ARTIFICIAL FEEDINGARTIFICIAL FEEDING,,SUPPLEMENTED SUPPLEMENTED
BREASTFEEDING, and BREASTFEEDING, and COMPLEMENTARY FEEDINGCOMPLEMENTARY FEEDING
Prof. Dr. Emel Gür
İÜ CTF Çocuk Sağ ve Hast ABD
ARTIFICIAL FEEDINGARTIFICIAL FEEDING
AArtificial Feedingrtificial Feeding
In this type of feeding, the baby receives only non-breastmilk
İf the family can afford it, it is İf the family can afford it, it is best to substitue breast-best to substitue breast-
feeding with industrial milk feeding with industrial milk formulae which all have formulae which all have composition similar to composition similar to
maternal milk.maternal milk.
If cow’s milk must be used, the If cow’s milk must be used, the milk must be diluted with water in milk must be diluted with water in
proportions of 1:1 in the first proportions of 1:1 in the first month, 2:1 between 1 and 4 month, 2:1 between 1 and 4
months. No dilution is necessary months. No dilution is necessary after 4 months. To increase after 4 months. To increase
calorie content, 5g. (1 teaspoon) calorie content, 5g. (1 teaspoon) of sugar is added to each 100g. of sugar is added to each 100g.
diluted or nondiluted milk.diluted or nondiluted milk.
AMOUNT OF MILK PER AMOUNT OF MILK PER MEALMEAL
1-2 week 60-90 ml3 wk - 2 mo. 120-150 ml2-3 mo. 150- 180 ml3-4 mo. 180-210 ml5-12 mo. 210-240 ml
The number of feedings per The number of feedings per dayday
0-1 week 6-101 week-1 mo. 6- 81-3 mo. 5- 6 3-7 mo. 4- 5 4-9 mo. 3- 48- 12 mo. 3
Principles of Principles of artificial artificial feedingfeeding
Fruit juıces can be started after the first month. Artificially fed babies do not need solid foods,
such as milk pudding before 4 months It is best to prepare milk formulae fresh at each
feeding Adequate preparation of the food, cleanliness
of the water, and the containers and utensils is essential
Principles of Principles of artificial artificial feedingfeeding
Artificially fed babies do not need solid foods, such as milk pudding before 4 months
Principles of Principles of artificial artificial feedingfeeding
Bottles and nipples must first be washed with soap and water using a long brush, than sterilized in boiling water for 10 minutes and left to cool on upside down position
For the uneducated mothers, it is best to recommended spoon feeding, using cups or glasses even in very young babies.
The nipple hole must be checked for size by looking at milk flow
Adequacy of intake is Adequacy of intake is assessed by weight assessed by weight
monitoringmonitoring
SSUPPLEMENTEDUPPLEMENTED BREAST-FEEDİNG BREAST-FEEDİNG
(MIXED FEEDING(MIXED FEEDING))
Supplemented BREAST-FEEDİNG Supplemented BREAST-FEEDİNG
(MIXED FEEDING(MIXED FEEDING))
An infant in his first 6 months is offered breast milk and in addition, other milks
and milk products as supplements.
The main indication for The main indication for supplementing breast-supplementing breast-
feeding is an arrest weight feeding is an arrest weight gain in a healthy breastfed gain in a healthy breastfed
infant which is not corrected infant which is not corrected despite all efforts to despite all efforts to
increase the maternal milk increase the maternal milk supply.supply.
The decision for The decision for supplementation is taken supplementation is taken
only after one or two weeks only after one or two weeks of monitoring. of monitoring.
Principles of supplemented Principles of supplemented feeding feeding
When the need for supplementation is established, this is done gradually
At first, the supplement is given once a day preferably in the evening (6.00-7.00 pm.), a time when the mother’s milk supply is usually the lowest.
The baby is breast-fed for 5-10 minutes and the supplement (milk formula and cow’s milk) is offered by spoon. İf the baby is not satisfied by one supplementation, two or more meals may be supplemented.
Principles of supplemented Principles of supplemented feedingfeeding
Spoon feeding must be preferred to bottle feeding. This is important for the continuation of breast-feeding and prevention of infections.
Fruit juices are started at 4 weeks and milk pudding at 4 months in babies on supplemented feedings
COMPLEMENTARY COMPLEMENTARY FEEDINGFEEDING
FEEDING BETWEEN 6-12 FEEDING BETWEEN 6-12 MONTHSMONTHS
Breastfeeding will not meet Breastfeeding will not meet the requirements of the the requirements of the babies over 6 monthsbabies over 6 months
After 6 months, breast-After 6 months, breast-feeding is supplemented with feeding is supplemented with
more concentrated foods.more concentrated foods.
Time of introduction of Time of introduction of supplemental foods supplemental foods
(6 months or earlier) (6 months or earlier) should be decided by weight should be decided by weight
monitoringmonitoring
Until 9th month breast-milk Until 9th month breast-milk is the primary diet of the is the primary diet of the
baby.baby.Foods initially supplement Foods initially supplement breast-feeding gradually breast-feeding gradually
replace breast-feeding and replace breast-feeding and at 9-12 months become the at 9-12 months become the
primary diet of the babyprimary diet of the baby
RESULTS OF EARLY AND LATE RESULTS OF EARLY AND LATE INTRODUCTION OF THE SUPPLEMENTAL INTRODUCTION OF THE SUPPLEMENTAL
FOODSFOODS
EARLY Decreasing of breast-
milk Gastroenteritis Allergy Malnutrition Obesity
LATE Growth retardation Infection Gastroenteritis Malnutriion Vitamin ve mineral
deficiency
REQUIREMENT OF ENERGY ACCORDING TO REQUIREMENT OF ENERGY ACCORDING TO AGEAGE
Age Energy (kcal/kg/day)
<3 mo. 120
3-6 mo. 115
6-8 mo. 110
9-1 mo. 105
1-3 mo. 100
4-6 mo. 85
7-10 mo. 85
11-14 yr. E 60
K 50
15-18 yr. E 45
K 40
Supplementary foods must Supplementary foods must be foods of high energy be foods of high energy
content, easy to digest, low content, easy to digest, low in fiber, in puree in fiber, in puree
consistency, easy to consistency, easy to prepare and free of spices.prepare and free of spices.
