrotizing enter colitis Otitis media Urinary tract infections Late onset sepsis in preterm infants

22. Continue… Decrease rates of Sudden infant death syndrome Types 1 and 2 diabetes Lymphoma Leukemia Hodgkin’s disease Overweight and obesity Food allergies Asthama

23. Benefits for mother Decrease postpartum bleeding More rapid uterine involution Increased child spacing Earlier return to prepregnant weight Decrease risk of breast and ovarian cancer Possible decreased risk of postmenopausal hip fracture and osteoprosis

24. Contraindication of breast feeding There are few conditions in which we cannot give breast feed to infant Reasons related to mother Short duration illness like fever, cracked nipples, breast abscess Serious illness like mental disorder, renal disorder, severe anemia, heart disease and active Tuberculosis Insufficient milk secretion

25. Reasons related to infant

26. Artificial feeding or top feeding or bottle feeding Artificial feeding is given to infant because of any contraindication in child and mother which can not feed properly to the infant Commercial formula are available which can be used as artificial feed or milk can be diluted in 3:1 ratio using boiled water Take care of proper hygiene Hold the infant during feeding with the head slightly elevated to facilitate passage of formula or breast milk into the stomach

27. Weaning or complementary feeding

28. Weaning Weaning is a process of gradually introducing foods other than breast milk in child’s feeding schedule. This process can be started from the age 5 th month onwards Points to be kept in mind during weaning Introduce one food at a time Start with small quantity and increase the quantity gradually Never do forceful feeding. If child do not like particular food ,discontinue it for sometime and reintroduce it in later stage Consistency of the food should be as per child’s age ,start with liquid foods and then move to semi solid to solid foods

29. Continue… Make diet more appealing by adding variety in foods Avoid spicy and fried foods

30. Weaning food for infants 5-6 months Juice mixed with little sugar and water start with 1-2 teaspoons and increase up to 30-50 ml Vegetable soups 1-2 teaspoons and increase to about 50ml Dal water, rice water Cereals Cooked in water or milk suji kheer 1-2 tbs in semisolid form

31. Weaning in 6-7 months Egg yolk 1-2 tbs and increase to 1 yolk Boiled and mashed vegetables and fruits 7-8 months Well cooked vegetables ,dal and thin khichri in semisolid form start in small amount and gradually increases 10-12 months Whole egg ,meat, vegetables ,fruits, chapatti, it varies from semisolid to solid form as per tolerance