WELCOME ALLWELCOME ALL

CF61

INFANT INFANT FEEDINGFEEDING

Dr Mohammad Nurul Huq

Feeding in Feeding in early 6 monthsearly 6 monthsand and

ComplementaryComplementary feedingfeeding

World Key factsWorld Key facts

Every child has the right to good nutrition (Convention on Every child has the right to good nutrition (Convention on the Rights of the Child)the Rights of the Child)Undernutrition is associated with 45% of U-5 deathsUndernutrition is associated with 45% of U-5 deaths2013: 2013: 161.5 million U-5 were stunted, 50.8 million wasted, 161.5 million U-5 were stunted, 50.8 million wasted, 41.7 million were overweight/obese41.7 million were overweight/obese36% are exclusively breastfed (EBF)36% are exclusively breastfed (EBF)<25% children get appropriate complementary foods (CF)<25% children get appropriate complementary foods (CF)1 million lives could be saved/y, if BF started in 11 million lives could be saved/y, if BF started in 1stst h of life h of life

Principles of IFPrinciples of IF

Counseling at ANC and after birthCounseling at ANC and after birth EBF first 6 moEBF first 6 mo Complementary feedingComplementary feeding BM for 2y BM for 2y NoNo bottle, bottle, nono machine machine NoNo animal milk in first 2y animal milk in first 2y NoNo commercial foods commercial foods

ANC: antenatal careEBF: exclusive breastfeeding. BM: breast milk

Principles of BFPrinciples of BF

EBF for first 6moEBF for first 6moDemand feedingDemand feedingEBM SOSEBM SOS BM for 2rBM for 2rCorrect position and attachmentCorrect position and attachmentBalanced family food for motherBalanced family food for motherNo pacifierNo pacifier

EBM: expressed breast milk. BM: breast milkEBM: expressed breast milk. BM: breast milk

World Breastfeeding Week World Breastfeeding Week (1-7 AUGUST)(1-7 AUGUST)

Marked/y in >170 countries to promote and Marked/y in >170 countries to promote and support BF, improve the health of babies (Innocenti support BF, improve the health of babies (Innocenti Declaration)Declaration)Making workplaces friendly to BF: a long way to goMaking workplaces friendly to BF: a long way to goA lot has improved in the past 22y to make A lot has improved in the past 22y to make workplaces BF-friendlyworkplaces BF-friendly'Breastfeeding and Work - Let's make it work!"'Breastfeeding and Work - Let's make it work!"

First 6 months: First 6 months: Exclusive Breast Exclusive Breast

FeedingFeeding

Exclusive Breast Feeding…Exclusive Breast Feeding…

… … feeding the newborn with feeding the newborn with onlyonly BM (Mother’s BM (Mother’s

milk!); milk!); not even a dropnot even a drop of water of waterfor for 6 6 calendar calendar mo mo (180d)(180d)

Why no water?Why no water?

Composition of BM makes extra water unnecessaryComposition of BM makes extra water unnecessaryeven in dry and hoteven in dry and hot climates climates! ! No No

dehydration!dehydration!

Better avoid possible contaminated water!Better avoid possible contaminated water!

Is EBF Enough?Is EBF Enough?

Yes!Yes! It is proved!It is proved!

– mother fed her baby mother fed her baby in-uteroin-utero for 9mo; she can for 9mo; she can still do it for another 6mostill do it for another 6mo

– 2 breasts can support 2 breasts can support 2 babies!2 babies!– no mammal fails!no mammal fails!

