This document discusses evidence and recommendations regarding infant and young child feeding. It provides the following key points:
1) The global strategy recommends exclusive breastfeeding for the first 6 months of life, continued breastfeeding for up to 2 years or beyond, and appropriate complementary feeding after 6 months with continued breastfeeding.
2) Evidence shows that breastmilk provides optimal nutrition and protection from infection for both full term and preterm infants. Breastmilk supports brain and immune system development.
3) Breastfeeding provides benefits for both mother and child in reducing risks of various diseases. The document outlines these health benefits supported by evidence classes I-III.
The document provides guidelines on infant and child feeding from birth through the first two years of life. It recommends exclusive breastfeeding for the first 6 months if possible, followed by gradually introducing complementary foods while continuing breastfeeding for the first year. Weaning should begin around 6 months of age. The document also discusses appropriate feeding schedules, establishing and maintaining milk supply, treating sore nipples, maternal diet, and addressing issues like malnutrition and obesity.
This document discusses anemia, including its definition, classification, causes, symptoms, diagnosis, and treatment. It covers iron deficiency anemia in depth and discusses its stages, signs, and tests. It also covers other nutritional anemias like megaloblastic anemia caused by vitamin B12 or folate deficiencies, copper deficiency anemia, and sideroblastic anemia. Non-nutritional anemias discussed include anemia of chronic disease, sickle cell anemia, thalassemia, and sports anemia. Proper diagnosis is important before providing nutritional or medical management of anemia.
This document discusses various types of chest injuries including blunt injuries, penetrating injuries, crush injuries, and inhalation burns. It covers the mechanisms, clinical features, investigations, and management of different chest traumas. Specific injuries discussed in more detail include tension pneumothorax, open pneumothorax, cardiac tamponade, and massive hemothorax which require immediate intervention due to their life-threatening nature. The document emphasizes the importance of airway management, oxygenation, and treatment of associated injuries in chest trauma patients.
The document discusses various types of anemia classified based on pathophysiology and morphology. It defines anemia and provides the normal hemoglobin levels. It describes deficiencies in iron, vitamin B12, folic acid and their effects on red blood cell formation leading to anemia. Pernicious anemia results from lack of intrinsic factor causing impaired vitamin B12 absorption. Aplastic anemia is defined as pancytopenia from bone marrow failure and stem cell deficiency. The causes, clinical features and morphology of different anemias are explained.
Updates In Bronchiolitis 23 2 2010 Dr HumaidEM OMSB
This document summarizes recent evidence on the diagnosis and management of bronchiolitis. It defines bronchiolitis and discusses causes such as respiratory syncytial virus (RSV) and human metapneumovirus. Clinical features include fever, cough, wheezing and respiratory distress. Risk factors for severe disease are described. Treatment is generally supportive with oxygen, fluids and respiratory support as needed. Bronchodilators and corticosteroids are not routinely recommended but may be considered in some cases.
The document discusses hemoptysis, defined as bleeding from the lungs or bronchial tubes. It describes the dual arterial blood supply to the lungs from the pulmonary and bronchial arteries. Conditions that reduce pulmonary arterial flow can increase bronchial artery contribution, making those vessels prone to rupture and bleeding. A comprehensive evaluation of hemoptysis includes history, physical exam, labs, chest imaging including radiography and CT, and bronchoscopy. CT is particularly useful for evaluating underlying lung abnormalities and identifying abnormal bronchial vessels to guide treatment.
The document provides guidelines on infant and child feeding from birth through the first two years of life. It recommends exclusive breastfeeding for the first 6 months if possible, followed by gradually introducing complementary foods while continuing breastfeeding for the first year. Weaning should begin around 6 months of age. The document also discusses appropriate feeding schedules, establishing and maintaining milk supply, treating sore nipples, maternal diet, and addressing issues like malnutrition and obesity.
This document discusses anemia, including its definition, classification, causes, symptoms, diagnosis, and treatment. It covers iron deficiency anemia in depth and discusses its stages, signs, and tests. It also covers other nutritional anemias like megaloblastic anemia caused by vitamin B12 or folate deficiencies, copper deficiency anemia, and sideroblastic anemia. Non-nutritional anemias discussed include anemia of chronic disease, sickle cell anemia, thalassemia, and sports anemia. Proper diagnosis is important before providing nutritional or medical management of anemia.
