MBBS Lecture

1. CF:88CF:88

2. CF 85

12. WELCOME ALLWELCOME ALL
CF61

13. INFANTINFANT
FEEDINGFEEDING
Dr Mohammad Nurul Huq
1.1. Feeding inFeeding in early 6 monthsearly 6 months
2.2. ComplementaryComplementary feedingfeeding

14. KEY FACTSKEY FACTS
Child has right toChild has right to good nutritiongood nutrition (Convention on Child Rights)(Convention on Child Rights)
Undernutrition is a/with 45% of U-5 deathsUndernutrition is a/with 45% of U-5 deaths
2017:2017: Globally 155 million U-5 are stunted (too short for
age), 52 million wasted (too thin for ht), & 41 million
overweight/obese
<40% are exclusively breastfed (EBF)<40% are exclusively breastfed (EBF)
<25% get correct complementary foods (CF)<25% get correct complementary foods (CF)
0.82 million U-5 lives could be saved/y, if BF started in 10.82 million U-5 lives could be saved/y, if BF started in 1stst
hh
BM improves IQ, schooling, higher income as adult;BM improves IQ, schooling, higher income as adult;
reduces health costs.reduces health costs. ItIt results in economic gains for
families as well as at national level

15. Bangladesh ScenarioBangladesh Scenario
 Previously EBF was a normPreviously EBF was a norm
 Now, only 40% are EBFNow, only 40% are EBF
 80% breastfeed their babies80% breastfeed their babies
 Family support is often lacking for EBFFamily support is often lacking for EBF
 2,000 crore taka could be saved/y by EBF2,000 crore taka could be saved/y by EBF
 Non-breastfeeding is disastrousNon-breastfeeding is disastrous
 Poor conception about CF is wide spreadPoor conception about CF is wide spread

16. Principles of IFPrinciples of IF
 Counseling at ANC & after birthCounseling at ANC & after birth
 EBF first 6moEBF first 6mo
 Complementary feedingComplementary feeding
 BM for 2yBM for 2y
 NoNo bottle,bottle, nono machinemachine
 NoNo animal milk in first 2yanimal milk in first 2y
 NoNo commercial foodscommercial foods
ANC: antenatal care
EBF: exclusive breastfeeding. BM: breast milk

18. Principles of BFPrinciples of BF
EBF for first 6moEBF for first 6mo
Demand feedingDemand feeding
EBMEBM SOSSOS
 BM for 2yBM for 2y
Correct position & attachmentCorrect position & attachment
Balanced family food for motherBalanced family food for mother
No pacifierNo pacifier
EBM: expressed breast milkEBM: expressed breast milk

19. World Breastfeeding WeekWorld Breastfeeding Week (1-7 August)(1-7 August)
In >170 countries: to promote & support BF, improveIn >170 countries: to promote & support BF, improve
health of babieshealth of babies (Innocenti Declaration: 1990)(Innocenti Declaration: 1990)
– Making workplaces friendly to BF: a long way to go:Making workplaces friendly to BF: a long way to go:
much has improved in 23y to make these BF-friendlymuch has improved in 23y to make these BF-friendly

24. First 6 mo: ExclusiveFirst 6 mo: Exclusive
Breast FeedingBreast Feeding

26. Exclusive Breast Feeding…Exclusive Breast Feeding…
…… feeding the newborn withfeeding the newborn with onlyonly BM (Mother’sBM (Mother’s
milk!);milk!); not even a dropnot even a drop of waterof water
forfor 66 calendarcalendar momo (180d)(180d)

27. Why no water?Why no water?
Composition of BM makes extra water unnecessaryComposition of BM makes extra water unnecessary
even in dry & hoteven in dry & hot climatesclimates!! No dehydration!No dehydration!
Better avoid possible contaminated water!Better avoid possible contaminated water!

28. Is EBF Enough?Is EBF Enough?
Yes!Yes!
 It is proved!It is proved!
– mother fed her babymother fed her baby in-uteroin-utero for 9mo; she canfor 9mo; she can
still do it for another 6mostill do it for another 6mo
– 2 breasts can support2 breasts can support 2 babies!2 babies!
– no mammal fails!no mammal fails!
Breast takes over the feeding roleBreast takes over the feeding role
of placenta after birthof placenta after birth

29. Is BM Enough? …Is BM Enough? …
 Wetness testWetness test
If a baby voids urineIf a baby voids urine ≥≥6 times/d6 times/d
& sucks 8-12 times/d& sucks 8-12 times/d
 Weight checkWeight check
First 6 mo: gains 125g/wFirst 6 mo: gains 125g/w
or 500g/moor 500g/mo

