a must know for parents on starting feeding from newborn to one year

1. The Art of Infant Feeding

2. Declaration:
 Statements and opinion expressed are of Author and
not necessarily those of Nepal Pediatric Society.
 The presenter has the complete and independent
control over the planning and content of the
presentation and is not receiving any compensation of
any kind from any person or any source for this
presentation.
 The presenter will acknowledge the sources as a
reference literature or picture.

3.  Nonorganic failure to thrive can be understood in
terms of both physical and emotional deprivation of the
child, and has both physical and behavioral signs.
Caloric deprivation of an infant may be caused more
or less innocently by lactation failure, extreme poverty,
parental ignorance of proper infant feeding, or strange
nutritional beliefs.
 Failure to Thrive - Diagnosis - Baby, Child, Mother, and Nonorganic - JRank Articles http://social.jrank.org/pages/246/Failure-Thrive-Diagnosis.html#ixzz21VV7L2WU

4.  Equipped with highly developed sensory capacities,
and a language consisting of smiles, gestures, eye-to-
eye contact, and vocalizations, the infant develops
with its mother a reciprocal communication system
that sets the stage for all future development.
 In spite of the recognition of the newborn's ability to
interact and respond to the environment, surprisingly
little attention has been paid to the behavior of the
infant in studies of the causation of early infant
malnutrition.
The Consultative Group on Early Childhood Care and Development: Coordinators' Notebook No. 7, February 1989

5.  Early feeding disturbances are quite frequent in the
infant population, affecting around 25% to 35% of
children.
 The most serious problems occur when inadequate
intake of food results in failure to thrive or growth
stunting.
 The early years of life are crucial in terms of brain
development, and the building of neuronal
connections.
 Early malnutrition could “program” the body of the
infant to develop health problems later on in life.
Loredana Lucarelli Journal of the American College of Nutrition, Vol. 23, No. 3, 259–271 (2004)

6. The art of infant feeding
Mother worries because……
Not gaining weight………
Not eating……………….
Vomits when fed…….
Looking thin when
compared
to his group……
Not taking solid…………..
Bone is thin………………
Skin is thin………………

7.  The denial of as little as 200-300 calories in a young
child’s daily diet is what makes the difference between
the normal growth and the faltering that starts the
descent towards illness and death.
 No obvious linkage between levels of child malnutrition
and income poverty the quantity of food required to
adequately feed an infant is affordable for practically
all families – half a chapatti or half a banana or a
boiled potato or a bowl of dal.
 http://www.hindu.com/2007/06/22/stories/2007062250151000.htm

8. Eating is a natural instinct for survival

9. Our first case………..
 Six months old female attends the clinic for
 Not gaining weight, does not take solid, vomits when
fed.
 FTCS (heart rate not good), 2.800 Kg, no perinatal
problem, formula by bottle in first three days, breast ,
formula, introduced lito: sarbottam, cows milk, honey:
feeds in lying position. Immunized.
 Present weight 5.300Kg, mild pallor. Development:
normal.

10. Our second case………..
 Six year old female attends the clinic for
 Not gaining weight, does not take solid, vomits when
fed.
 FTCS (previous CS), 2.800 Kg, no perinatal problem,
formula by bottle in first three days, breast and
formula, introduced lito: sarbottam, cows milk,
immunized. Mother still feeds. Grinds in mixture.
Wakes at 7.30 goes to bus 8.15.
 Present weight 12 Kg, mild pallor. Development
normal.

11. Feeding from birth
to
early adolescent:
 Nature teaches because it is essential for survival.
 Eating and feeding is an art which should be learned by
an eater or feeder.
 Eating requires involvement of more sensory organs.
 Eating is a process which is developmentally controlled.
 Feeding myth is present even with medical personnel.
 Educating the feeding process starts from antenatal
checkup.
 Counseling mother and father simultaneously.
 Poor appetite is common in food sensitivity syndromes.
The child becomes conditioned to refuse foods.

