This document provides guidance on feeding infants and older children. It begins with a recap of the advantages of breastfeeding, including physiological, economic, psychological and epidemiological benefits. It discusses the hormones involved in breastfeeding and provides tips for initiating breastfeeding successfully. The document then covers complementary feeding starting at 6 months, including recommended food groups and factors to consider in diet planning. It describes the IMNCI food box, which provides age-specific guidance on breastfeeding, meal frequency, appropriate consistency of foods, and hygiene from birth to 2 years. The key recommendations are to exclusively breastfeed for 6 months, continue breastfeeding for up to 2 years with complementary foods starting at 6 months, and provide balanced and nutritious family

1. Feeding Infants & Older Children
Surg Cdr RW Thergaonkar

2. Topics Covered
• Recap of Breastfeeding
• Complementary feeding
• Factors in Diet Planning
• IMNCI Food Box

3. Breastfeeding: A Recap

4. Advantages of breastfeeding
• Physiological – human milk for human baby,
cows milk for calf
• High lactose content
• Easily digestible protein – Whey 80%
• LCPUFAs
• Enzymes
• Immunologically / Microbiologically
• Lactoferrin protects from E. coli
• Bifidus factor promotes growth of lactobacilli
• PABA protects against malaria

5. Advantages of breastfeeding
• Physical
• Optimum fluidity
• Optimum temperature
• Economical
• Convenient
• No carrying / sterlising utensils
• Psychological
• Mother – infant bond
• Maternal Benefits
• Involution of uterus
• Decreases the incidence of ovarian & breast CA

6. Advantages of breastfeeding
• Epidemiologically : significant decrease in
mortality
• B/F babies are 14 times less likely to die from diarrhea
• B/F babies are 4 times less likely to die from
respiratory illnesses
• B/F babies are 2.5 times less likely to die from any
other infection

7. Know the Hormones
Mammogenesis - Oestrogen & Progesterone
Lactogenesis - Prolactin
Galactopoiesis - Prolactin, TSH, GH
Milk let down reflex - Oxytocin

8. •Rooting Reflex
•Sucking Reflex
•Swallowing Reflex

9. Initiating Breastfeeding
• The main prerequisite for successful breast feeding is
confidence that one can do it
– Inexperienced mothers have to develop it
– With nuclear families, the tradition whereby the old taught
the young about practical matters of life is lost
• Stimulus of sucking of the newborn starts the secretion
of milk
• To reach full milk production may take from 2 to 13 days.
During this period, baby and the breast are not yet in
equilibrium – the lady needs support, encouragement
and supervision so as not to give up

10. Initiating Breastfeeding
• Within 30 min of a normal delivery
• Within 4 hrs of a caesarean
• Colostrum is rich in proteins and immunoglobulins
• The small amounts that it is produced in, in the initial
days is sufficient to meet the babies requirements
• If you have too little milk - “Put him to breast, put him
to breast”

11. Initiating Breastfeeding
• Sucking in the first few days is essential to get the milk
flowing
• The small amount of milk produced is usually enough for
the baby’s needs
• Early feeds are to learn how to suck and not for taking in
large amounts of milk
• The quality of milk is always good
• Bottle feeding is dangerous

12. Signs of Good Attachment
• Chin touching breast
• Mouth wide open
• Lower lip turned outward
• More areola visible above than below the
mouth
• No pain while breastfeeding

14. Burping after feeding?
• For 10 – 15 min
• Continue even after the baby burps
• Various positions:

15. Signs of adequate breastfeeding
• Baby sleeps/ rests for 1 – 2 hrs following feed
• Urine > 5 times / day
• Stools > 1-2 times / day
• Mother can feel milk being drained from the
breast and the breast feels lighter following
the feed
• Mother can hear baby swallowing milk
• Regular weight gain

16. Complementary Feeding
• Breast milk inadequate after 6
mths age
• Complementary Feeding = foods
that complement breast milk and
ensure adequate energy, proteins
and other nutrition
• Complementary feeding
recommended at 6 mths in
addition to B/F
• Continued B/F upto 2 yrs

17. Balanced Diet
• Def:
– Nutritionally adequate and
appropriate
– Provides all nutrients in required
amounts and proper proportions
• Combination of carbohydrate rich
food, protein source, fat source
and sugar/salt for taste
• Calories: 55-60% CHO, 10-12%
proteins, 25-30% fat

18. Food Groups
• Cereals, millets & pulses
• Vegetables & fruits
• Milk & milk products
• Eggs, meat, fish
• Oils & nuts

19. Factors in Diet Planning
• Energy Density
– Calorie rich feeds
– Amylase rich foods
• Amount of feed
• Consistency of feed
• Frequency of Feed
• Hygene
• Helping the child

20. IMNCI Food Box

21. Upto 6 months
• Breastfeed s often as child wants,
day & night, at least 8 times / 24
hrs
• Do not give any other foods or
fluids, not even water
Remember: Continue
breastfeeding even if child is
sick

22. 6-12 months
• Breastfeed as long as child wants
• Give at least one katori serving at
a time of mashed roti / bread /
biscuit mixed in sweetened
undiluted milk
Or Mashed Roti/Rice/Bread mixed in
thick dal with added ghee/oil or
khichri added with oil/ghee

23. 6-12 months
Add cooked vegetable in the also in
the servings
Or sevian/dalia/halwa/kheer
prepared in milk or any cereal
porridge cooked in milk
• Offer banana / biscuit / cheeku /
mango / papaya as snacks in
between the serving

24. 6-12 months
Frequency: 3 times per day if
breastfed, 5 times per day if not
breastfed
Remember:
Keep child in your lap and feed with
your own hands
Wash your own and your child’s hands
with soap and water before each
feeding

25. 12 months to 2 years
• Breastfeed as often as the child
wants
• Offer food from the family pot
• Give at least 1 1/2 katori serving at
a time of :
Mashed roti/rice/bread mixed in
thick dal with added ghee/oil or
khichri with added oil/ghee. Add
cooked vegetables also in the
servings

26. 12 months to 2 years
Or
Mashed roti/rice/bread/biscuit
mixed in sweetened undiluted milk
Or
Sevian/dalia/halwa/kheer/ prepared
in milk or any cereal porridge cooked
in milk
Or
Mashed boiled / fried potatoes

27. 12 months to 2 years
Frequency: 5 times per day
Remember:
Sit by the side of the child and help
him finish the serving
Wash your child’s hands with soap
and water every time before feeding

28. 2 years and older
Give family food as 3 meals each day
Also, twice daily, give nutritious food
between meals such as
banana/biscuit/cheeku/mango/
Papaya as snacks

29. 2 years and older
Remember:
Ensure that the child finishes the
serving
Teach your child to wash his hands
with soap and water every time
before feeding

30. To Sum Up
• Balanced diet: essential at all ages
• Exclusive B/F till 6 mths continued
B/F till 2 yrs
• Qty, freq, consistency of feeds
• Mealtime Behaviour
• Hygene
• IMNCI Food Box

31. Thank You