30. If mother says: BMIf mother says: BM not enoughnot enough: check: check
– weight gainweight gain
– feeding techniquefeeding technique
– for illness in baby & motherfor illness in baby & mother
– malnutrition in mothermalnutrition in mother
– check for family supportcheck for family support
– working placeworking place

31. When BM is not enough!When BM is not enough!
 Baby is not sucking effectively:Baby is not sucking effectively:
ActionAction:: position & attachmentposition & attachment
 Mother is very busy & suckles lessMother is very busy & suckles less
ActionAction:: increase frequencyincrease frequency
 Baby does not suck long enoughBaby does not suck long enough
ActionAction:: suckle longer, stroke cheek, any discomfort?suckle longer, stroke cheek, any discomfort?
 Formulas are given: advise the mother about EBFFormulas are given: advise the mother about EBF
(You can refer the mother to BBF)(You can refer the mother to BBF)
BBF: Bangladesh Breastfeeding FoundationBBF: Bangladesh Breastfeeding Foundation

32. FAQ by motherFAQ by mother
 BM is not enough, baby cries a lot!BM is not enough, baby cries a lot!
 Shouldn’t I habituate him with a bottle?Shouldn’t I habituate him with a bottle?
 Can I use a bottle to feed BM?Can I use a bottle to feed BM?
 Can I give water?Can I give water?
contd

33. He has diarrhea from BM!He has diarrhea from BM!
 I am a working motherI am a working mother
 Can I feed him while I am lying?Can I feed him while I am lying?
 He has become v. windy on BFHe has become v. windy on BF
 He is passing lot of urineHe is passing lot of urine
FAQ …FAQ …

34. 101 Benefits of Breast Feeding!101 Benefits of Breast Feeding!
For MotherFor Mother
 Less obesity, may better lose wt.Less obesity, may better lose wt.
 Perfectly easy, cost effectivePerfectly easy, cost effective
(save >(save >$1,000/y). Convenient.$1,000/y). Convenient.
You can do anywhere anytimeYou can do anywhere anytime
 No extra labor/toolsNo extra labor/tools
 Bonding. Birth spacingBonding. Birth spacing (98%)(98%)
Formula bagFormula bag
 Reduces risks of breast & ovarian Ca, T2DM,Reduces risks of breast & ovarian Ca, T2DM,
postpartum depressionpostpartum depression

35. Benefits for InfantBenefits for Infant
 It is the nature’s wayIt is the nature’s way
 EnvironmentallyEnvironmentally friendlyfriendly
 BM nutrient values are just parallel to actual needsBM nutrient values are just parallel to actual needs
of the babyof the baby
 The baby grows optimallyThe baby grows optimally
contdcontd

36. Benefits for InfantBenefits for Infant ……
Fresh & flows round the clockFresh & flows round the clock
Easiest:Easiest: no toolsno tools
Preferred by babies even when sickPreferred by babies even when sick
Growth factorsGrowth factors
Delays allergyDelays allergy
Anemia, scurvy, rickets, etc. are rareAnemia, scurvy, rickets, etc. are rare
(infantile eczema)(infantile eczema)

37. Benefits for InfantBenefits for Infant ……
 Solute load of formulas is muchSolute load of formulas is much
more than that of BM (120 vsmore than that of BM (120 vs
88 mosm/l)88 mosm/l)
 Enteral inf. is virtually nilEnteral inf. is virtually nil
 ARI, otitis media, UTI rareARI, otitis media, UTI rare
 Better IQBetter IQ

38. Uniques of BMUniques of BM
 NoNo nutritionalnutritional deficienciesdeficiencies (mom well-nourished)(mom well-nourished)
 StandardStandard growthgrowth
 UniqueUnique combinationcombination of energy & nutrientsof energy & nutrients
 NumerousNumerous anti-infectives:anti-infectives:
 UniqueUnique bondingbonding
 UniquelyUniquely cheap & cost effectivecheap & cost effective

39. Lack of bonding

40. Anti-infectives in BMAnti-infectives in BM
Prevent viruses, bacteria & parasites:Prevent viruses, bacteria & parasites:
– Specific:Specific: antibodies (mainly IgA)antibodies (mainly IgA)
lymphocytes (humoral, CMI)lymphocytes (humoral, CMI)
– NonNon--specific:specific: lactoferrinlactoferrin
lysozymelysozyme
bifidus factorsbifidus factors
complementscomplements