12. Feeding from birth to
early adolescent: Importance......
 Lifelong eating patterns begin during this period.
 Adjusting caloric intake to needs .
 Learning to enjoy a variety of foods are major
objectives of feeding practices.
 six-month-old babies cannot eat by themselves.
 Feeding a[n]…infant…is time-consuming.
 Task of feeding is often entrusted to an older sibling.
 Medical professional do not teach how to feed.
 http://www.hindu.com/2007/06/22/stories/2007062250151000.htm

13. What questions to ask in relation
to the problem?
 Frequency of feeding?
 Amount / formula feeding/ lito or haluwa feeding?
 Who feeds?
 Position of feeding?
 Vomiting during feeding?
 Forced feeding?
 Using distractions?

14. The two important reason to
know the art of infant feeding:
 THE FIRST year of life is a time of more rapid growth,
development, and maturation than any subsequent
year.
 6 Kg in one year,
 Sucking - hand to mouth,
 Supine- sitting.
 Synapses
 A loving and stimulating environment.

15. The art of infant feeding
 Two areas of knowledge—
 the nutritional requirements of infants
 Intakes less than 80 kcal/kg/day are usually inadequate, and
intakes above 120 kcal/kg/day are usually associated with the
development of obesity
 Developmental synchronization of feeding behavior
 the practical application of feeding.

16. May interfere with establishing sound
eating habits……………..
 Developmental readiness is evident when an infant can
lift the head, sit with support, and turn the head to indicate
that he had enough to eat.
 Physiologic readiness occurs when an infant begin to
produce enzymes capable of digesting complex
carbohydrates and proteins other than milk protein.
 Some parents, based on unsupported belief, begin
providing solid foods for their infants before 4 months of
age.
 Stool exam: undigested food- supplementing enzyme.

17. 16

18. ha

20. The feeding physiology
sucking, swallowing, chewing
 Dynamic engagement of neural
circuitry influences the cellular
properties and synaptic
interactions among systems
 Motor learning (use) and
sensory feedback play a crucial
role in the development (i.e.,
recombination) of complex
motor acts.
 Environmental factors
associated with the infant and
caregiver interaction may begin
to shape infant use of tongue
and other muscle of mastication. modernguidetohealth.com

21. The motor physiology
 Mandibular coordination is
also distinct for each of the
alimentary behaviors of
sucking and chewing.
 distinctions in the
organization of mandibular
motor control may reflect
varying interarticulatory
constraints among oral
structures (e.g., tongue)
arising from widely varying
task demands.
 Tongue forms a spoon like
shape
GenioglossusGenioglossus
modernguidetohealth.com

22. Developmental progress………
 Factors important in the timing and nature of solid food
practices:
 developmental status of the infant
 the influence of early feeding practices and lifelong
dietary habits.
 Up to 3-4 months:
 the neuromuscular development of infants is appropriate
for sucking and swallowing liquids.
 3 and 6 months of age:
 recognition and the ability of the tongue to make paste by
adding saliva to the solid and swallowing mechanism.
75 % of children (2006-2010*) who are: introduced to solid, semi-solid or soft foods, (6-

23. Type of food and its effect in
behavior…………….
 The infant progresses from a monotonous, liquid,
white diet to increasing diversity in consistency, taste,
color, and temperature.
 About 6 months of age, and the ability to swallow
lumps at about 9 months of age leads to the
introduction of foods from the family table.

24. The neurological preparation for
feeding…………….
I. After birth:
 Rooting reflex
 Sucking reflex
 Swallowing reflex
 Palmar grasp
V. Twelve month:
 Good hand mouth
control.
 Close observation.
 Learns vocabulary.

