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Similar to C1 lecture Breast complementary feeding.pptx
C1 lecture Breast complementary feeding.pptx
- 1. Edomgenet Tesfaye M.D Assistantprofessor of Pediatrics and child health
- 2. Introduction Advantagesand contraindications of breast feeding Steps toward good breast feeding Complementary feeding Feeding problems Summary 2/13/2023 2 Outline
- 3. Breast feedingis 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. 2/13/2023 3 Introduction
- 4. Rooting reflexChild Sucking reflex Swallowing reflex Prolactin reflex Mother Letdown reflex 2/13/2023 4 Reflexes concerned with Breast feeding
- 5. Human Milk CowMilk 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 2/13/2023 5 Composition of Breast milk Vs. Cow milk
- 6. Inexpensive Readilyavailable 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. 2/13/2023 6 Advantages
- 7. Involution ofuterus by secretion of Oxytocin Contraception Decreased incidence of breast cancer Allergy to breast milk is rare Good source of Iron, Vitamin C 2/13/2023 7 Advantages
- 8. A 28year 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? 2/13/2023 8 Case 1
- 9. Chronic debilitatingmaternal illness Maternal Psychiatric conditions e.g. Post partum psychosis Maternal drug intake Babies with Galactosemia/Phenylketonuria (Absolute contraindication) Prematurity 2/13/2023 9 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. 2/13/2023 10 Endocrinology of lactation
- 11. Mother needsto 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. 2/13/2023 11 Initiation of breast feeding
- 12. At eachfeeding both breasts are offered but baby should start the next feed on alternate side. Burping 2/13/2023 12 continued
- 13. A 29year 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? 2/13/2023 13 Case 2
- 14. Weight gain Frequency and duration of breast feeding Sleep between feedings Diaper change per day 2/13/2023 14 Adequacy of Breast feeding
- 15. Mother shouldbe 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 2/13/2023 15 Steps toward Good breast feeding
- 16. Good attachment Baby’schin 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’smouth is WIDE open Jeanette Panchula - BSW, RN, PHN, IBCLC - Solano County Health and Social Services
- 18. Nose very closeor 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/swallowpattern 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.
- 21. Formula Milk Cow’s milk 2/13/2023 21 Other types of Feeding
- 22. Work outthe caloric requirement and water requirement. Interval of feed Boiled water is used to prepare formula milk. All utensils should be boiled/sterilized Burping 2/13/2023 22 continued
- 23. Age Calories/kg/day Infant 110 1-33100 4-6 90 7-9 80 10-12 70 13-15 60 2/13/2023 23 Caloric requirements
- 24. Calculate amountof milk(breast/formula) for a 10 kg infant in 24 hours? 2/13/2023 24 Exercise
- 25.
- 26. Complementary foods– additional foods including formulas, given to breast fed infants Replacement foods – foods other than formula given to formula fed infants 2/13/2023 26 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 2/13/2023 27 Complementary feeding
- 28. A parentof 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? 2/13/2023 28 Case 3
- 29. Feed infantsdirectly 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. 2/13/2023 29 Complementary feeding
- 30. Practice goodhygiene 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 2/13/2023 30 Complementary feeding
- 31. Weaning should bestepwise 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 byrestlessness 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 andvomiting 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 ratherthan 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 2year 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? 2/13/2023 36 Case 4
- 37. By theend 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 theage 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 feedingis 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. 2/13/2023 39 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 2/13/2023 40 References
- 41.