Breast takes over the feeding roleBreast takes over the feeding roleof placenta after birthof placenta after birth

Is BM Enough? …Is BM Enough? …

Wetness testWetness testIf a baby voids urine If a baby voids urine 6 times/d 6 times/d sucks 8-12 times/dsucks 8-12 times/d

Weight checkWeight checkFirst 6 mo: gains 125g/wFirst 6 mo: gains 125g/wor 500g/moor 500g/mo

If mother says: BM If mother says: BM not enoughnot enough: check: check

– weight weight – feeding techniquefeeding technique– for illness in baby and motherfor illness in baby and mother– malnutrition in mothermalnutrition in mother

When BM is not enough When BM is not enough Baby is not sucking effectively:Baby is not sucking effectively:

ActionAction: position and attachment: position and attachmentMother is very busy and suckles lessMother is very busy and suckles less

ActionAction: increase frequency: increase frequencyBaby does not suck long enoughBaby does not suck long enough

ActionAction: suckle longer, stroke cheek, check for any : suckle longer, stroke cheek, check for any discomfortdiscomfort

Formulas are given: advise the mother about EBFFormulas are given: advise the mother about EBF(You can refer the mother to BBF)(You can refer the mother to BBF)

BBF: Bangladesh Breastfeeding FoundationBBF: Bangladesh Breastfeeding Foundation

FAQ by motherFAQ by mother

BM is not enough, baby cries a lot!BM is not enough, baby cries a lot! Shouldn’t I habituate him with a bottle?Shouldn’t I habituate him with a bottle? Can I use a bottle to feed BM?Can I use a bottle to feed BM? Can I give water?Can I give water?

contd

He has diarrhea from BM!He has diarrhea from BM! I am a working motherI am a working mother Can I feed him while I am lying?Can I feed him while I am lying? He has become v. windy on BFHe has become v. windy on BF He is passing lot of urineHe is passing lot of urine

FAQ …FAQ …

101 Benefits of Breast Feeding!101 Benefits of Breast Feeding!For Mother For Mother

Less obesity, may lose wtLess obesity, may lose wt Perfectly easy, cost effectivePerfectly easy, cost effective

(($1,000 or more/y). Convenient.$1,000 or more/y). Convenient.You can breastfeed almost You can breastfeed almost anywhere anytimeanywhere anytime

No extra labor or toolsNo extra labor or tools Bonding. Birth spacingBonding. Birth spacing Formula bagFormula bag Some cancers are rare in BF mothersSome cancers are rare in BF mothers

Benefits for Infant

It is the nature’s wayIt is the nature’s way EnvironmentallyEnvironmentally friendly friendly Nutritional values are just parallel to actual needs of Nutritional values are just parallel to actual needs of

the baby the baby The baby grows optimallyThe baby grows optimally

contdcontd

Benefits for Infant Benefits for Infant … …

Fresh and flows round the clockFresh and flows round the clock

Easiest: Easiest: no toolsno tools

Preferred by babies even when sickPreferred by babies even when sickGrowth factorsGrowth factorsDelays allergyDelays allergyAnemia, scurvy, rickets, etc. are rareAnemia, scurvy, rickets, etc. are rare

Benefits for Infant Benefits for Infant … …

Solute load of formulas is much Solute load of formulas is much in excess to that of BM (120 vs in excess to that of BM (120 vs

88 mosm/l)88 mosm/l)Enteral infx. is virtually nil Enteral infx. is virtually nil ARI, otitis media, UTI rareARI, otitis media, UTI rareBetter IQBetter IQ

Uniques of BMUniques of BM

NoNo nutritional nutritional deficienciesdeficienciesStandardStandard growth growthUnique Unique combinationcombination of energy and nutrients of energy and nutrientsNumerous Numerous anti-infectives:anti-infectives:Unique Unique bondingbondingUniquely Uniquely cheap and cost effectivecheap and cost effective

Lack of bonding

Anti-infectives in BMAnti-infectives in BM

Prevent viruses, bacteria and parasites:Prevent viruses, bacteria and parasites:– Specific:Specific: antibodies (mainly IgA)antibodies (mainly IgA)

lymphocytes (humoral, CMI)lymphocytes (humoral, CMI)– NonNon--specific:specific: lactoferrin lactoferrin

lysozymelysozyme bifidus factorsbifidus factors complementscomplements

Lactoferrin: Lactoferrin: red iron-binding protein that retards red iron-binding protein that retards bacterial and fungal growthbacterial and fungal growth

Lysozyme: Lysozyme: a bacteriolytic protein (aka a bacteriolytic protein (aka muramidase)muramidase)