25. II. Sixth month:
 Good head control
 Starts sitting
 Hold objects
 Makes chewing movements
 Shows significant weight gain
 Shows interest in food.
 Can close mouth around a spoon
 Can move food from front to back
of mouth
 Can move tongue back and forth,
but is losing tendency to push food
with tongue.
.
 Seems hungry after 8-10 feeds of
breast milk or 40oz of formula in a
day.
 Sipping process
 Observes and imitates.
 Amount of breast milk decreases.
 Start solid with rice powder mixed
with breast milk or formula.
 Remember infant should make
paste of Lito in his/her mouth with
tongue movement.
 Infant will not eat cereal on the first
day; it will take some time to learn
it.

26. III. 6-8 months:
 This is the time for Transient
Erythroblastopenia of
childhood.
 Iron fortified solid is
necessary.
 Start feeding paste of banana,
cooked carrots, peaches etc.
 Paste of meat, fish, egg yolk
 Curd, tofu, beans, peas etc.
 3-9 Table spoon cereal in 2
feeding;
IV. Ninth month:
 Pincer grasp develops.
 Puts e everything in mouth.
 Begins to crawl.
 Explores.
 Moves jaw in Chewing
motion.
 Give bite size soft cooked
vegetables, small pieces of
banana, bread, cottage
cheese.

27. Relating to the diet:
 How much does the child eat?
 After first few days of birth:
 Breast feeding on demand.
 During the first month baby sleeps longer than four to five hours
cycle and starts missing feeding so baby needs to be wake-up for
feeding.
 Formula: 60-90ml per feed and will take every three to
four hours.
 Does the child getting enough calcium?
 Does the child getting enough iron?

28. Four months old child (6 Kg):
Total feeding: 8 feeds
7 Milk feed /4 oz per
feed.
1 Solid feed= 1
spoon/feed
660 Calorie
80 Calorie/Feed with
milk
20 Calorie/Feed with
solid
Every solid feeding will make
the infant hungry of 60 calorie

29. Lito or Haluwa
 LITO
•HALUWA
Water
Solid

30. Infant Feeding: 4 – 6 months.
• The introduction of food must be one at a
time, start each food once daily x 6 days,
before offering the next food.
• Once the infant tolerates each food, it may
be given until the baby rejects it, this usually
happens around 10 – 12 months of age.
• Feeding intervals should be every 4-5 hours
per meal.

31. 6 MONTHS:
 Introduce other cereal, 2-3 tablespoons per
day. After 6 days, feed as much as the baby
wants.
 Follow with other fruit, ½ cup or ½ jar once
daily. After 6 days, feed as much as the baby
wants.

32. Prior to 12 months of age, DO NOT
introduce the following:
 Citrus fruits and juices (orange, pineapple,
grapefruit, lemonade, tomato)
 Wheat cereal
 Honey*
 Whole milk
 Egg white
 Fish
 Chocolate, nuts, peanut butter.
*Shiva R, Bhanu W, Surabhi V, Karyan M. Infant botulism and immune globulin in the UK: a case
series of four Infants. Arch Dis Child. 2012; 97:459-460.

33. The developmental process of feeding
Suckles Controls
head
movemen
t
Sits with
support
Chews Grasp
s
Feeds
self
Improves
coordination
Holds
Birth
O
ne
year
9-12m
onth
s
7-9m
onths
6m
onth
s
8
m
onths
5-7m
onths
4-6m
onths
MILK Whole milk
Whole egg
3 meals a
Day + snac
Mashed
family
meal
Self with
spoon
Other cereal
Mashed fruits
Finger foods
Meat
Chicke
n
Beans
Yogurt
Egg
yolk
Diluted
fruit juice
Drink
from a
small cup
Vegetabl
es
Fruits
Iron
fortified
infant
cereal
(rice)

34. The period between age 1 and 2 yr:
 There is dramatic decrease in growth rate reflected in
disinterest in food.
 Around the age of 15 months, develop autonomy and
independence.
 Can completely self-feed and can seek food
independently.
 Growth, BMR, and endless activity require an energy
supply of 1300 kcal/day.
 Hunger, guide the child’s perception of time to eat.