41. Lactoferrin:Lactoferrin: iron-binding protein: retards bacterial &iron-binding protein: retards bacterial &
fungal growthfungal growth
Lysozyme:Lysozyme: bacteriolytic enzymebacteriolytic enzyme
Complements:Complements: with Ab. destroy particulate Ag.with Ab. destroy particulate Ag.
Bifidus factor:Bifidus factor: prebiotic; stimulates growth ofprebiotic; stimulates growth of L bifidus:L bifidus:
lowers pH: suppresses pathogenslowers pH: suppresses pathogens
Together they make gut unsuitable for pathogensTogether they make gut unsuitable for pathogens
Ab: Antibody. Ag: AntigenAb: Antibody. Ag: Antigen

42. Nutrition in BMNutrition in BM
 EnergyEnergy 70 kcal/100ml70 kcal/100ml
 LactoseLactose 7g/100ml7g/100ml
 FatFat 4.2g/100ml4.2g/100ml
 ProteinProtein 1.45g/100ml1.45g/100ml

43. MicronutrientsMicronutrients
 Fe, Zn, Cu, iodine, Ca, Cl, Na, Mn, P, K, etc.Fe, Zn, Cu, iodine, Ca, Cl, Na, Mn, P, K, etc.
 BM binds Fe, Zn, etc. to ease absorption butBM binds Fe, Zn, etc. to ease absorption but
prevent them from use by bacteriaprevent them from use by bacteria
 All vitamins if mother is not deficientAll vitamins if mother is not deficient

44. EBFEBF Ensures:Ensures:
a virtually infection free normala virtually infection free normal
G&D of the infant &G&D of the infant &
bonding between baby & motherbonding between baby & mother
G&D: growth & development

45. Why Breast is BestWhy Breast is Best
 Breast Feeding is theBreast Feeding is the healthiesthealthiest for mom & babyfor mom & baby
 BF is a wonderful way toBF is a wonderful way to bondingbonding
 BM contains allBM contains all nutrients optimallynutrients optimally
 It hasIt has antibodiesantibodies
 It prevents allergies, tummy problemsIt prevents allergies, tummy problems
 Breastfed babies areBreastfed babies are less obese/have less DM; more IQless obese/have less DM; more IQ
 BF may helpBF may help prevent SIDSprevent SIDS
 BF is the natural, healthy choice for mom & babyBF is the natural, healthy choice for mom & baby

46. BF DifficultiesBF Difficulties
Lack of family support;Lack of family support; lack of confidencelack of confidence
 Working motherWorking mother
 Multiple babiesMultiple babies
 Some diseasesSome diseases
 Breast engorgement, cracked/retracted nippleBreast engorgement, cracked/retracted nipple
 Breast inf.Breast inf.
 Breast tumor …Breast tumor …

47. Inverted NipplesInverted Nipples

48. Breastfeeding ChallengesBreastfeeding Challenges
not always easy for moms & babies:not always easy for moms & babies:
Discomfort.Discomfort. Sore nipple is normal in the first weeksSore nipple is normal in the first weeks
TimeTime.. Baby may take a huge time & effort. MoreBaby may take a huge time & effort. More
frequent than formulafrequent than formula
Diet.Diet. Baby may be sensitive to certain foodsBaby may be sensitive to certain foods
Most mothers find early struggles pass quickly,Most mothers find early struggles pass quickly,
& they settle into BF& they settle into BF

49. Some Moms Can’t Breastfeed!Some Moms Can’t Breastfeed!
A few! But it does not make you a bad momA few! But it does not make you a bad mom
Work.Work. Not all mothers can pump (EBM). Certain jobs mayNot all mothers can pump (EBM). Certain jobs may
make it hard to regular pumpingmake it hard to regular pumping
Companies with >50 employees are required by law toCompanies with >50 employees are required by law to
provide the time & place to pumpprovide the time & place to pump
Not enough milkNot enough milk
HIV/AIDS,HIV/AIDS, medicines can make it unsafe to breastfeedmedicines can make it unsafe to breastfeed
Addiction problems.Addiction problems. Alcohol/drug addict momsAlcohol/drug addict moms
Galactosemia/PKU.Galactosemia/PKU. They must be fed soy-basedThey must be fed soy-based
formulaformula

50. Technique of BFTechnique of BF
MostlyMostly naturalnatural; just feed on; just feed on demanddemand
 8-12 feeds/d8-12 feeds/d
 Some techniquesSome techniques ensureensure success:success:
correctcorrect positioningpositioning &&
attachmentattachment of the babyof the baby

51. Positioning the BabyPositioning the Baby
 Head & body is straightHead & body is straight
 Baby held close to bodyBaby held close to body
 Support baby’s whole bodySupport baby’s whole body
 Baby faces the breastBaby faces the breast
Good positioningGood positioning ensures comfortensures comfort

