1. Help the Baby
Grow & Develop
with
Human Rights
Dr Kuntal Biswas
MBBS, DPH, DNB(P), FCCP, FCAM, FMCESA
Registrar
Medical College & Hospitals, Kolkata.
What differences do you see?
2. Life
To the world
you may be
just one person,
but to one
person you may
just be the world.”
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3. Barker Hypothesis
Prenatal events establish lifelong physiological
patterns that may manifest as disease processes
in later life.
Term infants who are small for their gestational
age are predisposed to obesity and have an
increased susceptibility to cardiovascular disease
and Type II diabetes (impaired glucose tolerance)
in adulthood i.e „Adulthood Diseases of Infancy‟
as a consequence of physiologic adaptations to
under-nutrition during fetal life.
-David Barker, FRS, University of Southampton
4. Early Brain Development
• All behavioral development has to do with the brain.
• Brain development is dependent upon both experience and genetics
i.e. Nature & Nurture
• The brain has a great deal of plasticity and can recover over time.
• Growth of the brain occurs from the inside.
• There can be 15,000 synaptic connections for each cell.
• By 2 yrs age baby‟s brain has double & by 3 yrs triple synaptic
connections than adult brain, but in later life the brain mapping
decreases due to inappropriate handling.
• By age 3, 80% of synaptic connections are already made.
• 60% of nutrition is used by the brain during the first year of life.
This decreases to 30% by age 3.
• During the first 10 years of life the brain is twice as active as that of an
adult’s
• By 2nd decade of life growth levels off and pruning begins.
5. Importance of Early Psycho-Social Care of the Baby
• Babies thrive with warm,
responsive early care.
• Early care has a decisive,
long lasting impact on how
people develop, their ability
to learn, and their capacity to
regulate their own emotions.
• Increased experiences define
the wiring of infant‟s brain.
• Genetic & environmental
factors have a more dynamic,
qualitative interplay.
I.Q can be enhanced by teaching but Emotional
Intelligence can be increased by proper caring5
6. Human Brain Development
Synapse Formation Dependent on Early Experiences
Required
3 Components
1. Nutrition
2. Prevention of infection
3. Psycho Social Stimulation
Synaptic Connections
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7. Brain development
5 to 6 Weeks
Forebrain
7 Weeks
Neurons forming
rapidly,1000‟s/ mts Midbrain
Hindbrain
• 50,000 brain cells produced/second in
developing fetal brain
• 100 billion brain cells in adult
• 1million billion connections between
these brain cells: Determine IQ.
8. Emerging Brain Structures
• At 3 weeks after conception the neural plate, a flat
structure of cells, forms
• In the 4th month of prenatal development, axons begin
to form myelin, which helps to speed transmission
• Nerve cell generation complete.
• Cortex beginning to wrinkle.
• By 28 weeks after conception, the brain has all
the neurons it will ever have
• Myelinization completes by 30 yrs
7 Weeks 14 Weeks
6 Months
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9. Eight Phases in Embryonic and Fetal
Development at a Cellular Level
1. Mitosis 2. Migration 3. Aggregation 4. Differentiation
5. Synaptogenesis 6. Death 7.Rearrangement 8. Myelination
Between
40 and 75 %
of all neurons born
in embryonic and
fetal development
do not survive.
10. Brain Cell Connections in the Early Months
newborn 1 month 3 months 6 months
6 Years Old 14 Years Old
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11. IYCF Practices- INDIA 2006-68/150 2008-69/150
Key: 0-29% scores as 3/Red; 30-49% as 6/Yellow; 50-89% scores as 9/Blue; 90-100% scores as 10/Green.
Countries
IYCF Practices Score Scor
e
08 06
1. Initiation of Breastfeeding (within 1 hour) 3 3 India 69.0 68.0
2. Exclusive Breastfeeding (for first 6 months) 6 6 China 80. 5 Not done
3. Median Duration of Breastfeeding 10 10 Nepal 80.5 71.5
4. Bottle Feeding (<6 months) 6 6 Pakistan 86.0 75.5
5. Complementary Feeding (6-9 months) 3 3
Bangla 87.0 91.5
6. National Policy, Programme and 5 2 Desh
Coordination
Sri Lanka 116.5 101.5
7. Baby Friendly Hospital Initiative 4.5 4
8. Implementation of the International Code 10 8 Growth Faltering by Age
9. Maternity Protection 0 5
10. Health and Nutrition Care Systems 3.5 4
11. Mother Support and Community Outreach 5 4
12. Information Support 4 5
13. Infant Feeding and HIV 3 2
14. Infant Feeding during Emergencies 0 0
15. Mechanisms of Monitoring and Evaluation 5 7
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System
12. The Picture of Malnutrition-Today
Under 5 under-
nourished Children
10 Million die in the
world,
2.2 million in India
More than 50% of them
contributed by
Mal nutrition
IMS Act
E. Sakazakii (Infant Milk Substitutes, Feeding
What is it? Bottles and Infant Foods, 1992).
