0
Dr. K P Kushwaha
        Prof & Head,
BRD Medical College, Gorakhpur
Evidence classification
Evidence class      Criteria for evidence
• Class I           • Randomized control trial
         ...
Infant feeding Recommendations
    (Global strategies for Infant & Young
                            Child Feeding)
• Excl...
Infant feeding Recommendations
    (Global strategies for Infant & Young
                            Child Feeding)

• Pre...
HIV :2000 and 2006 WHO Recommendations

 •When replacement feeding      • Exclusive breastfeeding is
 is acceptable, feasi...
IYCF Practices-India
• Initiation with in 1 Hr     • 23.4
• Exclusive Breastfeeding     • 46.3
• Timely (appropriate ?)   ...
Trends in Nutritional Status
                Percent of children age under 3 years

                          NFHS-3      ...
Anaemia among Children
        Percent of children 6-35 months with anaemia


 79                                  81
    ...
How Many Children Receive Services
         from an AWC?
                                 ICDS (??? 0 – 6 yrs )
 80      P...
Benefits to Baby (evidence class I –III)
• Optimum growth
• Brain growth
• Reduce risk for:
   – Undernutrition
   – Upper...
Why Breast milk for preterm
• To Protect
       - Infections
       - NEC

• To Provide
       - PUFA, growth factors, hor...
Lancet 2004;363:1571-8 Singhal A, Cole TJ, Lucas
       A Breastmilk and Lipoprotein profile in
       adolescents born pr...
Breast milk composition
       differences (dynamic)
• Gestational age at birth
  (preterm and full term)

• Stage of lact...
Slide 14
Slide 15
Colostrum ( evidence class I-
            III )
Property             Importance
• Antibody ich
         - r         • prot...
Slide 17
More Benefits to Baby
                        (When they grow)


• Reduced risk for:
   - Dental disorders
   – Diabetes
 ...
Benefices for Mom
•   Rapid recovery after having a baby
•   Decreases risk of anemia
•   Weight reduction
•   Reduces ris...
Community
                        Benefits




                                          Breast milk is a
                ...
Breastfeeding prevents under
       nutrition and obesity
Under nutrition     40-50%

Obesity               50%



      E...
Breastfeeding decreases the prevalence
of obesity in childhood at age five and six years,
                    Germany
    ...
Higher Intelligence quotient ( Evidence class I-II)
                                        BF 12.9 points
  BF 2 points  ...
Potential Child Mortality Reduction
   from Preventive Interventions
                                                     ...
The value of breast milk
        to the national economy in India
• National production of breast milk by all mothers in I...
Comparative health care costs of treating breastfed
and formula-fed babies in the first year of life in a
    health maint...
In addition, the 1000 never-breastfed infants
                      had:

 • 2033 excess office visits
 • 212 excess hospi...
Slide 28
What is the infant mortality risk
               from not breastfeeding?
                    12
                          ...
The baby Killer
(Andy Chetley/war on want, 1974)




 • Sale of formula in India   Rs
 • Sale of Bottles in India   Rs

  ...
Mother of Twin


             Mother of twins - mother
             in law told her she
             didn’t have enough
  ...
Artificial jewelry   Real Gold jewelry




Animal Milk               Breast milk    Slide 32
How do we are compare




 Cow with calf   Mother Breastfeeding




                                        Slide 33
Why Mothers do not succeed?
                                    Marketing
                                        of      ...
Manufacturing Malnutrition
                     Are they parallel methods ?

Promoting best food for baby       And where ...
Marketing Confuses Mothers
    Confused mother           Baby’s Misery




•   Community Practices     • Nutritional & hea...
Which photograph will increase TRP ?
 (Even Media is afraid of Promoting Breastfeeding)




   Malnourished baby &        ...
Milk Donations
(What NGOs do for 0-6m nutrition?)




                                     Slide 38
Role of International Health
               Agencies


                   •   Mediator - Budget from      International
  ...
What is Advice
  Feed him on the left!
 Feed him on the right!
Feed him in the morning,
    Noon, and night!
  Yeah! Breas...
What is promotion?




                     Slide 41
Slide 42
What is support?
• How can we help?

• What will work for you?