This document discusses various types of chest injuries including blunt injuries, penetrating injuries, crush injuries, and inhalation burns. It covers the mechanisms, clinical features, investigations, and management of different chest traumas. Specific injuries discussed in more detail include tension pneumothorax, open pneumothorax, cardiac tamponade, and massive hemothorax which require immediate intervention due to their life-threatening nature. The document emphasizes the importance of airway management, oxygenation, and treatment of associated injuries in chest trauma patients.
The document discusses various types of anemia classified based on pathophysiology and morphology. It defines anemia and provides the normal hemoglobin levels. It describes deficiencies in iron, vitamin B12, folic acid and their effects on red blood cell formation leading to anemia. Pernicious anemia results from lack of intrinsic factor causing impaired vitamin B12 absorption. Aplastic anemia is defined as pancytopenia from bone marrow failure and stem cell deficiency. The causes, clinical features and morphology of different anemias are explained.
Updates In Bronchiolitis 23 2 2010 Dr HumaidEM OMSB
This document summarizes recent evidence on the diagnosis and management of bronchiolitis. It defines bronchiolitis and discusses causes such as respiratory syncytial virus (RSV) and human metapneumovirus. Clinical features include fever, cough, wheezing and respiratory distress. Risk factors for severe disease are described. Treatment is generally supportive with oxygen, fluids and respiratory support as needed. Bronchodilators and corticosteroids are not routinely recommended but may be considered in some cases.
The document discusses hemoptysis, defined as bleeding from the lungs or bronchial tubes. It describes the dual arterial blood supply to the lungs from the pulmonary and bronchial arteries. Conditions that reduce pulmonary arterial flow can increase bronchial artery contribution, making those vessels prone to rupture and bleeding. A comprehensive evaluation of hemoptysis includes history, physical exam, labs, chest imaging including radiography and CT, and bronchoscopy. CT is particularly useful for evaluating underlying lung abnormalities and identifying abnormal bronchial vessels to guide treatment.
1) Foreign body aspiration is a common pediatric emergency that occurs when children accidentally inhale non-food items. 2) Food items are the most common foreign bodies, and symptoms may not appear immediately but rather develop into recurrent lung infections. 3) Diagnosis involves chest x-rays and fluoroscopy, while treatment depends on whether the object is lodged in the upper airway or bronchial tubes, requiring either back blows, chest compressions, or bronchoscopy for removal.
Bronchiectasis is a chronic lung condition defined by abnormal dilatation of the bronchi. It can be caused by infections, genetic conditions, or other lung diseases that damage the airways. People with bronchiectasis commonly produce large amounts of sputum and experience recurrent lung infections. Diagnosis is made through chest imaging like CT scans. Treatment focuses on airway clearance and controlling infections with antibiotics. Surgical options are available for severe cases involving hemorrhage or localized disease.
This document discusses several congenital lung lesions and neonatal chest issues seen in infants. It provides descriptions of cystic adenomatoid malformation, pulmonary sequestration, bronchogenic cyst, congenital lobar emphysema, congenital diaphragmatic hernia, and bronchial atresia. For each condition, it summarizes the location, radiographic features on imaging such as x-ray and CT, and pathological findings. It also briefly discusses other neonatal issues like surfactant deficient disease and meconium aspiration syndrome.
- Bronchopneumonia is an inflammatory process involving the lung parenchyma that is primarily spreading inflammation of terminal bronchioles and their related alveoli.
- It is commonly caused by bacterial, viral, or fungal infections. Common bacteria include streptococcus pneumoniae, staphylococcus, and haemophilus influenzae.
- Symptoms include fever, respiratory distress, grunting, and retractions of the ribs. Diagnosis involves physical examination, chest x-rays, and laboratory tests.
- Treatment involves antibiotics, oxygen supplementation, maintaining hydration and nutrition, and supportive care. Complications can include sepsis, lung abscesses, and respiratory failure. Nursing care focuses on airway clearance and
Management of bronchial asthma in children Shaju Edamana
This document discusses the management of bronchial asthma in children. It defines asthma as a chronic inflammatory airway disorder characterized by episodes of coughing, wheezing, and shortness of breath in response to triggers. It outlines the clinical presentation of asthma in children and discusses alternative causes of wheezing. Diagnostic procedures and classifications of asthma control are also presented. The document recommends inhaled medications as preferred treatment delivered by various devices based on a child's age. It stresses the importance of education, monitoring, and follow-up to maintain asthma control. Acute exacerbations should be treated with oxygen, inhaled bronchodilators, systemic corticosteroids, and possibly anticholinergics.