’Killer bug
originating in The amendment of 2003
factories that elevated the IMS Act to
produce the new heights by extending
Formula. its scope to all products for
Severe children under 2 years
neurological
disorders may
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It is not a motorbike remain.
13. Intelligence quotient by type of feeding
BF 12.9 points
BF 2 points higher than FF
higher than FF Study in 9.5
year-olds
Study in 3-7
1996
year-olds
1982
BF 8.3 points
higher than FF
Study in 7.5-8
BF 2.1 points year-olds
higher than FF 1992
Study in 6 months
to 2 year- olds References:
1988 BM 7.5 points •Fergusson DM et al. Soc
higher than no BM SciMed 1982
•Morrow-Tlucak M et al.
Study in 7.5-8 SocSciMed 1988
BF = breastfed year-olds •Lucas A et al. Lancet 1992
FF = formula fed •Riva Eet al. Acta Paediatr 1996
BM = breast milk 1992
15. Good support is important in breastfeeding. Use a good pillow table or “My Brest
Friend” Pillow. Use good foot support, as well. Bring Baby to you. Leaning over to
feed will hurt your back.
Football Hold Cradle Hold Cross-Cradle Side Lying Proper Foot Support is important
1. Tickle from top lip to bottom lip. 2. Bring baby to you instead of you to him. 3. Make sure lips are flanged.
Feeding Twin Position when awake 15
Colostrum Feeding
Burping after feeding
16. Expressed Breast Milk & its use
Collection, Storage, and Handling
Wash hands 1st
Hand expression
Manual expression is an important skill for all nursing mothers. .
The basic technique
STEP 1 Cup the breast in hand with the thumb above and just
behind the areola (dark area) & fingers below, forming a “C.”
STEP 2 Squeeze thumb and fingers together while pushing back
toward the chest wall. Do not slide fingers along the skin.
STEP 3 Roll fingers forward, shifting the pressure from the back of
the breast toward the nipple.
STEP 4 The gentle pressure produced by rolling the thumb and
fingers won‟t damage tender breast tissue and milk ducts but will
BM can be release stored milk.
stored at Rotate hand around the breast in order to drain all the milk ducts.
room temp Use each hand on each breast.
for 8 hrs & in
Work on one breast for 3 to 5 minutes, switch to the other
Freeze for
breast, and then repeat the sequence on both breasts.
24 hrs-3 ds
Thawed BF Expressing milk from both breasts using this technique takes most
to be fed in women 20 to 30 minutes. 16
cup
17. POSTPARTUM BABY BLUES
For Mother
• Sunshine
•Taking time to get dressed and
• Transit period of fix hair
• Light activity or exercise
depression (*after doctor clears for
•Occurs first few days exercise in postpartum)
after delivery • Balanced diet
• Rest (as much as possible)
•Mother may experience • Talking to partner & friends
tearfulness, anorexia, dif about fears& concerns
ficulty sleeping, feeling • Talking about fears and
concerns
of let down • Support group of other
•Usually resolves in mothers .
10-14 days 17
18. Locomotors skills improve rapidly in the 15
months after birth and progress can be measured
by many developmental milestones.
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20. Children Learn What They Live
If a child lives with criticism, he learns to condemn.
If a child lives with hostility, he learns to fight.
If a child lives with ridicule, he learns to be shy.
If a child lives with shame, he learns to feel guilty.
If a child lives with tolerance, he learns to be patient.
If a child lives with encouragement, he learns confidence.
If a child lives with praise, he learns to appreciate.
If a child lives with fairness, he learns justice.
If a child lives with security, he learns to have faith.
If a child lives with approval, he learns to like himself.
If a child lives with acceptance and friendship,
he learns to find love in the world.
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By Dorothy Law Nolte
