The document discusses breastfeeding and complementary feeding recommendations for infants and children. It provides guidelines on exclusive breastfeeding for the first 6 months, continued breastfeeding with solid foods introduced between 6-24 months, and assessing adequate breastfeeding. The document also outlines potential feeding problems in the first year like underfeeding, overfeeding, and colic, and recommends introducing cereals, fruits and vegetables between 6-8 months as complementary foods.

1. Edomgenet Tesfaye M.D
Assistant professor of Pediatrics
and child health

2. 
 Introduction
 Advantages and contraindications of breast feeding
 Steps toward good breast feeding
 Complementary feeding
 Feeding problems
 Summary
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Outline

3. 
 Breast feeding is recommended as exclusive nutrient
source for feeding infants during the first 6 months
after birth and should be continued, with the
addition of solid foods atleast through the first 12 -24
months.
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Introduction

4. 
 Rooting reflex Child
 Sucking reflex
 Swallowing reflex
 Prolactin reflex Mother
 Letdown reflex
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Reflexes concerned with
Breast feeding

5. 
Human Milk Cow Milk
Calories 67 kcal/100ml 67 kcal/100ml
water 87% 87%
Carbohydrate 7.4% 4.4%
Fat 3.5% 3.5%
Protein 1.5% 3.5%
Lactalbumin: Caesin 60:40 20:80
Sodium 15mg 60mg
Phosphorus 15mg 90mg
Calcium 30mg 120mg
Iron 0.5 mg 0.1 mg
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Composition of Breast milk
Vs. Cow milk

6. 
 Inexpensive
 Readily available and free from pathogenic bacteria.
 Ideal composition for infant growth
 Establishment of healthy mother child relationship
 Contains Immunoglobulin IgG and IgA, protects
against certain infections.
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Advantages

7. 
 Involution of uterus by secretion of Oxytocin
 Contraception
 Decreased incidence of breast cancer
 Allergy to breast milk is rare
 Good source of Iron, Vitamin C
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Advantages

8. 
 A 28 year old Primiparous mother is newly
diagnosed with Retroviral infection. She is confused
about subsequent feeding of her newborn and
consulted you. What advice will you give her?
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Case 1

9. 
 Chronic debilitating maternal illness
 Maternal Psychiatric conditions e.g. Post partum
psychosis
 Maternal drug intake
 Babies with Galactosemia/Phenylketonuria
(Absolute contraindication)
 Prematurity
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Contraindications

10. 
 Hormones: Progesterone, estrogen, placental
lactogen, prolactin, cortisol, and insulin
 Oxytocin
 The intensity and duration of subsequent lactation
are controlled, in large part, by the repetitive
stimulus of nursing.
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Endocrinology of lactation

11. 
 Mother needs to be counseled about breast feeding
on her antenatal visits.
 Colostrum: deep lemon-yellow colored liquid
secreted initially by the breasts
 Feeding should be started with in half an hour of
delivery
 Baby should be fed on demand
 Breast feeding should be given for 15 – 20 minutes.
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Initiation of breast feeding

12. 
 At each feeding both breasts are offered but baby
should start the next feed on alternate side.
 Burping
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continued

13. 
 A 29 year old Primiparous mother is concerned
about her breast feeding. She doesn’t know whether
her breast milk is adequate for her newborn. How do
you assess the adequacy breast feeding?
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Case 2

14. 
 Weight gain
 Frequency and duration of breast feeding
 Sleep between feedings
 Diaper change per day
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Adequacy of Breast
feeding

15. 
 Mother should be sitting comfortably relaxed.
 Position the baby
1. Baby’s neck straight or bent slightly back
2. Baby’s body close to the mother’s body and whole
body supported.
3. Baby facing the breast with nose opposite to the
nipple
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Steps toward Good breast
feeding

16. 
Good attachment
 Baby’s chin is touching or very close to the breast.
 Baby’s mouth wide open.
 Baby’s lower lip turned outwards
 More areola is visible above than below the mouth.
2/13/2023 16
continued

17. WAIT until the
baby’s mouth is
WIDE open
Jeanette Panchula - BSW, RN, PHN, IBCLC - Solano County Health and Social Services

18. Nose very close or
touching breast
Chin deeply into
breast
Observe to make sure:
•Cheeks DO NOT suck in
•Breast moves toward the mouth
and not away
Lips flanged
Jeanette Panchula - BSW, RN, PHN, IBCLC - Solano County Health and Social Services

19. 
 Sustained suck/swallow pattern with occasional
pauses
 Audible swallowing
 Relaxed arms and hands
 Moist mouth
 Satisfied after feeding
Observe for signs of milk transfer
Jeanette
Panchula
-
BSW,
RN,
PHN,
IBCLC
-
Solano
County
Health
and
Social
Services

20. 
2/13/2023 20

21. 
 Formula Milk
 Cow’s milk
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Other types of Feeding

22. 
 Work out the caloric requirement and water
requirement.
 Interval of feed
 Boiled water is used to prepare formula milk.
 All utensils should be boiled/sterilized
 Burping
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continued