The document discusses various nutritional disorders including malnutrition, protein energy malnutrition (PEM), and specific vitamin deficiencies. It describes the classifications, etiologies, clinical manifestations, diagnoses, and treatments of marasmus, kwashiorkor, obesity, hypovitaminosis A, rickets, and osteomalacia. Key signs and laboratory findings for each condition are provided along with recommended daily allowances and prevention strategies.
- Failure to thrive is defined as inadequate physical growth diagnosed by observing growth trends on standard growth charts.
- It can be classified as organic (caused by medical issues) or nonorganic (caused by psychosocial factors) and further divided into prenatal or postnatal categories.
- Evaluating a child for failure to thrive involves taking a thorough history including feeding and medical history, performing a physical exam, and ordering basic screening labs tailored to the child's history and exam findings.
- Treatment focuses on increasing caloric intake to promote catch-up growth, addressing any underlying medical issues, modifying feeding behaviors, and involving psychosocial support services if nonorganic causes are suspected.
Acute bronchitis is an inflammation of the air passages in the lungs that is usually caused by a viral infection such as a cold or the flu. It causes coughing and other breathing problems that typically last around two weeks. While it is usually not a serious illness, it can sometimes be caused by bacterial infections or pollution. Diagnosis involves examining symptoms and listening to the lungs for abnormal sounds. Treatment focuses on relieving symptoms through rest, fluids, medication, and avoiding irritants. Complications are rare in otherwise healthy children.
Approach to a child with failure to thriveSingaram_Paed
This document discusses failure to thrive (FTT) in children. It defines FTT as inadequate physical growth compared to peers. FTT can be caused by inadequate calorie intake, absorption, increased needs, or utilization. It affects 5-10% of young children. Causes include psychosocial factors, infections, gastrointestinal issues, and neurological problems. Evaluation of a child with FTT involves medical history, physical exam, lab tests, and assessing nutrition. Treatment focuses on improving the child's diet and development stimulation, caregiver skills, and treating any underlying medical issues. Regular follow up is also important.
This document discusses various congenital lung abnormalities including tracheobronchial abnormalities (such as tracheal agenesis, stenosis, and tracheo-esophageal fistula), pulmonary underdevelopment (such as lung agenesis and lobar hypoplasia seen in Scimitar syndrome), bronchopulmonary foregut malformations (including bronchogenic cysts, enteric cysts, and cystic adenomatoid malformation), diaphragmatic abnormalities (congenital diaphragmatic hernia and eventration), and pulmonary arteriovenous malformations. Imaging plays an important role in evaluating these conditions and establishing diagnoses.
Infectious Bronchitis is a highly contagious viral disease affecting chickens worldwide. It causes respiratory disease and drops in egg production. The document outlines the etiology, transmission, economic impact, pathogenesis, clinical signs, post-mortem lesions, and diagnosis of the disease. Definitive diagnosis requires isolation or identification of the Infectious Bronchitis Virus through laboratory tests.
This document outlines a lesson plan for teaching students about nutritional deficiency diseases. The lesson introduces key terms like nutrients, vitamins, and minerals. It discusses diseases caused by deficiencies like goiter from iodine deficiency, kwashiorkor from protein deficiency, marasmus from protein and energy deficiencies, and rickets from vitamin D deficiency. Students learn the symptoms of each disease and how to prevent them by consuming a nutritious diet.
Bronchiectasis is an abnormal, permanent dilatation of the bronchi. It was first discovered in 1819 by René Laennec, the inventor of the stethoscope. Common causes include cystic fibrosis, childhood infections like pertussis and measles, and obstructive lung diseases. Patients present with chronic cough, sputum production, and recurrent lung infections. Diagnosis is made through chest imaging like CT scan which can classify the type of bronchiectasis. Treatment involves airway clearance techniques, antibiotics, anti-inflammatory drugs, and surgery in some severe cases. The goal is to treat infections, clear secretions, and reduce inflammation.
The document discusses asthma in children. It states that asthma is the most common chronic disease of childhood and is a leading cause of morbidity. The symptoms of asthma in children include recurrent wheezing, breathlessness, coughing especially at night or in the morning. It then discusses factors that can influence the development and expression of asthma such as genetic and environmental factors like allergens, infections, tobacco smoke, and air pollution. It also outlines some risk factors for asthma in younger children and discusses guidelines for diagnosing asthma in children of different age groups.