35. 4 to 6 years old………..
 Independent eating styles.
 They understand the time frame of meals and can save
their appetite for meals.
 Snacks form an integral part of the child’s nutrient intake
 Develop a sense of responsibility for healthy food
selection. They can understand that although all foods are
fine. Food jags may continue for a while.
 Parents should educate children , offer substitute choices
that the child can finally select from
 Energy requirements increase to 1800 kcal/ day

36. 7 to 12 years old………….
• Actual growth may slow down but preparing for the
puberty growth spurt.
• This prepuberty time maybe reflected by weight
buildup; an increase in chubbiness.
• Parents may plant the seeds of eating disorders
• Energy requirements increase to 2000 to 2200
kcal/day

37. Food refusal behavior
 Forced feeding.
 Diverting attention.
 Singly feeding.
 Unnecessary drugs.
 Iatrogenic enzyme inducers.
 Single pattern of food.
 Discrepancy between eating and developmental process.
 Change of environment.
 Different feeder.

38. Habbi! do
not force me
to eat. I can
eat myself.

39. Disorders Unique to or Beginning in
Infancy and childhood………..
 Failure to thrive:
 disorders of the CNS, endocrine system, congenital defects,
or intestinal obstruction, or it can occur due to inability to suck,
chew, or swallow related to neuromuscular problems.
 Colic: maybe associated with overfeeding, feeding too quickly,
swallowed air, or maternal or infant anxiety.
 hereditary or unknown
 feed the infant slowly in an upright position with the head and
chest tilted slightly backward.
 Fat malabsorption.

40. Our first case………..
 Six months old female attends the clinic for
 Not gaining weight, does not take solid, vomits when
fed.
 FTCS (heart rate not good), 2.800 Kg, no perinatal
problem, formula by bottle in first three days, breast
and formula, introduced lito: sarbottam, cows milk:
feeds in lying position. Immunized.
 Present weight 5.300Kg, mild pallor. Development
normal.

41. Our second case………..
 Six year old female attends the clinic for
 Not gaining weight, does not take solid, vomits when
fed.
 FTCS (previous CS), 2.800 Kg, no perinatal problem,
formula by bottle in first three days, breast and
formula, introduced lito: sarbottam, cows milk,
immunized. Mother still feeds. Grinds in mixture.
Wakes at 7.30 goes to bus 8.15.
 Present weight 12 Kg, mild pallor. Development
normal.

42. Some
myths:
 What is lito?
 Cow’s milk is good.
 Honey is good.
 Ghote chauthi keeps child healthy.
 Gripe water is good.
 Child cannot swallow thick food.
 Vitamins makes hungry.
 Enzymes helps in digestion.
 Herbal medicine brings strength.
 Force feeding has to be done.
 Meat or poultry product should not be used early.
 Vitamins increase appetite.
 Some foods are hot and some are cold.
 You can go on adding the
list………………

43. Thank you

44. 4 MONTHS.
 Introduce rice cereal, 2-3 tablespoons per
day, 1 tablespoon = 3 teaspoons.
 After 6 days, feed as much as the baby
desires.
 Follow with banana, ½ cup of natural banana
or prepared/commercial baby food, once
daily.
 After 6 days, feed as much as the baby
desires.
 Now, advance to the 5 months diet. Do not
stop the previous foods.

45. 5 MONTHS.
 Introduce other cereal, 2-3 tablespoons per
day. After 6 days, feed as much as the baby
accepts.
 Follow with pureed fruit, ½ cup. After 5 days,
feed as much as the baby accepts.
 Now, advance to the 6 months diet. Do not
stop the previous foods.

46. The neurological preparation for
feeding…………….
 After birth:
 Rooting reflex
 Sucking reflex
 Swallowing reflex
 Palmar grasp
Twelve month:
 Good hand mouth
control.
 Close observation.
 Learns vocabulary.