55. Attachment of the BabyAttachment of the Baby
 Mouth is wide-openMouth is wide-open
 Lower lip is turned outwardsLower lip is turned outwards
 Chin is touching breastChin is touching breast
 More areola is seen above than belowMore areola is seen above than below
Correct position-attachmentCorrect position-attachment ensure comfort & success of BFensure comfort & success of BF

57. Mouth opening

59. MESSAGEMESSAGE
 For 6mo BM is enoughFor 6mo BM is enough
 It protects the baby. It isIt protects the baby. It is
ready to feedready to feed
easy to doeasy to do
cost effectivecost effective
rewardingrewarding
environmentally friendly!environmentally friendly!
It is unique!It is unique!

60. Why Environmentally FriendlyWhy Environmentally Friendly
 Renewable sourceRenewable source
 No extra energy to make & process milkNo extra energy to make & process milk
 No plastic pollutionNo plastic pollution
 No extra man powerNo extra man power
 No inefficient land useNo inefficient land use
 No methane from cows!No methane from cows!
 No ads.No ads.
 No sterilizingNo sterilizing
 No luggage of toolsNo luggage of tools

62. Inefficient land use

63. No trees, no
crops!

66. Mothers! Pl. rememberMothers! Pl. remember
 Breasts are attached to youBreasts are attached to you
 You can’t forget!You can’t forget!
 They serve the perfect food at perfect temp., noThey serve the perfect food at perfect temp., no
matter where you are!matter where you are!

67. Infant formulasInfant formulas
Made fromMade from cow’s milk &cow’s milk & modified as per formulamodified as per formula
Varieties: vary in nutrients, calories, taste, digestibility, costVarieties: vary in nutrients, calories, taste, digestibility, cost
Standard milk-based formulas:Standard milk-based formulas:
 Almost all babies do well on these. Fussiness & colic areAlmost all babies do well on these. Fussiness & colic are
common problems. No need to change the formulacommon problems. No need to change the formula
 Cow's milk protein has been modified. Vegetable oils,Cow's milk protein has been modified. Vegetable oils,
minerals, vitamins are also addedminerals, vitamins are also added
Lactose-free formulas:Lactose-free formulas:
For Galactosemia, alactasia (usually begins after a 12mo)For Galactosemia, alactasia (usually begins after a 12mo)
 In diarrhea: usually no need of lactose-free formulaIn diarrhea: usually no need of lactose-free formula

68. Soy-based formulas:Soy-based formulas:
Soy proteins. No lactoseSoy proteins. No lactose
For parents who do not want animal protein, & forFor parents who do not want animal protein, & for
galactosemia or alactasiagalactosemia or alactasia
 They do not help milk allergies or colic. Babies may alsoThey do not help milk allergies or colic. Babies may also
be allergic to thembe allergic to them
Hypoallergenic IF (protein hydrolysate):Hypoallergenic IF (protein hydrolysate):
may be helpful for allergies to milk protein, skin rashes ormay be helpful for allergies to milk protein, skin rashes or
wheezing c/by allergies. Generally expensivewheezing c/by allergies. Generally expensive
IF: infant formulaIF: infant formula

69. Special formulas:Special formulas: used under supervision:used under supervision:
Reflux formulas:Reflux formulas: thickened with rice starch. Needed onlythickened with rice starch. Needed only
for reflux with FTT or who are v. uncomfortablefor reflux with FTT or who are v. uncomfortable
Formulas for preemies & LBWFormulas for preemies & LBW have extra calorieshave extra calories
and minerals to meet the needs of these infantsand minerals to meet the needs of these infants
Special formulas for CHD, malabsorptionSpecial formulas for CHD, malabsorption syn, &syn, &
problems digesting fat or processing certain amino aproblems digesting fat or processing certain amino a
Toddler formulasToddler formulas are offered as added nutrition forare offered as added nutrition for
toddlers who are picky eaters. To date, they have nottoddlers who are picky eaters. To date, they have not
been shown to be better than whole milk &been shown to be better than whole milk &
multivitamins. They are also expensive.multivitamins. They are also expensive.
Ready-to-useReady-to-use
Conc. liquid formulasConc. liquid formulas

70. Formulas areFormulas are
…… basically dried cow’s milkbasically dried cow’s milk
…… notnot designed for our babiesdesigned for our babies
…… devoid of the unique properties of BMdevoid of the unique properties of BM
So weSo we do not calldo not call thesethese ‘baby foods!’‘baby foods!’