This document discusses pharyngitis (inflammation of the pharynx). It notes that the most common infectious causes are streptococcus and various viruses. It then covers the etiology, symptoms, physical exam findings, complications, diagnosis and treatment of both viral and bacterial (specifically streptococcal) pharyngitis. Key points include that viral pharyngitis is usually self-limiting and only requires supportive care, while bacterial pharyngitis often requires antibiotics to prevent complications like rheumatic fever. Rapid strep tests and throat cultures can help diagnose the cause. Laryngitis, an inflammation of the larynx, is also briefly discussed.
Congenital anomalies of respiratory system A Radiological approachArif S
This document summarizes various congenital abnormalities of the respiratory system, including abnormalities of the upper and lower airways. It describes tracheobronchial abnormalities such as tracheal agenesis, stenosis, and tracheoesophageal fistula. Pulmonary abnormalities discussed include lung agenesis, hypoplasia, scimitar syndrome, and congenital lobar emphysema. The document also reviews bronchopulmonary foregut malformations, pulmonary sequestration, bronchogenic cysts, and pulmonary arteriovenous malformations. It concludes with a brief overview of congenital diaphragmatic hernia.
1) Foreign body aspiration is a common pediatric emergency that occurs when children accidentally inhale non-food items. 2) Food items are the most common foreign bodies, and symptoms may not appear immediately but rather develop into recurrent lung infections. 3) Diagnosis involves chest x-rays and fluoroscopy, while treatment depends on whether the object is lodged in the upper airway or bronchial tubes, requiring either back blows, chest compressions, or bronchoscopy for removal.
Bronchiectasis is a chronic lung condition defined by abnormal dilatation of the bronchi. It can be caused by infections, genetic conditions, or other lung diseases that damage the airways. People with bronchiectasis commonly produce large amounts of sputum and experience recurrent lung infections. Diagnosis is made through chest imaging like CT scans. Treatment focuses on airway clearance and controlling infections with antibiotics. Surgical options are available for severe cases involving hemorrhage or localized disease.
This document discusses several congenital lung lesions and neonatal chest issues seen in infants. It provides descriptions of cystic adenomatoid malformation, pulmonary sequestration, bronchogenic cyst, congenital lobar emphysema, congenital diaphragmatic hernia, and bronchial atresia. For each condition, it summarizes the location, radiographic features on imaging such as x-ray and CT, and pathological findings. It also briefly discusses other neonatal issues like surfactant deficient disease and meconium aspiration syndrome.
- Bronchopneumonia is an inflammatory process involving the lung parenchyma that is primarily spreading inflammation of terminal bronchioles and their related alveoli.
- It is commonly caused by bacterial, viral, or fungal infections. Common bacteria include streptococcus pneumoniae, staphylococcus, and haemophilus influenzae.
- Symptoms include fever, respiratory distress, grunting, and retractions of the ribs. Diagnosis involves physical examination, chest x-rays, and laboratory tests.
- Treatment involves antibiotics, oxygen supplementation, maintaining hydration and nutrition, and supportive care. Complications can include sepsis, lung abscesses, and respiratory failure. Nursing care focuses on airway clearance and
Management of bronchial asthma in children Shaju Edamana
This document discusses the management of bronchial asthma in children. It defines asthma as a chronic inflammatory airway disorder characterized by episodes of coughing, wheezing, and shortness of breath in response to triggers. It outlines the clinical presentation of asthma in children and discusses alternative causes of wheezing. Diagnostic procedures and classifications of asthma control are also presented. The document recommends inhaled medications as preferred treatment delivered by various devices based on a child's age. It stresses the importance of education, monitoring, and follow-up to maintain asthma control. Acute exacerbations should be treated with oxygen, inhaled bronchodilators, systemic corticosteroids, and possibly anticholinergics.
The document discusses various nutritional disorders including malnutrition, protein energy malnutrition (PEM), and specific vitamin deficiencies. It describes the classifications, etiologies, clinical manifestations, diagnoses, and treatments of marasmus, kwashiorkor, obesity, hypovitaminosis A, rickets, and osteomalacia. Key signs and laboratory findings for each condition are provided along with recommended daily allowances and prevention strategies.
- Failure to thrive is defined as inadequate physical growth diagnosed by observing growth trends on standard growth charts.
- It can be classified as organic (caused by medical issues) or nonorganic (caused by psychosocial factors) and further divided into prenatal or postnatal categories.
