Feeding Infants & Older ChildrenSurg Cdr RW Thergaonkar

Topics Covered

• Recap of Breastfeeding

• Complementary feeding

• Factors in Diet Planning

• IMNCI Food Box

Breastfeeding: A Recap

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

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

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

Know the Hormones

Mammogenesis - Oestrogen & Progesterone

Lactogenesis - Prolactin

Galactopoiesis - Prolactin, TSH, GH

Milk let down reflex - Oxytocin

Physiology of Lactation

•Rooting Reflex

•Sucking Reflex

•Swallowing Reflex

BABY REFLEXES

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

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”

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

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

Burping after feeding?

• For 10 – 15 min• Continue even after the baby burps• Various positions:

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

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

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

Food Groups

• Cereals, millets & pulses

• Vegetables & fruits

• Milk & milk products

• Eggs, meat, fish

• Oils & nuts

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

IMNCI Food Box

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

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

6-12 months

Add cooked vegetable in the also in the servingsOr 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

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 handsWash your own and your child’s hands with soap and water before each feeding

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

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

12 months to 2 years

Frequency: 5 times per day

Remember: Sit by the side of the child and help him finish the servingWash your child’s hands with soap and water every time before feeding

2 years and older

Give family food as 3 meals each dayAlso, twice daily, give nutritious food between meals such as

banana/biscuit/cheeku/mango/Papaya as snacks

2 years and older

Remember: Ensure that the child finishes the

servingTeach your child to wash his hands

with soap and water every time before feeding

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

Thank You