73. Harms from FormulasHarms from Formulas
 CMPICMPI
 Solute overloadSolute overload
 Chemicals, additives: flavoured, tastierChemicals, additives: flavoured, tastier
 Dislike for breast milkDislike for breast milk
 No adequate bondingNo adequate bonding
 Expensive but never fresh!Expensive but never fresh!
CMPI: cow’s milk protein intolerance

74. FAQ on formulasFAQ on formulas
Which brand is the bestWhich brand is the best
Add sugar?Add sugar?
Boil?Boil?
What water, mineral water?What water, mineral water?
How long can be kept?How long can be kept?

75. Feeding BottleFeeding Bottle
 TheThe worstworst invention!invention!
 Very dangerous for babiesVery dangerous for babies
 AA baby killerbaby killer sp. in the LICssp. in the LICs
 Diarrhea & other ID are xDiarrhea & other ID are x88 ::
 Death is xDeath is x44
So, you do notSo, you do not
advocate itadvocate it for your baby!for your baby!
LIC: low income country

76. Bottle-fed babies get diarrhea moreBottle-fed babies get diarrhea more
Difficult to keep bottles cleanDifficult to keep bottles clean
 Easily contaminateEasily contaminate
 Contaminated waterContaminated water
Bottle-fed babies get ARI moreBottle-fed babies get ARI more
 Sleep feedingSleep feeding
 VADX from frequent infx.VADX from frequent infx.
 ContaminationContamination

77. Harms from BottleHarms from Bottle
 EasilyEasily contaminatescontaminates
 Mortality & morbidityMortality & morbidity v highv high
 Diluted feeds:Diluted feeds: malnutritionmalnutrition
 Extra sugar/thickened feeds:Extra sugar/thickened feeds: obesityobesity
 Plastic bottles releasePlastic bottles release BPABPA
 Baby may refuse solids in time:Baby may refuse solids in time: late in solids:late in solids:
Mn., behavioral & developmental problemsMn., behavioral & developmental problems
contdcontd
Bisphenol A: belongs to diphenyl methane

78.  Feeding during sleep:Feeding during sleep:
– overfeedingoverfeeding
– indigestion, bloatingindigestion, bloating
– throat/respiratory infectionthroat/respiratory infection
– tooth decaytooth decay ((nursing bottle syn)nursing bottle syn)
 Lactational failureLactational failure
Harms from Bottle …Harms from Bottle …

79. When giving ORS or EBM
always use a cup &
spoon, never a feeding bottle
EBM: expressed breast
milk

80. BF & FigureBF & Figure
 Mother does not lose her figureMother does not lose her figure
 Helps lose wtHelps lose wt
 Breasts regain shapeBreasts regain shape
 Breast changes in pregnancy, so BF or not BF does notBreast changes in pregnancy, so BF or not BF does not
make any difference!make any difference!

81. AdvantagesAdvantages of Bottle Feeding!of Bottle Feeding!
Anyone can feed your babyAnyone can feed your baby
You can get round-the-clock restYou can get round-the-clock rest
You can also pump BM & feed by bottleYou can also pump BM & feed by bottle
You feed less often: bYou feed less often: babies digest formula slowerabies digest formula slower
Everything you do as a mother, your love, attention,Everything you do as a mother, your love, attention,
& care, will give baby the best start in life& care, will give baby the best start in life

82. ConclusionConclusion
 Every mother can BF (<1% cannot)Every mother can BF (<1% cannot)
 Frequent suck keeps up supply of BMFrequent suck keeps up supply of BM
 Breasts of all sizes are equally goodBreasts of all sizes are equally good
 Shape of nipple does not matter, as long as babyShape of nipple does not matter, as long as baby
takes the breast well into the mouthtakes the breast well into the mouth

83. MCQMCQ
 EBF for 180 days
 Breast milk contains live cells
 Strict schedule is preferable
 Complementary feeding starts from 4 mo
 BM contains secretory IgA

84. Extra water is beneficial for EBF babiesExtra water is beneficial for EBF babies
BF in first hr can save 1 million babiesBF in first hr can save 1 million babies
Formula feeding doesn’t harm bondingFormula feeding doesn’t harm bonding
Formulas are made from milk of millions of cowsFormulas are made from milk of millions of cows
More risk of obesity with bottle feedingMore risk of obesity with bottle feeding
MCQMCQ

85. SAQSAQ
What are the positioning & attachment for EBF?What are the positioning & attachment for EBF?
How do you counsel to make BF a success?How do you counsel to make BF a success?
What are the benefits of EBF?What are the benefits of EBF?
What are the harms of formula feeding?What are the harms of formula feeding?
What are the harms of bottle feeding?What are the harms of bottle feeding?