- Evaluating a child for failure to thrive involves taking a thorough history including feeding and medical history, performing a physical exam, and ordering basic screening labs tailored to the child's history and exam findings.
- Treatment focuses on increasing caloric intake to promote catch-up growth, addressing any underlying medical issues, modifying feeding behaviors, and involving psychosocial support services if nonorganic causes are suspected.
Acute bronchitis is an inflammation of the air passages in the lungs that is usually caused by a viral infection such as a cold or the flu. It causes coughing and other breathing problems that typically last around two weeks. While it is usually not a serious illness, it can sometimes be caused by bacterial infections or pollution. Diagnosis involves examining symptoms and listening to the lungs for abnormal sounds. Treatment focuses on relieving symptoms through rest, fluids, medication, and avoiding irritants. Complications are rare in otherwise healthy children.
Approach to a child with failure to thriveSingaram_Paed
This document discusses failure to thrive (FTT) in children. It defines FTT as inadequate physical growth compared to peers. FTT can be caused by inadequate calorie intake, absorption, increased needs, or utilization. It affects 5-10% of young children. Causes include psychosocial factors, infections, gastrointestinal issues, and neurological problems. Evaluation of a child with FTT involves medical history, physical exam, lab tests, and assessing nutrition. Treatment focuses on improving the child's diet and development stimulation, caregiver skills, and treating any underlying medical issues. Regular follow up is also important.
This document discusses various congenital lung abnormalities including tracheobronchial abnormalities (such as tracheal agenesis, stenosis, and tracheo-esophageal fistula), pulmonary underdevelopment (such as lung agenesis and lobar hypoplasia seen in Scimitar syndrome), bronchopulmonary foregut malformations (including bronchogenic cysts, enteric cysts, and cystic adenomatoid malformation), diaphragmatic abnormalities (congenital diaphragmatic hernia and eventration), and pulmonary arteriovenous malformations. Imaging plays an important role in evaluating these conditions and establishing diagnoses.
Infectious Bronchitis is a highly contagious viral disease affecting chickens worldwide. It causes respiratory disease and drops in egg production. The document outlines the etiology, transmission, economic impact, pathogenesis, clinical signs, post-mortem lesions, and diagnosis of the disease. Definitive diagnosis requires isolation or identification of the Infectious Bronchitis Virus through laboratory tests.
This document outlines a lesson plan for teaching students about nutritional deficiency diseases. The lesson introduces key terms like nutrients, vitamins, and minerals. It discusses diseases caused by deficiencies like goiter from iodine deficiency, kwashiorkor from protein deficiency, marasmus from protein and energy deficiencies, and rickets from vitamin D deficiency. Students learn the symptoms of each disease and how to prevent them by consuming a nutritious diet.
Bronchiectasis is an abnormal, permanent dilatation of the bronchi. It was first discovered in 1819 by René Laennec, the inventor of the stethoscope. Common causes include cystic fibrosis, childhood infections like pertussis and measles, and obstructive lung diseases. Patients present with chronic cough, sputum production, and recurrent lung infections. Diagnosis is made through chest imaging like CT scan which can classify the type of bronchiectasis. Treatment involves airway clearance techniques, antibiotics, anti-inflammatory drugs, and surgery in some severe cases. The goal is to treat infections, clear secretions, and reduce inflammation.
The document discusses asthma in children. It states that asthma is the most common chronic disease of childhood and is a leading cause of morbidity. The symptoms of asthma in children include recurrent wheezing, breathlessness, coughing especially at night or in the morning. It then discusses factors that can influence the development and expression of asthma such as genetic and environmental factors like allergens, infections, tobacco smoke, and air pollution. It also outlines some risk factors for asthma in younger children and discusses guidelines for diagnosing asthma in children of different age groups.
This document discusses pharyngitis (inflammation of the pharynx). It notes that the most common infectious causes are streptococcus and various viruses. It then covers the etiology, symptoms, physical exam findings, complications, diagnosis and treatment of both viral and bacterial (specifically streptococcal) pharyngitis. Key points include that viral pharyngitis is usually self-limiting and only requires supportive care, while bacterial pharyngitis often requires antibiotics to prevent complications like rheumatic fever. Rapid strep tests and throat cultures can help diagnose the cause. Laryngitis, an inflammation of the larynx, is also briefly discussed.
