ppt of artificial feeding in children.pptx

artificial feeding

1. ALL INDIA INSTITUTE OF MEDICAL SCIENCES, RISHIKESH PRACTICE TEACHING ON : ARTIFICIAL FEEDING AND WEANING.

2. GENERAL OBJECTIVE At the end of the class students will be able to learn the concept about artificial feed and weaning. SPECIFIC OBJECTIVES At the end of the class the students will be able to :

3. ARTIFICIAL FEEDING Artificial feeding means to feed the child other than breast milk. It involves the use of breast milk substitute in the form of liquid milk, i.e., cow milk or commercially available dried whole milk. Artificial feeding should be started only if mother is unable to breastfeed the baby.

4. INDICATION OF ARTIFICIAL FEEDING Death or absence of mother Prolonged maternal illness Failure of breast milk production iv. 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.

5. AIMS OF ARTIFICIAL FEEDING To provide adequate nutrition to infants. To substitute breast milk and provide nutrients approximately same as breast milk. To fulfil the needs of the child for proper growth and development.

6. PRINCIPLES OF ARTIFICIAL FEEDING: The decision of giving artificial feeding must be taken after failure of all the efforts to breastfeed the baby. Artificial milk should be provided using appropriate feeding methods. Bottle-feeding must be avoided and mothers need explanation or information about the hazards of bottle feeding. Strict cleanliness in the preparation and feeding procedures should be practiced. Milk leftover from previous feed should not be used again. The milk should be Luke warm as it should not be too hot nor too cold.

7. Cont.…… If dried milk is used it should be reconstructed as per direction given by the manufacturer. Always burp the child as the allows to push out the swallowed air, prevent vomiting, abdominal discomfort.

8. HAZARDIOUS EFFECTS OF ARTIFICIAL FEEDING: Danger of contamination. Multiple nutritional deficiencies. Lactose intolerance. Obesity. Atherosclerosis. Poor learning abilities. Poor parent child relationship.

9. FACTORS CONTRIBUTING TO RISING INCIDENCE OF ARTIFICIAL FEEDING: Lack of interest in breast feeding. Wrong beliefs and ignorance related to breastfeeding. Increasing number of working mothers. Aping the western countries. Changing lifestyle. Availability of alternatives of mothers milk. Publicity and deceptively appealing advertisements.

10. ARTIFICIAL FEED INCLUDES : Cow milk. Buffalos milk. Commercially prepared formulas.

11. COW’S MILK Cow milk is one of the cheap alternative of breast milk and it is widely used with in Indian families. At 12 months old (but not before), your child can be introduced to cow’s milk. Before your child is 12 months old, cow’s milk may put him or her at risk for intestinal bleeding. It also has too many proteins and minerals for your baby’s kidneys to handle and does not have the right amount of nutrients your baby needs.

12. Cont … It is recommended by the paediatricians and WHO if it is very important to give cow milk as no other alternative is left then 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 150 ml of milk per 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.

13. COMPARISON OF HUMAN MILK AND COW MILK: Component Human milk Cow milk(100ml) water same same Protein{g} 1.1( whey protein) 3.3(casein dominant) Carbohydrate{g} 7.2 4.7 Lipid{g} 3.5 3.5 Minerals Iron better Absorbed Low iron and copper

14. ADVERSE EFFECTS OF COWS MILK FOR CHILDREN : Hard to digest, because of high protein content. Low iron content = 0.5mg| dl. Poor Absorption: 10% only. Can cause anaemia as it is responsible for intestinal bleeding. Can cause diarrhoea. Can Cause gases and colic pain in infant. Not for baby up to 12 months After 1 year consume but not than 24 oz/ day.

15. BUFFALOS 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.

16. DRIED MILK FORMULA OR COMMERCIALLY PREPARED FORMULA: Formula is a breast milk substitute made from a special dried-milk powder. It must be reconstituted according to the recommendations of the manufacturer. The general principle of manufacturing powdered milk is to reduce proteins to 1.5. 2.5 g/100ml, increase lactose content to 6 gm/100ml, reduce minerals like sodium and phosphates and modify fats by homogenization and substituting part of saturated animal fat with unsaturated vegetable oil. In spite of all these changes, this milk is biologically inferior to breast milk.