• We have answers that will help you

• we can help by obs...
Two Most Common Complaints
“I don’t have enough milk”
      Find out why she thinks this
      Find out if the baby is gai...
When a mother thinks…
  She does not have enough milk

 Her first response is to supplement
             with formula

 Th...
Two Most Common Complaints
“I have sore nipples”

     Most common cause of sore nipple is
     poor positioning and latch...
Slide 47
Slide 48
Two Most Common Complaints
“I have sore nipples”

     If your help with positioning and latch
     doesn’t improve the pa...
Listen
                                           carefully
                                                              ...
New 2006 WHO Guidance
             (HIV and 0-6 Months)
• Exclusive breastfeeding does carry lower risk of HIV
  transmiss...
• The state shall regard the raising the
  level of nutrition and the standard of
  living of it’s people and the
  improv...
• If you believe in the importance of
  breastfeeding to mother and baby and
  you have imagination and
  determination an...
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Nutrition And The 0 6 Months Infants (Final

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Transcript of "Nutrition And The 0 6 Months Infants (Final"

  1. 1. Dr. K P Kushwaha Prof & Head, BRD Medical College, Gorakhpur
  2. 2. Evidence classification Evidence class Criteria for evidence • Class I • Randomized control trial ;at least one • Class II • Well organized control trials without randomization, cohort or case control ,cross sectional, retrospective ;more than one • Class III • Case reports, reports of expert comittees, guidelines,
  3. 3. Infant feeding Recommendations (Global strategies for Infant & Young Child Feeding) • Exclusive breastfeeding form birth to 6 months • Appropriate complementary feeding after 6 months + Breastfeeding • Sustaining breastfeeding for 2 years and beyond • Related maternal, nutrition & care • Building community support and health system support protecting infant feeding practices from commercial influences Slide 3
  4. 4. Infant feeding Recommendations (Global strategies for Infant & Young Child Feeding) • Preterm, ELBW, VLBW and above 1600gm. All need breastmilk. • Feeding method and approaches are varied. Slide 4
  5. 5. HIV :2000 and 2006 WHO Recommendations •When replacement feeding • Exclusive breastfeeding is is acceptable, feasible, recommended for HIV-infected affordable, sustainable and women for the first 6 months of life safe, avoidance of all unless replacement feeding is breastfeeding by HIV- acceptable, feasible, affordable, infected mothers is sustainable and safe for them and recommended. their infants before that time. • When replacement feeding is • Otherwise, exclusive acceptable, feasible, affordable, breastfeeding is sustainable and safe, avoidance of all recommended during the first breastfeeding by HIV-infected months of life. women is recommended Slide 5
  6. 6. IYCF Practices-India • Initiation with in 1 Hr • 23.4 • Exclusive Breastfeeding • 46.3 • Timely (appropriate ?) • 55.8 complement • Sustained breastfeeding 2 • 38.4 years and beyond (Squeezing and discarding of colostrum and prelacteal feeds are quite common) Source: NHFS-3 Slide 6
  7. 7. Trends in Nutritional Status Percent of children age under 3 years NFHS-3 NFHS-2 51 45 43 40 23 20 Stunted Wasted Underweight (Low-height-for-age) (Low-weight-for-height) (Low-weight-for- age) Source: NHFS-2 & 3 Slide 7
  8. 8. Anaemia among Children Percent of children 6-35 months with anaemia 79 81 72 74 Total Urban Rural NFHS-2 Slide 8
  9. 9. How Many Children Receive Services from an AWC? ICDS (??? 0 – 6 yrs ) 80 Percent of age-eligible children in areas with an AWC 70 60 50 40 33 30 26 23 20 18 20 16 10 0 g od ns s ol e rin up ic ho fo io rv ito k- at sc ry se ec iz on e- ta un ch ny m Pr en m A lth th em Im w ea l ro pp H G Su How many 0-6 ms are being looked after? Source: NHFS-3 Slide 9
  10. 10. Benefits to Baby (evidence class I –III) • Optimum growth • Brain growth • Reduce risk for: – Undernutrition – Upper and lower respiratory infections – Otitis media (ear infections) – Urinary tracts – Sytemic Infections – Gastroenteritis – Allergies – Overweight/obesity – SIDS Slide 10
  11. 11. Why Breast milk for preterm • To Protect - Infections - NEC • To Provide - PUFA, growth factors, hormone, tropic factors - Better visual and cognitive development • To Involve mother in care, including KMC • To Provide nutrition's with high bio availability Evidence class I Slide 11
  12. 12. Lancet 2004;363:1571-8 Singhal A, Cole TJ, Lucas A Breastmilk and Lipoprotein profile in adolescents born preterm: Followup of a prospective randomised study (n=926) 2.8 2.6 2.4 LDL to HDL ratio 2.2 2 1.8 1.6 Evidence class I 1.4 1.2 1 Lowest 3rd (13%) Middle Third (65%) Highest Third (100%) Human Milk Intake Slide 12