91. Najat Vallaud-
Belkacem (b. 4
Oct 1977)
Moroccan, is the
first French F.
Minister of Ed,
(age 38)

92. COMPLEMENTARYCOMPLEMENTARY
FEEDINGFEEDING
(After 6mo: Family Foods Along(After 6mo: Family Foods Along
with BF for 2y)with BF for 2y)

93. Principles of CFPrinciples of CF
 Family foodFamily food
 Affordable, balanced, locally availableAffordable, balanced, locally available
 Demand feedingDemand feeding
 No insistence,No insistence, not ceremonial !not ceremonial !
 Easy preparationEasy preparation
 No bottle, no machineNo bottle, no machine
 No sleep feedingNo sleep feeding
Foods that keep parents healthy, also keepFoods that keep parents healthy, also keep
baby healthybaby healthy

94. Why CF?Why CF?
More calories (rapid growth, more activities )More calories (rapid growth, more activities )
Calorie denseCalorie dense foodsfoods
ExplorationExploration of foodsof foods
HabituationHabituation with family foodswith family foods
Integration with the familyIntegration with the family
Varieties of foodsVarieties of foods
Solid foodsSolid foods after tooth eruptionafter tooth eruption

95. Less sugarsLess sugars after tooth eruptionafter tooth eruption
ProtectiveProtective foods (non-nutritional elements)foods (non-nutritional elements)
Development of behavior & personalityDevelopment of behavior & personality
 Iron gap, vitamin A gapIron gap, vitamin A gap
 FitnessFitness
– teeth make the infantteeth make the infant functionally maturefunctionally mature!!
Why CF…Why CF…

96. Weaning!Weaning!
Means taking the childMeans taking the child off the breast!off the breast!
But avail benefits of BM as long as possible!But avail benefits of BM as long as possible!
The term isThe term is d i s c a r d e dd i s c a r d e d
Complementary FeedsComplementary Feeds to complement BFto complement BF

97. CF:CF: is it difficult task?is it difficult task?
NoNo
It cannot be ..It cannot be ..
It should not be ..It should not be ..
It is natural!It is natural!
Natural is easy!Natural is easy!
We should not make easy thing difficult!We should not make easy thing difficult!

98. Who make it difficult?Who make it difficult?
Profiteers!Profiteers!
WithWith fancyfancy food names!food names!
– Follow up-, catch upFollow up-, catch up
– Grow up iron-, -sure, My Boy!Grow up iron-, -sure, My Boy!
– All Vitamins, A-Z foods, etc.!All Vitamins, A-Z foods, etc.!
Promotion of bottle & blenderPromotion of bottle & blender
Trade promotion!Trade promotion!

99. Time of starting of CFTime of starting of CF
After 6After 6 calendar mo (180d)calendar mo (180d); starting of 7; starting of 7thth
momo
Why not earlier?Why not earlier?
Too early may cause diarrhea, Mn, IDAToo early may cause diarrhea, Mn, IDA
Risk of obesity, allergy,Risk of obesity, allergy, atherosclerosisatherosclerosis
May deprive the baby ofMay deprive the baby of uniqueunique BMBM

100. Why not late?Why not late?
 Baby adopts familyBaby adopts family
foods best nowfoods best now
 Delay may causeDelay may cause
– rejection of solidsrejection of solids
– faulty feedingfaulty feeding
Prolonged EBF causesProlonged EBF causes
FTTFTT
IDA, VADXIDA, VADX
Poor resistancePoor resistance
Developmental &Developmental &
behavioralbehavioral
problemsproblems
FTT failure to thrive. VADX: vit A def & xerophthalmiaFTT failure to thrive. VADX: vit A def & xerophthalmia

101. FAQ from our mothersFAQ from our mothers
When to startWhen to start CerelacCerelac,, Junior Horlicks …Junior Horlicks … ??
What formula is the BEST?What formula is the BEST?
Use blender?Use blender?
What rice? What oil? ….What rice? What oil? ….
What fruit? What banana?What fruit? What banana?
Banana & orange cause cold?Banana & orange cause cold?
Veggies cause gas!?Veggies cause gas!?