Complements:Complements: proteins that with antibodies destroy proteins that with antibodies destroy particulate antigensparticulate antigens

Bifidus factor: a CHO that stimulates growth of L bifidus (prebiotic) that lowers pH of gut and suppresses pathogens

Together they make gut unsuitable for pathogensTogether they make gut unsuitable for pathogensCHO: carbohydrateCHO: carbohydrate

Nutrition in BMNutrition in BM

Energy Energy 70 kcal/100ml70 kcal/100ml Lactose Lactose 7g/100ml7g/100ml Fat Fat 4.2g/100ml4.2g/100ml Protein Protein 1.45g/100ml1.45g/100ml

MicronutrientsMicronutrients

Fe, Zn, Cu, iodine, Ca, Cl, Na, Mn, P, K, etc. Fe, Zn, Cu, iodine, Ca, Cl, Na, Mn, P, K, etc. BM binds Fe, Zn, etc. to ease absorption but BM binds Fe, Zn, etc. to ease absorption but

prevent them from use by bacteriaprevent them from use by bacteria All vitamins if mother is not deficientAll vitamins if mother is not deficient

EBF EBF Ensures:Ensures:

a virtually a virtually infection freeinfection free normalnormal uneventfuluneventful G&D of the infant and G&D of the infant and bonding between baby and motherbonding between baby and mother

G&D: growth and development

Why Breast is BestWhy Breast is Best

BF is the healthiest for mom and babyBF is the healthiest for mom and babyBF is a wonderful way to bondingBF is a wonderful way to bondingBM naturally has all the nutrients optimallyBM naturally has all the nutrients optimallyBM has Ab that prevents inf.BM has Ab that prevents inf.BF can help prevent allergies, stomach problemsBF can help prevent allergies, stomach problemsBreastfed babies are less obese or have diabetesBreastfed babies are less obese or have diabetesBF may help prevent SIDSBF may help prevent SIDSBF is the natural, healthy choice for mom and babyBF is the natural, healthy choice for mom and baby

BF DifficultiesBF Difficulties

Lack of family supportLack of family supportLack of confidenceLack of confidenceWorking motherWorking motherMultiple babiesMultiple babiesSome diseasesSome diseasesBreast engorgementBreast engorgementCracked or retracted nippleCracked or retracted nippleBreast infectionBreast infectionBreast tumor …Breast tumor …

Breastfeeding ChallengesBreastfeeding Challenges

BF is not always easy for moms and babies:BF is not always easy for moms and babies:Discomfort.Discomfort. Sore nipple is normal in the first weeksSore nipple is normal in the first weeksTimeTime.. Baby may take a huge time and effort. More Baby may take a huge time and effort. More frequent than formulafrequent than formulaDiet.Diet. Baby may be sensitive to certain foodsBaby may be sensitive to certain foods

Most mothers find early struggles pass quickly, Most mothers find early struggles pass quickly, and they settle into BFand they settle into BF

Some Moms Cannot BreastfeedSome Moms Cannot Breastfeed

A few! But it does not make you a bad momA few! But it does not make you a bad momWork.Work. Not all mothers can pump (EBM). Certain jobs may Not all mothers can pump (EBM). Certain jobs may make it hard to stick to a regular pumping schedulemake it hard to stick to a regular pumping schedule Companies with >50 employees are required by law to Companies with >50 employees are required by law to

provide the time and place to pumpprovide the time and place to pumpNot enough milkNot enough milkHealth and safety.Health and safety. HIV/AIDS. Medicines can make it unsafe HIV/AIDS. Medicines can make it unsafe to breastfeedto breastfeedAddiction problems.Addiction problems. Alcohol/drug addict momsAlcohol/drug addict momsGalactosemia.Galactosemia. They must be fed soy-milk based formulaThey must be fed soy-milk based formula

Technique of BFTechnique of BF

Mostly Mostly naturalnatural; just feed on ; just feed on demanddemand 8-12 feeds/d8-12 feeds/d Some techniques Some techniques ensureensure success: success:

correct correct positioningpositioning and andattachmentattachment of the baby of the baby