  13. 13. Breast milk composition differences (dynamic) • Gestational age at birth (preterm and full term) • Stage of lactation (colustrum and mature milk) • During a feed (foremilk and hindmilk) Evidence class I Slide 13
  14. 14. Slide 14
  15. 15. Slide 15
  16. 16. Colostrum ( evidence class I- III ) Property Importance • Antibody ich - r • protects against infection and allergy • Many white cells • protects against infection • Purgative • clears meconium; helps prevent jaundice • Growth factors • helps intestine mature; prevents allergy, intolerance • Vitamin - A rich • reduces severity of some infection (such as measles and diarrhoea); prevents vitamin A related eye diseases - Slide 16
  17. 17. Slide 17
  18. 18. More Benefits to Baby (When they grow) • Reduced risk for: - Dental disorders – Diabetes – Crohn’s disease – Childhood Leukemia – Cardiovascular disease – Celiac disease – Rheumatoid arthritis Evidence class II -III Slide 18
  19. 19. Benefices for Mom • Rapid recovery after having a baby • Decreases risk of anemia • Weight reduction • Reduces risk of breast cancer • Reduces risk of ovarian cancer • May reduce risk of endometrial cancer • Reduces risk for osteoporosis • Delays next pregnancy Evidence class II -III Slide 19
  20. 20. Community Benefits Breast milk is a Fewer healthcare New parents miss Natural and Visits & lower Less work Renewable Treatment costs resource Evidence class III Slide 20
  21. 21. Breastfeeding prevents under nutrition and obesity Under nutrition 40-50% Obesity 50% Evidence class II-III
  22. 22. Breastfeeding decreases the prevalence of obesity in childhood at age five and six years, Germany 5 4.5 4.5 4 3.8 Prevalence (%) 3.5 0 months 3 2.3 2 months 2.5 1.7 3-5 months 2 1.5 6-12 months 1 0.5 0 months breastfeeding Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and obesity: cross sectional study. BMJ, 1999, 319:147-150. Slide 22
  23. 23. Higher Intelligence quotient ( Evidence class I-II) BF 12.9 points BF 2 points higher than FF higher than FF Study in 9.5 year-olds Study in 3-7 1996 year-olds 1982 BF 8.3 points higher than FF Study in 7.5-8 BF 2.1 points year-olds higher than FF 1992 Study in 6 months to 2 year- olds References: 1988 BM 7.5 points •Fergusson DM et al. Soc higher than no BM SciMed 1982 •Morrow-Tlucak M et al. Study in 7.5-8 SocSciMed 1988 BF = breastfed year-olds •Lucas A et al. Lancet 1992 FF = formula fed •Riva Eet al. Acta Paediatr 1996 BM = breast milk 1992 Slide 23
  24. 24. Potential Child Mortality Reduction from Preventive Interventions Deaths prevented Number as proportion of Preventive Intervention (thousands) all child deaths Breastfeeding 1301 13% Insecticide-treated materials 691 7% Complementary feeding 587 6% Zinc 459 5% H influenzae vaccine 403 4% Antiseptic delivery 411 4% Water, sanitation, hygiene 326 3% Jones et al. How many deaths can we prevent this year? Lancet 2003 Slide 24
  25. 25. The value of breast milk to the national economy in India • National production of breast milk by all mothers in India for the children they were breastfeeding at the time of the estimate was about 3944 million liters over 2 yrs. • If the breast milk produced were replaced by tinned milk, it would cost 118 billion Rupees. • If imported, the breast- m substitutes would cost 4.7 ilk million USD. • If breastfeeding practices were optimal, breast milk production would be twice the current amount, doubling the savings by fully utilizing this “national resource”. Adapted from: Gupta and Khanna. Economic value of breastfeeding in India. The National Medical Journal of India, 1999, May-June 12(3):123-7. Slide 25
  26. 26. Comparative health care costs of treating breastfed and formula-fed babies in the first year of life in a health maintenance organization (HMO) When comparing health statistics for 1000 never breastfed infants with 1000 infants exclusively breastfed for at least 3 months, the never breastfed infants had: • 60 more lower respiratory tract illnesses • 580 more episodes of otitis media, and •1053 more episodes of gastrointestinal illnesses Adapted from: Ball & Wright. Health care costs of formula-feeding in the first year of life. Pediatrics, 1999, April, 103(4 Pt 2):870-6. Slide 26
  27. 27. In addition, the 1000 never-breastfed infants had: • 2033 excess office visits • 212 excess hospitalizations • 609 excess prescriptions These additional health care services cost the managed care system between $331 and $475 per never- b reastfed infant during the first year of life. Adapted from: Ball & Wright. Health care costs of formula-feeding in the first year of life. Pediatrics, 1999, April, 103(4 Pt 2):870-6. Slide 27