17. CATEGORIES OF COMMERCIALLY PREPARED INFANT FORMULA: There are four main categories of commercially prepared infant formula: Cows milk based formula. Soy based formula Casein or hydrolysate formulas. Amino acid formulas.

18. Pre NAN is a spray dried baby formula milk with DHA-ARA for premature/ low birth weight newborns during and after hospital discharge. It is a source of DHA-ARA, MCT and Whey Protein. Mother's milk is best for your baby. This formula powder comes in tin pack that ensures enhanced safety, hygiene and convenience.

19. Nestlé NAN PRO 1 is a spray dried infant formula with Whey Protein, DHA, ARA and Probiotic for infants from birth when they are not breastfed. Nestlé NAN PRO 1 contains L. reuteri - L. reuteri is a Probiotic. Nestlé NAN PRO 1 contains Whey Protein. Whey Protein is a component of milk protein, which is easy to digest. Nestlé NAN PRO 1 contains DHA. Important Notice: Mother's milk is best for your baby.

20. PREPARATION OF FORMULA MILK: Commercially available dried powdered milk is reconstituted by mixing: One level measure of milk powder+ 30 ml of water. Technique: Person preparing infant formula should wash their hands and then all the equipment's used to prepare the formula with soap and water. Sterilizing bottles and other equipment 5 minutes in boilong water must be required where hot water dishwasher is not present. Boil the water and then cool, it down to reconstitute powdered or concentrated liquid formulas. Prepare the formula using manufacturer instructions. Discard any milk remaining in the bottle after the feeding is the excellent medium for bacterial growth.

21. ALTERNATIVE METHODS OF FEEDING Babies can be fed artificially by following way: Katori and Spoon feeding. Paladai feeding. Cup feeding. Intragastric feeding.

22. INDICATION OF USING ALTERNATIVE METHODS OF FEEDING: Baby Prematurity. Sickness. Cleft Lip/ Palate. Mother Sick. Working. Breast related issues{mastitis, engorged breast, flattened or sore nipples}

23. KATORI AND SPOON FEEDING When the neonate cannot suck on the breast due to prematurity or any congenital malformation and feed is provided with the help of katori and spoon , it is called katori and spoon feeding method. Advantages: • Useful for collecting even small amount of colostrum. • Useful to feed baby with cleft lip/ cleft palate. Disadvantages: • Slow method of feeding. • Difficult to manage a spoon and katori while holding the infant.

24. TECHNIQUES OF KATORI AND SPOON FEEDING: The Katori and spoon should be washed thoroughly and boiled for 10 minutes. Take required amount of feed in the cup and keep it covered. Change soiled diaper. 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 the 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 left lateral position.

25. PALADAI FEEDING A paladai is a small bowl with a long pointed smooth beak. It is make up of steel and has the capacity of 15-20 ml. It is a traditional method of feeding babies in Asia and has been endorsed by the WHO for feeding Preterm babies. Advantages: Baby can be fed faster than cup or spoon. Less spillage. Disadvantages: Aspiration.

26. TECHNIQUE OF FEEDING USING PALADAI FEEDING: Infant should be awake and held in semi-upright position in caregivers lap. Boil it for 10 min. Take a measured amount of milk in the paladai . Place a small piece of cloth in front to catch spillage. Touch the edge of the paladai to the outer side of lower lip. Tilt the paladai slightly such that the milk reaches the baby’s lip. After feeding the baby must be held upright for 15-20 min for burping and then made him lie on his left side to avoid regurgitation

27. CUP FEEDING: Another good method of feeding the baby is directly by cup. Another good method of feeding the baby is directly by cup. Volume of the cup must be 50-90 ml, its edges should be rounded and smooth. A baby who is cup fed needs to be given 5 ml extra at each feed to allow for spillage from cup. Advantages: It is easy available. Easy to clean. Disadvantage: Dribbling and spillage.

28. TECHNIQUE OF CUP FEEDING Wash the cup thoroughly and boil it for 10 minutes. Take the required amount of feed with 5 ml 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. 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 left lateral position.