Positioning the BabyPositioning the Baby

Head and body is straight Head and body is straight Baby held close to bodyBaby held close to body Support baby’s whole bodySupport baby’s whole body Baby faces the breastBaby faces the breast

Good positioning Good positioning ensures comfortensures comfort

Attachment of the Baby Attachment of the Baby

Mouth is wide-openMouth is wide-openLower lip is turned outwardsLower lip is turned outwardsChin is touching breastChin is touching breastMore areola is seen above than belowMore areola is seen above than below

Correct position and attachment Correct position and attachment ensure comfort and ensure comfort and success of BFsuccess of BF

Mouth opening

MessageMessage

Up to 6mo BM is enough Up to 6mo BM is enough It protects the baby. It is It protects the baby. It is

ready to feedready to feedeasy to doeasy to docost effectivecost effectiverewardingrewardingenvironmentally friendly!environmentally friendly!it is unique!it is unique!

Why Environmentally FriendlyWhy Environmentally Friendly

Renewable sourceRenewable source No extra energy to make and process milkNo extra energy to make and process milk No plastic pollutionNo plastic pollution No extra man powerNo extra man power No inefficient land useNo inefficient land use

contd

Environmentally Friendly....Environmentally Friendly....

No methane from cowsNo methane from cows No adsNo ads No sterilizing No sterilizing No luggage of toolsNo luggage of tools

Inefficient land use

No trees, no crops!

Remember mother!Remember mother!

Breasts are attached to youBreasts are attached to you You can’t forget! You can’t forget! They serve the perfect food at perfect temp., no They serve the perfect food at perfect temp., no

matter where you are!matter where you are!

Infant formulasInfant formulas

Made from cow’s milk and designed to provide nutritional Made from cow’s milk and designed to provide nutritional needs of infantsneeds of infants

A variety are available: vary in nutrients, calories, taste, A variety are available: vary in nutrients, calories, taste, digestibility, and costdigestibility, and cost

TYPESTYPESStandard milk-based formulas: Standard milk-based formulas: Almost all babies do well on these. Fussiness and colic are Almost all babies do well on these. Fussiness and colic are

common problems. No need to change the formulacommon problems. No need to change the formula Cow's milk protein has been changed to be more like BM. Cow's milk protein has been changed to be more like BM.

Vegetable oils, minerals, vitamins are also added Vegetable oils, minerals, vitamins are also added

Soy-based formulas:Soy-based formulas:from soy proteins. No lactose. For parents who do not want from soy proteins. No lactose. For parents who do not want

animal protein, and for galactosemia or alactasiaanimal protein, and for galactosemia or alactasia They do not help milk allergies or colic. Babies may also They do not help milk allergies or colic. Babies may also

be allergic to them be allergic to them

Hypoallergenic IF (protein hydrolysate):Hypoallergenic IF (protein hydrolysate):may be helpful for allergies to milk protein, skin rashes or may be helpful for allergies to milk protein, skin rashes or

wheezing c/by allergies. Generally expensive wheezing c/by allergies. Generally expensive

Lactose-free formulas:Lactose-free formulas:used for Galactosemia, alactasia (usually begins after a used for Galactosemia, alactasia (usually begins after a

12mo)12mo) In diarrhea: usually no need of lactose-free formulaIn diarrhea: usually no need of lactose-free formula

Special formulas:Special formulas: used under supervision: used under supervision:Reflux formulas: Reflux formulas: thickened with rice starch. Needed only thickened with rice starch. Needed only

for reflux with FTT or who are v. uncomfortablefor reflux with FTT or who are v. uncomfortableFormulas for preemies and LBW Formulas for preemies and LBW have extra calories have extra calories

and minerals to meet the needs of these infantsand minerals to meet the needs of these infantsSpecial formulas for cong. HD, malabsorption Special formulas for cong. HD, malabsorption syn, syn,

and problems digesting fat or processing certain amino a and problems digesting fat or processing certain amino a Toddler formulas Toddler formulas are offered as added nutrition for are offered as added nutrition for

toddlers who are picky eaters. To date, they have not been toddlers who are picky eaters. To date, they have not been shown to be better than whole milk and multivitamins. shown to be better than whole milk and multivitamins. They are also expensive. They are also expensive.

