At the end of this session, you will be able to List the advantages of breastfeeding Describe artificial feeding of Infants Enumerate the differences b/n human and cow’s milk Explain the concept of weaning Enumerate the 10 steps of Baby-Friendly Hospital Initiative

1. Preventive Medicine in
Obstetrics, Paediatrics and
Geriatrics
Dr. Jayaramachandran S
Associate Professor
Department of Community Medicine

2. At the end of this session, you will be able to
ü List the advantages of breastfeeding
ü Describe artificial feeding of Infants
ü Enumerate the differences b/n human and cow’s milk
ü Explain the concept of weaning
ü Enumerate the 10 steps of Baby Friendly Hospital Initiative

4. Facts about breastfeeding
• Globally, only 38% of infants 0-6 months are exclusively breastfed
• Early initiation of breastfeeding can prevent 20% of newborn deaths
• Feeding of colostrum decreases neonatal and post neonatal deaths
• Babies who are exclusively breastfed for the first six months of age
are 11 times less likely to die from diarrhoea and 15 times less likely
to die from pneumonia
• Breastfeeding is least expensive

5. Facts about breastfeeding

6. Breast-feeding
• Breast milk is the ideal food for the infant
• No other food is required by the baby until 6 months after birth
• Under normal conditions, Indian mothers secrete 450 to 600 ml of
milk daily with 1.1 gm protein per 100 ml.
• The energy value of human milk is 70 kcal per 100 ml.

7. Advantages of breast feeding – Newborn
1. It is safe, clean, hygienic, cheap and available to the infant at correct
temperature
2. It fully meets the nutritional requirements of the infant in the first
few months of life
3. It contains antimicrobial factors such as macrophages, lymphocytes,
secretory lgA, anti-streptococcal factor, lysozyme and lactoferrin
which provide considerable protection not only against diarrhoeal
diseases and necrotizing enterocolitis, but also against respiratory
infections in the first months of life

8. Advantages of breast feeding – Newborn
4. It is easily digested and utilized by both the normal and premature
babies
5. It promotes "bonding" between the mother and infant
6. Sucking is good for the baby – it helps in the development of jaws
and teeth
7. It protects babies from the tendency to obesity
8. It prevents malnutrition and reduces infant mortality

9. Advantages of breast feeding – Newborn
9. It provides several biochemical advantages such as prevention of
neonatal hypocalcaemia and hypomagnesemia
10. It helps parents to space their children by prolonging the period of
infertility
11. Special fatty acids in breast milk lead to increased intelligence
quotients and better visual acuity.
12. A breast-fed baby is likely to have an IQ of around 8 points higher
than a non-breast fed baby

10. Advantages of breast feeding – Mother
Early initiation of breast-feeding
• Lowers the mother's risk of postpartum haemorrhage and anaemia,
• Boosts mother's immune system
• Delays next pregnancy and reduces the insulin of diabetic mothers.
• It protects mothers from ovarian and breast cancers and osteoporosis

11. MAA (Mothers’ Absolute Affection)
• It involves a comprehensive set of activities on protection, promotion
and support of breastfeeding and child feeding at community and
facility levels.
• The chief components of the MAA Programme are community
awareness generation, strengthening inter personal communication
through ASHA, skilled support for breastfeeding at delivery points in
public health facilities, and monitoring and award/recognition.

12. WHO and UNICEF recommend
• Initiation of breastfeeding within the first hour of life
• Exclusive breastfeeding up to 6 months of age
• Breastfeeding on demand
• No use of bottles, teats or pacifier
• Continued breastfeeding up to 2 years of age or beyond, with
introduction of nutritionally adequate and safe complementary (solid)
foods at 6 months.

14. Artificial Feeding – Indications
üFailure of breast milk
üProlonged illness or death of the mother
It is crucial for the baby to be fed "breast-milk substitutes”
a) Dried whole milk powder
b) Fresh milk from a cow or other animal
c) Commercial formulae

15. Principles of Artificial Feeding
Nutrient Requirement
Protein First 6 months: 2 g/kg & End of one year: 1.5 g/kg
13-14 g protein daily during the first year of life
8 to 10 % of calories are given as protein
Carbohydrate 10 g/kg of body weight daily
After 4 months of age, undiluted boiled and cooled milk
should be given
150 ml of milk / kg – 100 kcal / kg / day
Infants need feeding : 6-8 times a day & older babies 5 times a day

16. a) Dried whole milk powder
• The safest milk which is scientifically prepared for infant feeding
• It is free from bacteria; there is little danger from flies
• It does not become sour and is simple to reconstitute
• It is usually fortified with vitamins.
• But it is expensive (beyond the reach of many Indian families)

17. b) Fresh milk from a cow or other animal
• A cheaper alternative which is well within the reach of many Indian
families is cow's milk, which in fact is widely used for infant feeding.
• Recommended dilution of cow's milk during the first 2 months in
order to reduce the solute load on neonatal kidneys.
• Artificial feeding is a hazardous procedure in poor homes because of
the dangers of contamination and over-dilution of the feed.

18. Schedule for infant feeding with cow's milk

20. Comparison between breast milk
during the 1st month of lactation and
unprocessed cow milk

24. Weaning

25. Weaning
• Weaning is not sudden withdrawal of child from the breast.
• It is a gradual process starting around the age of 6 months, because
the mother's milk alone is not sufficient to sustain growth beyond 6
months.
• It should be supplemented by suitable foods rich in protein and other
nutrients.
• These are called "supplementary foods".

26. Weaning
• These are usually cow's milk, fruit juice, soft cooked rice, suji, dhal
and vegetables.
• The weaning period is the most crucial period in child development,
• A knowledge of weaning foods and practices is an important aspect of
preventive and social paediatrics.
• At the age of one year, the child should receive solid foods consisting
of cereals, pulses, vegetables and fruits.

27. Baby Friendly Hospital Initiative

28. Baby Friendly Hospital Initiative
• The Baby-friendly Hospital Initiative (BFHI) was launched by WHO and
UNICEF in 1991, following the Innocenti Declaration of 1990.
• The initiative is a global effort to implement practices that protect,
promote and support breastfeeding.
• The ten steps summarize a package of policies and procedures that
facilities providing maternity and newborn services should implement
to support breastfeeding.

29. Baby Friendly Hospital Initiative – 10 steps
• The "Baby friendly" hospitals in India are also expected to adopt and
practice guidelines on other interventions critical for child survival
including antenatal care, clean delivery practices, essential newborn
care, immunization and ORT

30. Baby Friendly Hospital Initiative – 10 steps

31. Baby Friendly Hospital Initiative – 10 steps

32. Baby Friendly Hospital Initiative – 10 steps

33. Baby Friendly Hospital Initiative – 10 steps

34. Baby Friendly Hospital Initiative – 10 steps

35. Written assignment to be submitted
1. List the importance of breastfeeding of Infants
2. Describe the principles of artificial feeding for
Infants.
3. Enumerate the 10 steps of Baby Friendly Hospital
Initiative

36. Any Questions?