1) The document provides notes on infant feeding and care taken by Mariechen Puchert during her second year studies. It includes information on breastfeeding, formula feeding, growth charts, and indications for various feeding methods. 2) Details are given on nutritional requirements for preterm and term infants, advantages of breast milk, signs of proper breastfeeding attachment, and guidelines for expressing and storing breastmilk. 3) Contraindications to breastfeeding and drugs to avoid while breastfeeding are listed, along with guidelines for use of medications by breastfeeding mothers. Standard infant formulas and those for special conditions are also outlined.

1. Mariechen Puchert 2010
NOTE/Disclaimer: These are notes I made for myself during my second year. I cannot
guarantee that there aren’t mistakes. I do know that studying them were great help to me. I
used notes and powerpoints given to my class by lecturers (University of Stellenbosch,
Tygerberg Campus, South Africa) as well as the following textbooks:
Clinical Gynaecology : TF Kruger, MH Botha
Ostetrics in South Africa: Cronje
Nutrition
Growth charts
Oral rehydration
Breastfeeding
Immunisation
Female education
Family planning
Food supplementation
Indications for NGT
• Less than 34 weeks gestation
• Respiratory Distress Syndrome
• Feeding difficulties – ill, cleft palate, asphyxia
• Abdominal distension
Length of NGT = [manubrium to xiphisternum] x 2 + 2.5
Advantages of cup feeding
o Small preterm infants can
o Little energy required
o Hygienic, easy to clean
o Breast milk can be expressed into
o Safe
o Moves tongue in same way as breastfeeding
o Infant determines rate
Indications for bottle-feeding
1. Adoption
2. HIV-exposed infant
3. Maternal psychosis
4. Maternal breast cancer
5. Medications
♫ Term infants require 80-90 calories per day
♫ Preterm infants require 120 calories per day
♫ Preterm infants need vitamin and iron supplementation
Breast milk
Most appropriate food for the newborn up to 6 months.
Ideal: exclusively breastfed and then weaned from 6 months to two years.

2. Mariechen Puchert 2010
Tandem feeding Feeding babies at the same time from different pregnancies
Adequate feeding:
• Satisfactory weight gain
• Five to six wet nappies per day
• Happy, content baby
Breast milk advantages
o Less protein than cow’s milk
o Whey is major protein as opposed to casein in cow’s milk. Whey is more
digestible and less allergenic.
o Whey-casein ratio = 60:40
o Colostrums
o Unsaturated easily digested fats (cow’s milk has saturated)
o More lactose than cow’s milk
o Less vitamin D and K, but better absorbed
o Anti-infective properties
o Lower incidence of allergies
o Bonding
o Cognitive development
Maternal benefits of breastfeeding
1. Uterine involution
2. Reduced risk of breast cancer
3. Rapid return to pre-pregnant figure
4. Cost saving
Indications for fortification of breastmilk
a. Preterm <1500g
b. Fluid-restricted infant
c. Unsatisfactory weight gain
Weaning Process of gradually introducing solids into the baby’s diet
Indications for expression
• Working mother
• Engorged breasts
• Nipple problems
• Weak baby
Signs of correct attachment
o Baby’s whole body faces mother
o Baby’s head in line with body
o Baby’s head free to move
o Baby’s face close to breast
o Baby’s chin touches breast
o Baby’s mouth wide open
o Areola almost completely in mouth
o Slow, deep suckles

3. Mariechen Puchert 2010

4. Mariechen Puchert 2010
Formula Feeds
Newborn contraindications to breastfeeding
Galactosemia
Phenylketonuria
STANDARD INFANT FORMULAS FOR HEALTH TERM BABY
0-6 months Nan 1 S-26-1
Lactogen 1 SMA 1 Similac
Infacare 1 C&G Premium 1
6-12 months Nan 2 Lactogen 2 S-26 Promil 2
Infacare 2 Similac C&G Follow On 2
>12 months Cow’s milk – pasteurised and full strength
Nan 3 Inacare 3 C&G Step-up 3
SPECIAL MILK PROFILES
Low Birth Weight Prenan S26 LBW Gold C&G Nenatal
Cow’s milk allergy Nan-HA Similac AdvanceHA Soy Milk
Lactose intolerance Infasoy 1, 2 Isomil 1, 2 Nan Soya 1, 2
Sucrose intolerance AL 110
Fat intolerance Portagen
Chronic diarrhoea Alfare Pregestimil C&G Pepti Junior
Intestinal resection Alfare Pregestimil C&G Pepti Junior
No refrigeration Nan Pelargon
Drugs while breastfeeding
General guidelines
1. Only essential drugs given
2. Short-acting forms
3. Alternative forms
4. Single components rather than compounds
Contraindicated agents
• Drugs of abuse
• Antineoplastic drugs
• Immunosuppressants
• Gold salts
• Iodides
• Radio-pharmaceuticals
Agents to avoid
o Alcohol
o Amioderone
o Antidepressants
o Aspirin
o Iodine and lithium

5. Mariechen Puchert 2010
o Retinoids