102. Boil formula?Boil formula?
Times of feeds?Times of feeds?
If no appetite?If no appetite?
Add sugar?Add sugar?
Grapes?Grapes?
How much water?How much water?
How to give eggs?How to give eggs?
 ……
FAQ …FAQ …

103. What types of food?What types of food?
Family foodFamily food is really goodis really good; the baby deserves it!; the baby deserves it!
It isIt is fresh & soft, balancedfresh & soft, balanced
vvaried in texture & flavoraried in texture & flavor
Consider food value:Consider food value: no poor/rich foodno poor/rich food
Not 1 or 2 foods only:Not 1 or 2 foods only: monotonous!monotonous!
Energy dense; more roughage/fiberEnergy dense; more roughage/fiber
More vitamins, mineralsMore vitamins, minerals
No animal milk!No animal milk!
Don’t forget water!Don’t forget water!

104. Why Family Food?Why Family Food?
Always fresh!Always fresh!
Cheap, affordableCheap, affordable
Foods vary dailyFoods vary daily
Integrity with & discovery of familyIntegrity with & discovery of family
BondingBonding
Food varies from country to countryFood varies from country to country
No international food!No international food!

105. International food?International food?
No!No!
 Local foodsLocal foods
 Family foodsFamily foods
 Mother’s foods forMother’s foods for mother’s babymother’s baby!!
Be careful!Be careful! They like to rob away your kitchenThey like to rob away your kitchen

106. Why not commercial foods?Why not commercial foods?
 Not natural; not fresh,Not natural; not fresh, costly!costly!
 Monotonous!Monotonous!
 ManyMany chemicals!chemicals!
– preservatives, additives, tasting salt, flavors, etc.preservatives, additives, tasting salt, flavors, etc.
 It may be old, contaminatedIt may be old, contaminated
 Risk of obesityRisk of obesity
 …… using bottleusing bottle
 …… constipationconstipation
 …… late starting of solidslate starting of solids
 …… addictionaddiction

107. How to start CF?How to start CF?
 Offer when the child is hungry!Offer when the child is hungry!
 Start foods from plant; first aStart foods from plant; first a CHOCHO preferably ricepreferably rice
((suji);suji); add sugar, oil, spiceadd sugar, oil, spice
 At 1-2w intervals add others (At 1-2w intervals add others (khichurykhichury, soup, etc), soup, etc)
 Mix egg in small amounts & increase graduallyMix egg in small amounts & increase gradually
 Give fruits, vegetables, waterGive fruits, vegetables, water

108. Schedule of CFSchedule of CF
 3 times a day for 6-9 months3 times a day for 6-9 months
 4 times a day for 9-12 ,,4 times a day for 9-12 ,,
 5 times a day for 12-24 ,,5 times a day for 12-24 ,,
Up to 12mo: BF first, then CFUp to 12mo: BF first, then CF
1-2 years: CF first1-2 years: CF first

109. Foods for 6-9 monthsFoods for 6-9 months
Suji, riceSuji, rice
Khir or payeshKhir or payesh
Khichury, fruits, vegetablesKhichury, fruits, vegetables
Egg, meat, fishEgg, meat, fish
WaterWater
Make the child habituated with family food withinMake the child habituated with family food within
6-8 months; may be a modified suitable way6-8 months; may be a modified suitable way

110. Foods for 9-12 monthsFoods for 9-12 months
 Khichury, rice, dal, sKhichury, rice, dal, soupoup
 Fruits, vegetablesFruits, vegetables
Eggs, meat, fishEggs, meat, fish
 Home made sweetsHome made sweets
Foods for 12-24 moFoods for 12-24 mo
More solids, more variedMore solids, more varied
Regular foods taken with parentsRegular foods taken with parents

111. Favour for fruitsFavour for fruits
 Seasonal fresh fruitsSeasonal fresh fruits
 Vitamins, minerals, fiberVitamins, minerals, fiber
 ProtectantsProtectants
 Fresh vs processedFresh vs processed
 How much juice a day?How much juice a day?
 Fruits in diarrhea: up to 100ml/dFruits in diarrhea: up to 100ml/d

113. A banana a dayA banana a day
keeps the Dr awaykeeps the Dr away
Energy, protection, stimulant, relaxant (tryptophan)Energy, protection, stimulant, relaxant (tryptophan)
Number 1 fruit for athletesNumber 1 fruit for athletes
Better academic performanceBetter academic performance
Contains all vitaminsContains all vitamins
Good calories (2 bananas = 90min workGood calories (2 bananas = 90min work))
PrebioticPrebiotic moremore⇒⇒

114. A banana a day …A banana a day …
All 3 sugars (fructose, sucrose, glucose)All 3 sugars (fructose, sucrose, glucose)
Fiber, iron, laxativeFiber, iron, laxative
Extremely high in KExtremely high in K++
, low in salt:, low in salt:
regulates BP.regulates BP. Low risk of strokeLow risk of stroke
Anti-irritant for skinAnti-irritant for skin
Well protected, tasty!Well protected, tasty!
Available year roundAvailable year round

115. Grapes are sour for our baby!!Grapes are sour for our baby!!
Partly rotten! Difficult to cleanPartly rotten! Difficult to clean
Chance of contaminationChance of contamination
Not protectedNot protected
Mainly sugarMainly sugar
Expensive!Expensive!