23. 
Age Calories/kg/day
Infant 110
1-33 100
4-6 90
7-9 80
10-12 70
13-15 60
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Caloric requirements

24. 
 Calculate amount of milk(breast/formula) for a 10
kg infant in 24 hours?
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Exercise

25. 
Complementary
Feeding
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26. 
 Complementary foods – additional foods including
formulas, given to breast fed infants
 Replacement foods – foods other than formula given
to formula fed infants
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Complementary Feeding

27. 
 Timely
 Adequate
 Safe
 Properly fed
Frequency
 6-8 months: 2-3 times per day
 9-11 months: 3 -4 times per day
 12-24 months: 4-5 times per day
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Complementary feeding

28. 
 A parent of 6 month old infant who came for well
baby follow up asked you what kind of solid foods,
how and when to start? How do you advise this
parent?
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Case 3

29. 
 Feed infants directly and assist older children when
they feed themselves ,being sensitive to their hunger
and satiety cues.
 Feed slowly and patiently
 Avoid distraction feeding.
 If children don’t like the food you provided,
experiment with different combinations, textures,
tastes and methods of encouragement.
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Complementary feeding

30. 
 Practice good hygiene and proper food handling.
 Amount of food offered should be small at first and
gradually increased as child gets older while
maintaining breast feeding.
 Gradually increase food consistency and variety as
the infant gets older adapting to the infant’s
requirement and abilities.
 Meal frequency
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Complementary feeding

31. 
Weaning should be stepwise to both breast fed
and formula fed infants
 Cereals, a good source of iron, usually should be the
first food
 Vegetable & fruits are introduced next
 Meats follows shortly
 finally eggs
 One new food should be introduced at a time
 Additional new foods should be spaced by 3-4 days
 Adverse reactions (families with food or other allergies)
Complementary feeding

32. 
Underfeeding
 Suggested by restlessness and crying
 Failure to gain wt.
 Possible causes
 Check frequency of feeding, mechanics of feeding
 Abnormal mother infant bonding
 Possible systemic disease
 Rx – instructing mother about the art of BF and
psychological support
_ specific management of systemic illnesses
Feeding problems during the 1st year of
life

33. 
Overfeeding
 Regurgitation and vomiting
 Reg. –return of small amount of swallowed food
 Vomiting – more complete emptying of stomach
 Too high in fat – delay in gastric emptying, cause
abdominal distention and Discomfort,
 Too high in CHT- distention and flatulence
Loose stools
 Milk stool – loose, greenish yellow containing
mucus with freq. of 6-8 times/24hrs
 All diarrhea - infectious

34. 
Constipation
 Consistency rather than freq. is the basis for
diagnosis
 Perform PR exam
 Aganglionic megacolon, tight or spastic anal
sphincter
 May be caused by an insufficient amount of food
or fluid
 From diets that are too high in fat or protein or
deficient in bulk
 Functional constipation – the most common
 Enemas and suppositories – temporary use
…continued

35. 
 Colic – infantile colic
 Common in infants younger than 3 month
 The attack usually begins suddenly with a loud
continuous cry
 Etiology is not usually apparent
 Holding the infant upside helps and burping
continued

36. 
 A 2 year and 8 months old female child was brought
by her parent with a complaint of decreased feeding.
Otherwise no past chronic illness and physical
examination is unremarkable. What is your next
step?
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Case 4

37. 
 By the end of 1st year- 3 meals a day plus 1-2 snacks
 Changes in eating behavior
 Reduced food intake –rate of growth declines
 Lack of interest in food – temporary
 Never force feed
 Self selection of diets – should be respected
 Self feeding by infant
 Basic daily diets
 Grains, fruits, vegetables, meats and dairy products-balanced
diet with
 Snacks between meals- orange or other fruit juice with biscuit
 Vegetarian diet – vitamin B12 and trace mineral deficiency
Feeding during the 2nd year of life

38. 
 After the age of 2 years
 The child's diet – the same as family diet
 Emphasis on grains, fruits, and vegetables
 Restriction of dietary fat to 30% of total energy
 Saturated fatty acid -< 10%
 Cholesterol – not more than 100mg/1000kcal
 Poly unsaturated fatty acid -7-8% of energy
 Unsaturated fatty acid – 12-13% of energy
 Such diet support normal growth of children
Feeding during later
childhood

39. 
 Breast feeding is recommended as exclusive nutrient
source for feeding infants during the first 6 months.
 Correct attachment and positioning are important for
adequate breast feeding useful for growth of
children.
 Complementary feeding needs to be timely,
adequate, safe and properly fed.
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Summary

40. 
 Basis Pediatrics
 Pan American health Organization(2003), guiding
principles for complementary feeding of the breast
fed child
 Nelson text book of Pediatrics 21st edition
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References

41. 
Thank you!!!
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