Ready-to-useReady-to-useConc. liquid formulasConc. liquid formulas

Formulas Formulas

… … basically dried cow’s milkbasically dried cow’s milk… … notnot designed for our babiesdesigned for our babies… … devoid of the unique properties of BM devoid of the unique properties of BM

So we So we do not calldo not call these these ‘baby foods!’‘baby foods!’

Harms from FormulasHarms from Formulas

CMPICMPI Solute overloadSolute overload Chemicals, additivesChemicals, additives Dislike for breast milkDislike for breast milk No adequate bondingNo adequate bonding Expensive but never fresh!Expensive but never fresh!

CMPI: cow’s milk protein intolerance

FAQ on formulas FAQ on formulas

Which brand is the bestWhich brand is the bestAdd sugar?Add sugar?Boil?Boil?What water, mineral water?What water, mineral water?How long can be kept?How long can be kept?

Feeding BottleFeeding Bottle

The The worstworst invention! invention! Very dangerous for babiesVery dangerous for babies A A baby killer baby killer specially in the LICsspecially in the LICs Diarrhea and other ID are xDiarrhea and other ID are x88 : : Death is xDeath is x44So, you do not So, you do not advocate it advocate it for your baby!for your baby!

LIC: low income country

Bottle-fed babies get diarrhea moreBottle-fed babies get diarrhea moreDifficult to keep cleanDifficult to keep clean Easily contaminatesEasily contaminates Contaminated waterContaminated water

Bottle-fed babies get ARI moreBottle-fed babies get ARI more Sleep feedingSleep feeding VADX from frequent infx.VADX from frequent infx. ContaminationContamination

Harms from BottleHarms from Bottle

Easily contaminatesEasily contaminates Mortality and morbidity v highMortality and morbidity v high Diluted feeds: Diluted feeds: malnutritionmalnutrition Extra sugar/thickened feeds: Extra sugar/thickened feeds: obesityobesity Plastic bottles release BPAPlastic bottles release BPA Baby may refuse solids in time: Baby may refuse solids in time: late in solids: Mn., late in solids: Mn.,

behavioral and developmental problemsbehavioral and developmental problemscontdcontd

Bisphenol A: belongs to diphenyl methane

Feeding during sleep:Feeding during sleep:– overfeedingoverfeeding– indigestion, bloatingindigestion, bloating– throat/respiratory infectionthroat/respiratory infection– tooth decay tooth decay ((nursing bottle syn)nursing bottle syn)

Lactational failureLactational failure

Harms from Bottle …Harms from Bottle …

When giving ORS or EBM always use a cup and spoon, never a feeding bottle

EBM: expressed breast milk

Advantages of Bottle FeedingAdvantages of Bottle Feeding

Anyone can feed your babyAnyone can feed your babyYou can get round-the-clock helpYou can get round-the-clock helpYou can also pump BM and feed by bottleYou can also pump BM and feed by bottleYou feed less often.You feed less often. Babies digest formula slower, Babies digest formula slower,

so you may have fewer feeding times so you may have fewer feeding times Remember that everything you do as a mother, Remember that everything you do as a mother,

your love, attention, and care, will give baby the your love, attention, and care, will give baby the best start in lifebest start in life

BF and FigureBF and Figure

Does not lose her figureDoes not lose her figure Helps lose wt Helps lose wt Breasts regain former shape (use a bra when breasts are Breasts regain former shape (use a bra when breasts are

heavy)heavy) Breast changes in pregnancy, so BF or not BF does not Breast changes in pregnancy, so BF or not BF does not

make any differencemake any difference

ConclusionConclusion

Every mother can BF (<1% cannot)Every mother can BF (<1% cannot) Frequent suck keeps up supply of BMFrequent suck keeps up supply of BM Breasts of all sizes are equally goodBreasts of all sizes are equally good Shape of nipple does not matter, as long as baby Shape of nipple does not matter, as long as baby

takes the breast well into the mouthtakes the breast well into the mouth

MCQMCQ

EBF for 180 days Breast milk contains live cells Strict schedule is preferable Complementary feeding starts from 4 mo Giving water to baby is useful in EBF BM contains secretory IgA

SAQSAQ

What are the positioning and attachment for EBF?What are the positioning and attachment for EBF?How do you counsel to make BF a success?How do you counsel to make BF a success?What are the benefits of EBF?What are the benefits of EBF?What are the harms of formula feeding?What are the harms of formula feeding?What are the harms of bottle feeding?What are the harms of bottle feeding?