29. INTRAGASTRIC FEEDING: This is an alternative mode of feeding for babies who are not capable of swallowing. This may be prematurity, or due to illness. When the intragastric tube is inserted through the nose it is known as nasogastric or NG tube and when inserted through the mouth it is known as orogastric or OG tube. Intragastric feeding is a passive method of feeding as the baby does not participate actively in feeding. Advantages: Very Small < 32 weeks of Gestation and sick babies can be fed. Disadvantage: Dislodgement of tube can cause aspiration. Trauma to nasal mucosa.

30. PROBLEMS ASSOCIATED WITH ARTIFICIAL FEEDING : The problems associated with artificial feeding are- Constipation due to undigested protein. This can be relieved by adding sugar to the milk. Overfeeding Underfeeding Aerophagy (Swallowing of air) leading to distension of abdomen, colic and aspiration. Low pH formulas may lead to acidosis. Malnutrition, if feeds are over diluted

31. It is expensive and its preparation is tedious. High incidence of Infection if hygiene is not maintained. Cow's milk contains higher sodium and phosphorous leading to increased solute load on kidneys which predispose babies to hypertonic dehydration. Artificially fed infants are at higher risk of gastroenteritis, anaemia, hyperphosphatemia, hypocalcaemia and latent or clinical scurvy.

32. COMPLEMENTARY FEEDING OR WEANING Complementary feeding or weaning is the process of giving an infant other foods and liquids along with breast milk after the age of 6 months as breast milk alone is no longer sufficient to meet the nutritional requirements of growing baby. It is the process by which the infant gradually becomes accustomed to adult diet.

33. GUIDING PRINCIPLES FOR COMPLEMENTARY FEEDING : Principle 1: Practice exclusive breastfeeding from birth up to 6 months of age and introduce complementary foods after 6 months of age along with breastfeeding. Principle 2 : Continue frequent on-demand breastfeeding until 2 years of age or beyond. Principle 3 : Practice responsive (active) feeding applying the principles of psychosocial care. Feed infants slowly and patiently and encourage them to eat but do not force them. If the child refuses to eat any food, experiment with different food combinations, tastes and textures.

34. Principle 4: Practice good hygiene and proper food handling to reduce the risk of diarrhoea. Principle 5: Start at 6 months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding. Principle 6: Gradually increase food consistency and variety as the infant grows older, adapting to the infant's requirements and abilities. Begin liquids at 6 months. By 8 months he can eat semi-solids and by 12 months he can eat solid foods as consumed by rest of the family member.

35. Principle 7: Increase the number of times the child is fed complementary food, as the child gets older. A breastfed infant who is 6-8 months old needs 2-3 meals a day and at 9-23 months he needs 4-meals a day. Principle 8 : Feed a variety of nutrient rich foods to ensure that all nutrient needs are met. Complementary foods should provide sufficient energy, macro and micronutrients. Complementary food should include animal products, dairy products, pulses, fruits, vegetables and oils.

36. KEYS TO SAFE FEEDING Wash hands. Keep food in clean utensils. Separate raw and cooked food. Cook food thoroughly. Keep food at safe temperatures. Use safe water and raw material. Give freshly prepared food to baby. Keep the cooked food covered.

37. WEANING FOODS Examples of weaning foods that may be started according to the child's ability to feed are: 1. Liquids: Soup of vegetables, pulses, rice water and fruit juices. 2. Semi Solids: Mashed potato, pulses, boiled vegetables, mashed banana, soft cooked rice and fish. 3. Solids : Cooked rice, chapati, idli , bread, biscuits, groundnuts, banana and fruits.

38. SUMMARY Breast feeding is the best food for infants. Feeding should be initiated as soon as possible after the birth but there are certain conditions where artificial feeds or formula feeds are to be used , they should be well prepared and should be given in appropriate amount and concentration, using different alternative methods , but remember their use should not be encouraged.

39. REFERENCES: Hockenberry J Marilyn, Wilson David.Wongs Essential's of paediatric Nursing: Health promotion of the toodler and family. 8th edition.Elsevier,a division of Reed Elsevier India pvt limited;2012.pg 227-232. 2. Sharma Rimple . Essentials of Pediatric Nursing.2nd edition. Jaypee publishers.p355-58. 3 Indian Academy of Pediatrics ( IAP) Guideline of Artificial feeding.