  28. 28. Slide 28
  29. 29. What is the infant mortality risk from not breastfeeding? 12 Pooled Odds Ratios Ghana 10 Lowest tercile of 8 mat. education 6 4 2 0 0-1 mo 2-3 mo 4-5 mo 6-8 mo 9-11 mo 12-24 mo WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet. 2000 Feb 5;355(9202):451-5. Slide 29
  30. 30. The baby Killer (Andy Chetley/war on want, 1974) • Sale of formula in India Rs • Sale of Bottles in India Rs Slide 30
  31. 31. Mother of Twin Mother of twins - mother in law told her she didn’t have enough for two, UNICEF 1992, Mushtaq Khan Slide 31
  32. 32. Artificial jewelry Real Gold jewelry Animal Milk Breast milk Slide 32
  33. 33. How do we are compare Cow with calf Mother Breastfeeding Slide 33
  34. 34. Why Mothers do not succeed? Marketing of No Lack of formula role Early Models Assistance No confidence Hospital practice No support NO? ‘modern’ way No Correct information Fear Tied down Evidence class I-III Work or Embarrassed school Slide 34
  35. 35. Manufacturing Malnutrition Are they parallel methods ? Promoting best food for baby And where is miracle Sales Who its production • Benefits to – – Manufactures • Who is benefited – Scientists • At which cost ? – Shareholders – System – Health workers • At which cost ? Slide 35
  36. 36. Marketing Confuses Mothers Confused mother Baby’s Misery • Community Practices • Nutritional & health • Health system care • Commercial influences • Attitude • Work & employment • Urbanization • HIV & disaster Slide 36
  37. 37. Which photograph will increase TRP ? (Even Media is afraid of Promoting Breastfeeding) Malnourished baby & A beautiful women mother breastfeeding Which photograph will create controversy ? Slide 37
  38. 38. Milk Donations (What NGOs do for 0-6m nutrition?) Slide 38
  39. 39. Role of International Health Agencies • Mediator - Budget from International Pressure 25% -US groups Assembly • 70% from of Infant food IBFAN Industrialized countries manufactories • How far taking strong stands on sensitive issues ?? Slide 39
  40. 40. What is Advice Feed him on the left! Feed him on the right! Feed him in the morning, Noon, and night! Yeah! Breastfeeding! Slide 40
  41. 41. What is promotion? Slide 41
  42. 42. Slide 42
  43. 43. What is support? • How can we help? • What will work for you? • We have answers that will help you • we can help by observing a feeding your baby Slide 43
  44. 44. Two Most Common Complaints “I don’t have enough milk” Find out why she thinks this Find out if the baby is gaining Inquire about baby’s urine output Inquire about what medications, including birth control meds that she is taking or has been given Slide 44
  45. 45. When a mother thinks… She does not have enough milk Her first response is to supplement with formula This causes her supply to diminish Exactly the opposite of what We want to happen! Slide 45
  46. 46. Two Most Common Complaints “I have sore nipples” Most common cause of sore nipple is poor positioning and latch Mothers want hands-on help with breastfeeding Mothers are NOT embarrassed by hands- on help Slide 46
  47. 47. Slide 47
  48. 48. Slide 48
  49. 49. Two Most Common Complaints “I have sore nipples” If your help with positioning and latch doesn’t improve the pain within 24-48 hours, refer on!!! Remember that the second most common reason for stopping breastfeeding is sore nipples…so act quickly!!! Slide 49
  50. 50. Listen carefully Ask open ended questions Respect Provide Practical Effective Help Accept Communication what she ‘thinks’ or feels Explore Feelings Identify & Information, Evidence class I-II Praise right Options, things Suggestions Slide 50
  51. 51. New 2006 WHO Guidance (HIV and 0-6 Months) • Exclusive breastfeeding does carry lower risk of HIV transmission than mixed feeding • HIV-infected infants should continue to be breastfed • Repeated assessments of feeding choice with mother • Breastfeeding beyond 6 months may be best for some HIV-exposed infants • Counselling should focus on 2 main options (replacement feeding and exclusive breastfeeding for 6 months), with other local options discussed only if mother interested • Home-modified animal milk no longer recommended for all of first 6 months – only to be used as short-term measure Slide 51
  52. 52. • The state shall regard the raising the level of nutrition and the standard of living of it’s people and the improvement of public health as amongst it’s primary duties _ _. Constitution of India, Article 47 Slide 52
  53. 53. • If you believe in the importance of breastfeeding to mother and baby and you have imagination and determination and develop the necessary skills ; even in most difficult situations you may find a way _ _. Slide 53 -Thanks-
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