COMPLEMENTARY COMPLEMENTARY FEEDINGFEEDING

(Family Foods Along with BF)(Family Foods Along with BF)

Principles of CFPrinciples of CF

Family foodFamily foodAffordable, balanced, locally availableAffordable, balanced, locally availableDemand feedingDemand feedingNo insistence, not ceremonialNo insistence, not ceremonialEasy preparation: no bottle, no machineEasy preparation: no bottle, no machineNo sleep feedingNo sleep feeding

Why CF?Why CF?

After 6 mo

More calories: rapid growth, more activities Calorie dense foodsExploration of foodsHabituation with family foods, multiple foodsSolid foods after tooth eruption Integration with the familyIntegration with the family

Less sugars Less sugars after tooth eruptionafter tooth eruptionProtective Protective foods; non-nutritional elementsfoods; non-nutritional elementsDevelopment of behavior and personalityDevelopment of behavior and personality Iron gap, vitamin A gapIron gap, vitamin A gap FitnessFitness

– teeth make the infant teeth make the infant functionally maturefunctionally mature!!

Why CF…Why CF…

Weaning!Weaning!

Means taking the child Means taking the child off the breast! off the breast! But avail benefits of BM as long as possible!But avail benefits of BM as long as possible!The term is The term is d i s c a r d e dd i s c a r d e dComplementary FeedsComplementary Feeds to complement BF to complement BF

CF: is it difficult task?CF: is it difficult task?

NoNo It cannot beIt cannot be It should not beIt should not be It is natural! So it is easyIt is natural! So it is easy We should not make easy thing difficult We should not make easy thing difficult

Who made it difficult?Who made it difficult?

Profiteers! Profiteers! With fancy food names!With fancy food names!– Follow up-, catch upFollow up-, catch up– Grow up iron-, -sure, My Boy!Grow up iron-, -sure, My Boy!– All Vitamins, A-Z foods, etc.!All Vitamins, A-Z foods, etc.!

Promotion of bottle and blenderPromotion of bottle and blender

Trade promotion!Trade promotion!

Time of startingTime of starting

After 6 After 6 calendar mo (180d)calendar mo (180d)Why not earlier?Why not earlier?

Too early may cause diarrhea, Mn, IDAToo early may cause diarrhea, Mn, IDARisk of obesity, allergy, Risk of obesity, allergy, atherosclerosisatherosclerosisMay deprive the baby of May deprive the baby of uniqueunique BM BM

Why not late?Why not late?

Baby adopts family Baby adopts family foods best nowfoods best now

Delay may causeDelay may cause– rejection of solidsrejection of solids– faulty feedingfaulty feeding

Prolonged EBF causesProlonged EBF causesFTT FTT IDA, VADXIDA, VADXPoor resistance Poor resistance Developmental andDevelopmental and

behavioral problemsbehavioral problems

FTT failure to thriveFTT failure to thrive

VADX: vit A def and xerophthalmiaVADX: vit A def and xerophthalmia

FAQ FAQ

When to start When to start CerelacCerelac, , Junior HorlicksJunior Horlicks??What formula is the best?What formula is the best?Use blender?Use blender?What rice? What oil? ….What rice? What oil? ….What fruit? What banana? What fruit? What banana? Banana and orange cause cold?Banana and orange cause cold?Veggies cause gasVeggies cause gas

Boil formula?Boil formula?Times of feeds?Times of feeds? If no appetite?If no appetite?Add sugar?Add sugar?