Congenital anomalies of respiratory system A Radiological approachArif S
This document summarizes various congenital abnormalities of the respiratory system, including abnormalities of the upper and lower airways. It describes tracheobronchial abnormalities such as tracheal agenesis, stenosis, and tracheoesophageal fistula. Pulmonary abnormalities discussed include lung agenesis, hypoplasia, scimitar syndrome, and congenital lobar emphysema. The document also reviews bronchopulmonary foregut malformations, pulmonary sequestration, bronchogenic cysts, and pulmonary arteriovenous malformations. It concludes with a brief overview of congenital diaphragmatic hernia.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Nutrition And The 0 6 Months Infants (Final
1. Dr. K P Kushwaha
Prof & Head,
BRD Medical College, Gorakhpur
2. Evidence classification
Evidence class Criteria for evidence
• Class I • Randomized control trial
;at least one
• Class II • Well organized control
trials without
randomization, cohort or
case control ,cross
sectional, retrospective
;more than one
• Class III • Case reports, reports of
expert comittees,
guidelines,
3. Infant feeding Recommendations
(Global strategies for Infant & Young
Child Feeding)
• Exclusive breastfeeding form birth to 6 months
• Appropriate complementary feeding after 6 months
+ Breastfeeding
• Sustaining breastfeeding for 2 years and beyond
• Related maternal, nutrition & care
• Building community support and health system
support protecting infant feeding practices from
commercial influences
Slide 3
4. Infant feeding Recommendations
(Global strategies for Infant & Young
Child Feeding)
• Preterm, ELBW, VLBW and above 1600gm. All need
breastmilk.
• Feeding method and approaches are varied.
Slide 4
5. HIV :2000 and 2006 WHO Recommendations
•When replacement feeding • Exclusive breastfeeding is
is acceptable, feasible, recommended for HIV-infected
affordable, sustainable and women for the first 6 months of life
safe, avoidance of all unless replacement feeding is
breastfeeding by HIV- acceptable, feasible, affordable,
infected mothers is sustainable and safe for them and
recommended. their infants before that time.
• When replacement feeding is
• Otherwise, exclusive
acceptable, feasible, affordable,
breastfeeding is
sustainable and safe, avoidance of all
recommended during the first
breastfeeding by HIV-infected
months of life.
women is recommended
Slide 5
6. IYCF Practices-India
• Initiation with in 1 Hr • 23.4
• Exclusive Breastfeeding • 46.3
• Timely (appropriate ?) • 55.8
complement
• Sustained breastfeeding 2 • 38.4
years and beyond
(Squeezing and discarding of colostrum and
prelacteal feeds are quite common)
Source: NHFS-3
Slide 6
7. Trends in Nutritional Status
Percent of children age under 3 years
NFHS-3 NFHS-2
51
45 43
40
23
20
Stunted Wasted Underweight
(Low-height-for-age) (Low-weight-for-height) (Low-weight-for- age)
Source: NHFS-2 & 3
Slide 7
8. Anaemia among Children
Percent of children 6-35 months with anaemia
79 81
72 74
Total Urban Rural NFHS-2
Slide 8
9. How Many Children Receive Services
from an AWC?
ICDS (??? 0 – 6 yrs )
80 Percent of age-eligible children in areas with an AWC
70
60
50
40 33
30 26
23
20 18
20 16
10
0
g
od
ns
s
ol
e
rin
up
ic
ho
fo
io
rv
ito
k-
at
sc
ry
se
ec
iz
on
e-
ta
un
ch
ny
m
Pr
en
m
A
lth
th
em
Im
w
ea
l
ro
pp
H
G
Su
How many 0-6 ms are being looked after?
