Child nutrition and breast feeding & updated recommendations

1. Child nutrition and
Breast feeding
counselling
BY DR. TAHER KARIRI
SUPERVISOR: DR. AMANI QOTB
FAMILY MEDICINE PROGRAM

2. Objectives :
To know the skills to conduct a Counselling
Be able to deal with a patient in the clinic
To know the recommendation regarding breastfeeding

3. Content
Epidemiology
Counselling Skills
Breastfeeding Counselling
Child Nutrition Recommendations
References

4. Al Juaid et al.
2014

5. The decline in breastfeeding duration in Saudi Arabia since 1985

6. Study Insufficient milk (%)
Sickness of mother
or child (%)
New pregnancy (%)
Breastfeeding
problems (%)
Others (%)
1987, National (Al-
Othaimeen 1987 [35]) 22.97 7.4 67.7 - 1.95
1987, National (Al-Mazrou
1994 [18]) 43 11 4 11 21
1991, National (Al-Shehri
1995 [20]) 45 9.5 3.5 5 17.5
1992, Makkah (West)
(Kordy 1992 [24]) 30.9 8.4 27.3 1.25 -
1995, Riyadh (Central) (Al-
Ayed 1998 [32]) 52.6 - - - 27.5
1999, Riyadh (Central) (Al-
Jassir 2004 [19]) 66.1 4.1 5.1 - 20.6
2001-02, Jeddah (West)
(Fida 2003 [33]) 50 8.2 1.8 1.8 10.9
2002-03, National (Al-
Jassir 2006 [34]) 48.3 11.5 13.2 - 8.8
2004-05, National (El
Mouzan 2009 [27]) 45.5 30.4 - 11.9 12.2
2005, Riyadh (Central) (Al-
Hreashy 2008 [26]) 49.6 11.2 - 11.6 6.6
2011, Jeddah (West)
(Eldeek 2012 [22])
32 19 - - 3.3

7. Conclusion
The duration of breastfeeding is decline over time.
Older, less educated, multiparous mothers, lived in rural
communities & low socio-economic class were more likely to
breastfeed and have prolonged duration.
The most common cause of breastfeeding is insufficient breast milk;
a reason that may be more perceived than real.

8. COUNSELLING SKILLS

9. Listening and Learning Skills
Use helpful non-verbal communication
Ask open questions
Use responses and gestures that show interest
Reflect back what the mother/caregiver says
Empathize – show that you understand how she/he feels
Avoid words that sound judging

10. Building Confidence and Giving Support
Skills
Accept what a caregiver thinks and feels
Recognize and praise what a mother/caregiver and child are
doing right
Give practical help
Give relevant information
Use simple language
Make one or two suggestions, not commands

11. Breastfeeding
Counselling

12. Approved date, internationally: August 1st-7th, 2015
Approved date, locally: Shawal 16th-22th, 1436H
Theme of the World Breastfeeding Week 2015:

13. Establish good rapport:
-Introduce yourself
-Take bio-data
-ICEE

14. Ask about current situation:
-Attempts to breast feed?
-Duration?
-Difficulties?

15. Educate mother about importance of
breast feeding:
• Psychological
bond
• immunity
• allergic disease
and Asthma
• Infection
protection
• Good laxative.
Benefits
for
baby:
• uterine bleeding
• Natural
contraception
• Protect from Breast
& Ovarian cancer
• No need to prepare
• No cost
Benefits
for
mother:

16. Techniques of breast feeding
Should be initiated as soon after delivery
Mother sit comfortably with back supported or on one side.
Better in private comfortable place
Baby should have large part of areola in his mouth.
Baby should be directly facing the nipple, without turning head.
At start compress the nipple with thump and index then give baby.
Start on one breast for 10 mins, then shift to other breast till baby stop.

18. During first 2 weeks feed on demand or every 2 hours.
Feeding less at night is ok but not more than 5 hours between feeds.
Exclusive breast feeding for 6 months.
Best to continue breast feeding until baby is 2 years old.

19. Don’t offer baby any breast milk in bottle during first 6 weeks.
Milk supply increase by adequate fluids, sleep, relaxed environment.
Clean breast with water, keep it dry with loose clothing.

20. Is Baby Getting Enough Milk?
6-8 wet diapers/
day
3-4 bowel
movement/
day
Back to birth
weight after 2 w.
Milk is leaking
from the
other breast
Hear the baby
swallowing.

21. Working Mother
Maternity leave.
Ask about facilities at work? Nursery?
Breaks? Distance from home? Bottles!
-Breast pump!

22. Contraception
-Lactation as contraception:
Before first menstruation up to 95%
After menstruation is unreliable .
Combined vs Progesterone only pills.

23. At end of visit:
-If they have any more questions.
-Thank the patient

24. Barriers of Breastfeeding
Breast(nipple) pain
Mastitis
Lack of milk secretion
Work

25. Breastfeeding Contraindications
Herpes Simplix of the
breasts.
Active TB. CMV Chemotherapy
Radiotherapy Drug abuse HIV
Galactosemia of the
Infant
T cell lymphotropic
Viruses type I,II in the
Mother
Mother using Oxidant
with child has G6PD

26. Child Nutrition
Recommendations

27. Evidence
Rating
Clinical Recommendation
C
C
C
A toddler’s diet should include two or three servings of milk or other
dairy products per day.
Fat and cholesterol should not be restricted in children younger than
two years. Children older than two years should consume an average
of 30 percent of total energy from fat.
Toddlers should not have more than 4 to 6 ounces of 100 percent fruit
juice per day; whole fruits and vegetables should be offered instead.

28. Evidence
Rating
Clinical Recommendation
CDaily supplementation with 200 IU of vitamin D is recommended
for toddlers who consume less than 2 cups of milk daily or do not
get regular sunlight exposure; otherwise, vitamin and mineral
supplementation is unnecessary except in undernourished and
chronically ill toddlers.

29. Evidence
Rating
Clinical Recommendation
C
C
C
Good nutritional habits should be fostered by sitting at the table,
turning off the television, and interacting socially.
Parents should offer children a variety of foods, expose them
repeatedly to healthy foods, and model healthy eating behaviors.
To reassure parents and detect undernourished children, physicians
should monitor growth patterns, including body mass index.

30. Iron Supplements
SCREENING
Recommendation
•Full-term – 1 mg/kg daily (maximum 15 mg) at 4 months old till
introduction of a food that rich with iron.
•Premature – 2 to 4 mg/kg daily (maximum 15 mg) after the 2
weeks of age & continued through the first year of life.

33. Weaning
Start to introduce solid food from age of 6 months.
Start with small amount one type of food at a time.
Given before breast feed.
Prepared food at home are best, like:
At 6 months e.g. vegetables, soup, egg yolk, soft fruits, cereals.
At 8-10 months e.g. fish, chicken, meat, bread
After 1 year can eat regular family diet.

34. Continue breastfeeding up to 2 y.o.
Do not add Honey ,Sugar or salts .
Do not feed your child if he able to .
Ensure mother understanding .
Take any questions .
Next appointment

35. Complementary and alternative medicine
(CAM)

36. Home Message
Breastfeeding is a public health issue , not merely a lifestyle choice.
Family physicians should provide education about breastfeeding &
follow up throughout the course of life.
Family physicians should work to remove the barriers of
breastfeeding this include advocating for adequate paid maternity
leave.

37. References
Fayza Rayes Book

38. THANK YOU