116. Vibrant Rainbow VegetablesVibrant Rainbow Vegetables
Non-nutritious parts: fiberNon-nutritious parts: fiber
ProtectantsProtectants
Rich in vitamins & mineralsRich in vitamins & minerals
PrebioticPrebiotic
Some can be taken freshSome can be taken fresh
60% drugs are derived from plants

117. The egg storyThe egg story
• After 6moAfter 6mo
• First class proteinFirst class protein
• Must be:Must be: well cooked/hard boiled/friedwell cooked/hard boiled/fried
• NeverNever poached or half boiledpoached or half boiled
• Cooking destroys 70% allergenicityCooking destroys 70% allergenicity
Semicooked eggs contains bugs from poultry unless pasteurized!

118. The ‘khichury’The ‘khichury’
The basic foodThe basic food !!
Really tasty. You can add anything to it!Really tasty. You can add anything to it!
Unique!Unique! All essential amino acidsAll essential amino acids
Different taste from different ingredientsDifferent taste from different ingredients
It is new daily!It is new daily!
Not monotonousNot monotonous

119. The chips/The chips/fizzy drinksfizzy drinks storystory
No outdoor foodsNo outdoor foods (chips, biscuits, candies!)(chips, biscuits, candies!)
Chance of contaminationChance of contamination
Are mainly sweets, not balancedAre mainly sweets, not balanced
Salt overloadSalt overload
May not be of good qualityMay not be of good quality
 AdditivesAdditives
 Empty calories!Empty calories!

120. Non-nutritious:Non-nutritious: emptyempty
calories!calories!

121. How to offer?How to offer?
Breast feed firstBreast feed first
Make the session enjoyableMake the session enjoyable
No bottle/blender: use cup & spoonNo bottle/blender: use cup & spoon
Temporary withdrawal of rejected foodTemporary withdrawal of rejected food
Postpone foods causing V&DPostpone foods causing V&D

123. The blender storyThe blender story
 Risk of contaminationRisk of contamination
 Solids may be rejectedSolids may be rejected
 Risk of habituationRisk of habituation
 Expensive!Expensive!

125. How frequently?How frequently?
On demand!On demand!
Don’t force/insist!Don’t force/insist!
Don’t expect eating the whole amountDon’t expect eating the whole amount
Don’t feed in sleepDon’t feed in sleep (only possible with bottle)(only possible with bottle)

126. Adopt the baby to family foodsAdopt the baby to family foods
After suji give khichury, soup, etc.After suji give khichury, soup, etc.
Don’t hurry! Give a slice of orange/lemon or aDon’t hurry! Give a slice of orange/lemon or a
piece of carrot! S/he explores it!piece of carrot! S/he explores it!
Keep the baby with all at the dinning tableKeep the baby with all at the dinning table
– offer something on dish. S/he will spill some!offer something on dish. S/he will spill some!
– don’t be upset!don’t be upset!

127. Working motherWorking mother
 Not a problemNot a problem
 Problem not with working statusProblem not with working status
 The attendant should be convincedThe attendant should be convinced
 Cup & spoon feedingCup & spoon feeding
 Adequate maternity leaveAdequate maternity leave

128. ConclusionConclusion
Family foodsFamily foods are:are:
scientific, hygienicscientific, hygienic
cheap,cheap, naturalnatural
simple, easysimple, easy
 really good!really good!
enjoyableenjoyable
every day new!every day new!
no problem withno problem with
working mother!working mother!
We do not make feeding difficultWe do not make feeding difficult

129. Mom must beMom must be
beside me!beside me!

130. MCQMCQ
CF started after 6moCF started after 6mo
Blending makes food more digestibleBlending makes food more digestible
Vegetables have non-nutritional protectantsVegetables have non-nutritional protectants
Before 1y CF should be given firstBefore 1y CF should be given first
Best age to adapt family foods is 6-8moBest age to adapt family foods is 6-8mo
 Rich foodsRich foods are the best foodsare the best foods
 Feeding bottle is a baby killerFeeding bottle is a baby killer

131. Next lectureNext lecture
E. P. I. TARGETE. P. I. TARGET
DISEASESDISEASES