Source: NHFS-3 Slide 9
10. Benefits to Baby (evidence class I –III)
• Optimum growth
• Brain growth
• Reduce risk for:
– Undernutrition
– Upper and lower respiratory infections
– Otitis media (ear infections)
– Urinary tracts
– Sytemic Infections
– Gastroenteritis
– Allergies
– Overweight/obesity
– SIDS
Slide 10
11. Why Breast milk for preterm
• To Protect
- Infections
- NEC
• To Provide
- PUFA, growth factors, hormone, tropic factors
- Better visual and cognitive development
• To Involve mother in care, including KMC
• To Provide nutrition's with high bio availability
Evidence class I
Slide 11
12. Lancet 2004;363:1571-8 Singhal A, Cole TJ, Lucas
A Breastmilk and Lipoprotein profile in
adolescents born preterm: Followup of a
prospective randomised study (n=926)
2.8
2.6
2.4
LDL to HDL ratio
2.2
2
1.8
1.6
Evidence class I
1.4
1.2
1
Lowest 3rd (13%) Middle Third (65%) Highest Third (100%)
Human Milk Intake
Slide 12
13. Breast milk composition
differences (dynamic)
• Gestational age at birth
(preterm and full term)
• Stage of lactation
(colustrum and mature milk)
• During a feed
(foremilk and hindmilk)
Evidence class I
Slide 13
16. Colostrum ( evidence class I-
III )
Property Importance
• Antibody ich
- r • protects against infection and
allergy
• Many white cells • protects against infection
• Purgative • clears meconium; helps
prevent jaundice
• Growth factors • helps intestine mature;
prevents allergy, intolerance
• Vitamin
- A
rich • reduces severity of some
infection (such as measles and
diarrhoea); prevents vitamin
A related eye diseases
-
Slide 16
18. More Benefits to Baby
(When they grow)
• Reduced risk for:
- Dental disorders
– Diabetes
– Crohn’s disease
– Childhood Leukemia
– Cardiovascular
disease
– Celiac disease
– Rheumatoid arthritis
Evidence class II -III
Slide 18
19. Benefices for Mom
• Rapid recovery after having a baby
• Decreases risk of anemia
• Weight reduction
• Reduces risk of breast cancer
• Reduces risk of ovarian cancer
• May reduce risk of endometrial cancer
• Reduces risk for osteoporosis
• Delays next pregnancy
Evidence class II -III
Slide 19
20. Community
Benefits
Breast milk is a
Fewer healthcare
New parents miss Natural and
Visits & lower
Less work Renewable
Treatment costs
resource
Evidence class III
Slide 20
22. Breastfeeding decreases the prevalence
of obesity in childhood at age five and six years,
Germany
5 4.5
4.5
4 3.8
Prevalence (%)
3.5
0 months
3
2.3 2 months
2.5
1.7 3-5 months
2
1.5 6-12 months
1
0.5
0
months breastfeeding
Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and
obesity: cross sectional study. BMJ, 1999, 319:147-150.
Slide 22
23. Higher Intelligence quotient ( Evidence class I-II)
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
Slide 23
24. Potential Child Mortality Reduction
from Preventive Interventions
Deaths prevented
Number as proportion of
Preventive Intervention (thousands) all child deaths
Breastfeeding 1301 13%
Insecticide-treated materials 691 7%
Complementary feeding 587 6%
Zinc 459 5%
H influenzae vaccine 403 4%
Antiseptic delivery 411 4%
Water, sanitation, hygiene 326 3%
Jones et al. How many deaths can we prevent this year? Lancet 2003 Slide 24
25. The value of breast milk
to the national economy in India
• National production of breast milk by all mothers in India
for the children they were breastfeeding at the time of the
estimate was about 3944 million liters over 2 yrs.
• If the breast milk produced were replaced by tinned milk,
it would cost 118 billion Rupees.
• If imported, the breast- m substitutes would cost 4.7
ilk
million USD.
• If breastfeeding practices were optimal, breast milk
production would be twice the current amount, doubling
the savings by fully utilizing this “national resource”.
Adapted from: Gupta and Khanna. Economic value of breastfeeding in India. The National
Medical Journal of India, 1999, May-June 12(3):123-7.
Slide 25
26. Comparative health care costs of treating breastfed
and formula-fed babies in the first year of life in a
health maintenance organization (HMO)
When comparing health statistics for 1000 never breastfed
infants with 1000 infants exclusively breastfed for at least 3
months, the never breastfed infants had:
• 60 more lower respiratory tract illnesses
• 580 more episodes of otitis media, and
•1053 more episodes of gastrointestinal illnesses
Adapted from: Ball & Wright. Health care costs of formula-feeding in the first year of life.
Pediatrics, 1999, April, 103(4 Pt 2):870-6.
Slide 26
27. In addition, the 1000 never-breastfed infants
had:
• 2033 excess office visits
• 212 excess hospitalizations
• 609 excess prescriptions
These additional health care services
cost the managed care system
between $331 and $475 per never- b reastfed infant
during the first year of life.
Adapted from: Ball & Wright. Health care costs of formula-feeding in the first year of life.
Pediatrics, 1999, April, 103(4 Pt 2):870-6.
Slide 27
29. What is the infant mortality risk
from not breastfeeding?