Grapes?Grapes?How much water?How much water?How to give eggs?How to give eggs?

FAQ… FAQ…

What types of food?What types of food?

Family foodFamily food is really goodis really good; ; the baby deserves it!the baby deserves it!Fresh and soft, balancedFresh and soft, balancedConsider food value: Consider food value: no poor/rich foodno poor/rich foodVaried in texture and flavorVaried in texture and flavorNot 1 or 2 foods onlyNot 1 or 2 foods only

(more)(more)

Type of food …Type of food …

Energy denseEnergy denseMore roughage/fiberMore roughage/fiberMore vitamins, and mineralsMore vitamins, and mineralsNo animal milkNo animal milkNot monotonousNot monotonousDon’t forget water!Don’t forget water!

Why Family Food?Why Family Food?

Always fresh!Always fresh!Cheap, affordableCheap, affordable Integrity and discovery of familyIntegrity and discovery of familyBondingBondingFood varies from country to countryFood varies from country to country

No international food!No international food!

International food?International food?

NoNo Local foodsLocal foods Family foodsFamily foods Mother’s foods for her baby!Mother’s foods for her baby!

Be careful! Be careful! They like to rob away your kitchenThey like to rob away your kitchen

Why not commercial foods?Why not commercial foods?

Not natural; not fresh, costly!Not natural; not fresh, costly! MonotonousMonotonousMany Many chemicals!chemicals!

– preservatives, additivespreservatives, additives– tasting salt, flavors, etc.tasting salt, flavors, etc.

It may be old, contaminatedIt may be old, contaminated(more)(more)

Commercial foods.. Commercial foods..

Risk of obesityRisk of obesity … … using bottleusing bottle … … constipationconstipation … … late starting of solidslate starting of solids … … addictionaddiction

How to start CF?How to start CF?

Start foods from plant; first a Start foods from plant; first a CHO CHO preferably rice preferably rice ((suji); suji); add sugar, oil, spiceadd sugar, oil, spice

At 1-2w intervals add others (At 1-2w intervals add others (khichurykhichury, soup, etc) , soup, etc) Mix egg in small amounts and increase graduallyMix egg in small amounts and increase gradually Give fruits, waterGive fruits, water

Schedule of CFSchedule of CF

3 times a day for 6-9 months3 times a day for 6-9 months 4 times a day for 9-12 ,,4 times a day for 9-12 ,, 5 times a day for 12-24 ,,5 times a day for 12-24 ,, Up to 12mo: BF first, then CFUp to 12mo: BF first, then CF1-2 years: CF first1-2 years: CF first

Foods for 6-9 monthsFoods for 6-9 months

Suji, rice Suji, rice Khir or payeshKhir or payeshKhichury, fruits, vegetablesKhichury, fruits, vegetablesEggEggWater Water

Foods for 9-12 monthsFoods for 9-12 months

Khichury, rice, dal, sKhichury, rice, dal, soupoup Fruits, vegetables, eggs Fruits, vegetables, eggs Home made sweetsHome made sweets

Foods for 12-24 moFoods for 12-24 moMore solids, more variedMore solids, more variedRegular foods taken with parentsRegular foods taken with parents

Favour for fruitsFavour for fruits

Seasonal fresh fruitsSeasonal fresh fruits Vitamins, minerals, fiberVitamins, minerals, fiber ProtectantsProtectants Fresh vs processedFresh vs processed How much juice a day?How much juice a day? Fruits in diarrheaFruits in diarrhea

A banana a day A banana a day

keeps the Dr awaykeeps the Dr away Energy, protection, Energy, protection, stimulant, stimulant,

relaxant (tryptophan)relaxant (tryptophan) Number 1 fruit for athletesNumber 1 fruit for athletes Better academic performanceBetter academic performance Contains all vitamins Contains all vitamins Good calories (2 bananas=90 min work)Good calories (2 bananas=90 min work)moremore

A banana a day …A banana a day …

All 3 sugars (fructose, sucrose, glucose)All 3 sugars (fructose, sucrose, glucose)Fiber, iron, laxativeFiber, iron, laxativeExtremely high in KExtremely high in K++, low in salt: , low in salt: regulates BP. regulates BP. Low risk of strokeLow risk of strokeAnti-irritant for skin Anti-irritant for skin

Well protected, tasty! Well protected, tasty! Available year roundAvailable year round

Grapes are sour!!Grapes are sour!!