Supplementary foods are Supplementary foods are best given by cup and best given by cup and
spoon, and introduced one spoon, and introduced one at a time and in small at a time and in small
amounts (1-2 teaspoons), amounts (1-2 teaspoons), and the amount increased and the amount increased
every dayevery day
Fruit juice and fruit puree Fruit juice and fruit puree (apples or peaches) and (apples or peaches) and
milk pudding prepared with milk pudding prepared with rice flour are the first rice flour are the first
supplementary foods to be supplementary foods to be started. Vegetable purees, started. Vegetable purees, yoghurt, eggs, meats are yoghurt, eggs, meats are
gradually introducesgradually introduces
The nitrat content of The nitrat content of spinach must be given as spinach must be given as soon as prepared. Fava soon as prepared. Fava
beans are not beans are not recommended becouse of recommended becouse of favism, eggplants are not favism, eggplants are not
recommended because they recommended because they are poor in minerals and are poor in minerals and
vitaminsvitamins
Points to remember when Points to remember when starting supplementsstarting supplements
They must be prepared fresh, kept in a cool place away from insects
Some babies prefer a salty taste, while others like sweet taste. The choice of the food must be done with some flexibility to suit the baby’s preference
The baby must not be forced . İf the baby refuses the food, that particular food is withheld for a few days
Points to remember when Points to remember when starting supplementsstarting supplements
Water given to babies younger than 12 months must always be boiled. Water used in the preparation of supplemental foods must also be clean
In preparing the foods, attention must be paid to measure the right amounts
(1 teaspoon=5ml; 1 tablespoon =15ml; 1 cup or 1 water glass=200ml; 1 tea glass=100ml)
AMOUNT OF SUPPLEMANTARY AMOUNT OF SUPPLEMANTARY FOODS PER MEALFOODS PER MEAL
Age (month) Tablespoon
6 6
7 7
8 8
9 9
10 10
11 11
12-24 at least 10
Time of introduction of Time of introduction of supplemental foodssupplemental foods
6th-7th months
7th-8th months
Fruit juice and puree Vegetable purees Milk pudding Yoghurt
Meat, chicken, fish Lentile, chickpea, bean Egg yolk (It ıs initially is given hard boiled and started in small amount)
Time of introduction of Time of introduction of supplemental foodssupplemental foods
8th-9th months
9th-12th months
Cereals (rice, wheat, macaroni, bread )
Children can be introduced to the family table
FEEDİNG BETWEEN 1-5 FEEDİNG BETWEEN 1-5 YEARS YEARS
After 9 months, breast-After 9 months, breast-feeding ceases to be the feeding ceases to be the
basic diet of the baby. The basic diet of the baby. The baby should be completely baby should be completely
weaned at 2 yearsweaned at 2 years
Children can be trained to Children can be trained to self feed by spoon starting self feed by spoon starting at age at age 12 months 12 months and can and can
be introduced to the family be introduced to the family table table
The child must have his/her The child must have his/her own separate plate and own separate plate and
must be carefully observed must be carefully observed to note what he/she eats to note what he/she eats
and how muchand how much
Between 1 and 5 years, Between 1 and 5 years, children need to have children need to have fourfour
meals a day meals a day The diet should include The diet should include
basic foodstuffs which are; basic foodstuffs which are; milk and milk foods, meats milk and milk foods, meats
and eggs, fruits andand eggs, fruits and vegetablesvegetables, starchy foods, starchy foods
A child of this age must A child of this age must receivereceive
500g milk dailyTwo servings of either meatsAn egg every day (on alternate days if
eating meats regularly)Vegetables once or twice a dayFruits once or twice a dayOne or two servings of starchy food and 3
slices of bread
Food requirements are Food requirements are different in induvidual different in induvidual
children and children must children and children must never be forced to eatnever be forced to eat
Children should not eat Children should not eat candies and other sweet candies and other sweet
frequentlyfrequentlyTea and coffee are Tea and coffee are
stimulants which should stimulants which should not be given to young not be given to young
childrenchildren
All children should have their All children should have their own tooth-brush starting at own tooth-brush starting at
age 18 monthage 18 month
FEEDING AT SCHOOL AGEFEEDING AT SCHOOL AGE
FEEDING AT SCHOOL AGEFEEDING AT SCHOOL AGE
Breakfast is an important meal Usually the reason for this is faulty family eating
habits and neglect of meeting around the breakfast table regularly
Parents should abstain from negative comments on the food at meals
Serving should not be too large and each member of the family must try to finish his serving
FEEDING AT SCHOOL AGEFEEDING AT SCHOOL AGE
It must be remembered that a child under 5 can eat only half the amount of an adult, and a 12 year old boy only 2/3 the amount of the teenager
The child is encouraged to finish his plate by educating him about changing food requirements by age, sex, size and physical activity
School age children also need to have a balanced diet including the basic foods