12
Pooled Odds Ratios Ghana
10
Lowest tercile of
8 mat. education
6
4
2
0
0-1 mo 2-3 mo 4-5 mo 6-8 mo 9-11 mo 12-24 mo
WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of breastfeeding on infant
and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet. 2000 Feb 5;355(9202):451-5.
Slide 29
30. The baby Killer
(Andy Chetley/war on want, 1974)
• Sale of formula in India Rs
• Sale of Bottles in India Rs
Slide 30
31. Mother of Twin
Mother of twins - mother
in law told her she
didn’t have enough
for two, UNICEF 1992,
Mushtaq Khan
Slide 31
33. How do we are compare
Cow with calf Mother Breastfeeding
Slide 33
34. Why Mothers do not succeed?
Marketing
of No
Lack of formula role
Early Models
Assistance No
confidence
Hospital
practice
No
support
NO?
‘modern’
way No
Correct
information
Fear
Tied down
Evidence class I-III Work or Embarrassed
school
Slide 34
35. Manufacturing Malnutrition
Are they parallel methods ?
Promoting best food for baby And where is miracle
Sales Who its
production
• Benefits to –
– Manufactures • Who is benefited
– Scientists • At which cost ?
– Shareholders
– System
– Health workers
• At which cost ? Slide 35
36. Marketing Confuses Mothers
Confused mother Baby’s Misery
• Community Practices • Nutritional & health
• Health system care
• Commercial influences • Attitude
• Work & employment • Urbanization
• HIV & disaster
Slide 36
37. Which photograph will increase TRP ?
(Even Media is afraid of Promoting Breastfeeding)
Malnourished baby & A beautiful women
mother breastfeeding
Which photograph will create controversy ?
Slide 37
39. Role of International Health
Agencies
• Mediator - Budget from International
Pressure 25% -US
groups Assembly
• 70% from of Infant food
IBFAN Industrialized countries
manufactories
• How far taking strong stands on sensitive issues ??
Slide 39
40. What is Advice
Feed him on the left!
Feed him on the right!
Feed him in the morning,
Noon, and night!
Yeah! Breastfeeding!
Slide 40
43. What is support?
• How can we help?
• What will work for you?
• We have answers that will help you
• we can help by observing a feeding your baby
Slide 43
44. Two Most Common Complaints
“I don’t have enough milk”
Find out why she thinks this
Find out if the baby is gaining
Inquire about baby’s urine output
Inquire about what medications,
including birth control meds that she is
taking or has been given
Slide 44
45. When a mother thinks…
She does not have enough milk
Her first response is to supplement
with formula
This causes her supply to diminish
Exactly the opposite of what
We want to happen!
Slide 45
46. Two Most Common Complaints
“I have sore nipples”
Most common cause of sore nipple is
poor positioning and latch
Mothers want hands-on help with
breastfeeding
Mothers are NOT embarrassed by hands-
on help
Slide 46
49. Two Most Common Complaints
“I have sore nipples”
If your help with positioning and latch
doesn’t improve the pain within 24-48
hours, refer on!!!
Remember that the second most common
reason for stopping breastfeeding is sore
nipples…so act quickly!!!
Slide 49
50. Listen
carefully
Ask open
ended
questions
Respect
Provide
Practical
Effective Help
Accept Communication
what she
‘thinks’ or
feels
Explore
Feelings
Identify & Information,
Evidence class I-II Praise right Options,
things
Suggestions
Slide 50
51. New 2006 WHO Guidance
(HIV and 0-6 Months)
• Exclusive breastfeeding does carry lower risk of HIV
transmission than mixed feeding
• HIV-infected infants should continue to be breastfed
• Repeated assessments of feeding choice with mother
• Breastfeeding beyond 6 months may be best for some
HIV-exposed infants
• Counselling should focus on 2 main options
(replacement feeding and exclusive breastfeeding for
6 months), with other local options discussed only if
mother interested
• Home-modified animal milk no longer
recommended for all of first 6 months – only to be
used as short-term measure
Slide 51
52. • The state shall regard the raising the
level of nutrition and the standard of
living of it’s people and the
improvement of public health as
amongst it’s primary duties _ _.
Constitution of India, Article 47
Slide 52
53. • If you believe in the importance of
breastfeeding to mother and baby and
you have imagination and
determination and develop the
necessary skills ;
even in most difficult situations you may
find a way _ _.
Slide 53
-Thanks-