Partly rotten! Difficult to cleanPartly rotten! Difficult to cleanChance of contamination Chance of contamination Not protectedNot protectedMainly sugarMainly sugarExpensive!Expensive!

Vibrant Rainbow VegetablesVibrant Rainbow Vegetables

Non-nutritious parts: fiberNon-nutritious parts: fiberProtectantsProtectantsRich in vitamins and mineralsRich in vitamins and mineralsPrebioticPrebioticSome can be taken freshSome can be taken fresh

60% drugs are derived from plants

The egg storyThe egg story

• After 6 moAfter 6 mo• First class protein First class protein • Must be: Must be: well cooked/hard boiled/friedwell cooked/hard boiled/fried

• NeverNever poached or half boiled poached or half boiled • Cooking destroys 70% allergenicityCooking destroys 70% allergenicity

Semicooked eggs contains bugs from poultry unless pasteurized!

The ‘khichury’The ‘khichury’

The basic foodThe basic foodReally tastyReally tastyUnique!Unique! All essential amino acids All essential amino acidsDifferent taste from different ingredientsDifferent taste from different ingredientsDaily newDaily newNot monotonousNot monotonous

The chips storyThe chips story

No outdoor foods: chips, biscuits, candies!No outdoor foods: chips, biscuits, candies!Chance of contaminationChance of contaminationAre mainly sweets, not balancedAre mainly sweets, not balancedSalt overloadSalt overloadMay not be of good qualityMay not be of good quality

Non-nutritious: empty calories

How to offer?How to offer?

Breast feed firstBreast feed firstMake the session enjoyableMake the session enjoyableNo bottle/blender: use cup n spoonNo bottle/blender: use cup n spoonTemporary withdrawal of rejected foodTemporary withdrawal of rejected foodPostpone foods causing V&DPostpone foods causing V&D

The blender storyThe blender story

Risk of contaminationRisk of contamination Solids may be rejectedSolids may be rejected Risk of habituationRisk of habituation Expensive!Expensive!

How frequently?How frequently?

On demandOn demandDon’t force/insist!Don’t force/insist!Don’t expect eating the whole amountDon’t expect eating the whole amountDon’t feed in sleep Don’t feed in sleep (only possible with bottle)(only possible with bottle)

Adopt the baby to family foodsAdopt the baby to family foods

After suji give khichury, soup, etc.After suji give khichury, soup, etc.Don’t hurry! Give a slice of orange/lemon or a Don’t hurry! Give a slice of orange/lemon or a

piece of carrot! S/he explores it!piece of carrot! S/he explores it!Keep the baby with all at the dinning tableKeep the baby with all at the dinning table

– offer something on dish. S/he will spill some!offer something on dish. S/he will spill some!– don’t be upset!don’t be upset!

Working mother Working mother

Not a problem Not a problem Problem not with working statusProblem not with working status The attendant should be convincedThe attendant should be convinced Cup and spoon feedingCup and spoon feeding Adequate maternity leaveAdequate maternity leave

Conclusion Conclusion

Family foods Family foods are:are:scientific, hygienicscientific, hygieniccheap, cheap, naturalnaturalsimple, easysimple, easy really good!really good!

enjoyableenjoyableevery day new!every day new!no problem with no problem with

working mother!working mother!

We do not make feeding difficultWe do not make feeding difficult

Mom must be Mom must be beside me!beside me!

MCQMCQ

CF started at 6 moCF started at 6 moBlending makes food more digestibleBlending makes food more digestibleVegetables have non-nutritional protectantsVegetables have non-nutritional protectantsBefore 1 y CF should be given firstBefore 1 y CF should be given firstBest age to adapt family foods is 8 moBest age to adapt family foods is 8 mo

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Immunization Immunization