INFANT AND YOUNG CHILD FEEDING PRACTICE

DIVISI NUTRISI DAN PENYAKIT METABOLIKBAG/SMF ANAK FK UNUD/RSUP SANGLAH DENPASAR

Soal:seorang bayi laki,diajak ibunya ke praktek untuk imunisasi, usia 3 bulan, BB 5,5 kg, PB 59 cm, saat ini minum ASI dan sudah diberikan susu formula sejak 2 minggu yang lalu.

1. Status nutrisi: Antropometri: BB/U -2SD s/d -1SD; PB/U -1SD s/d -2SD; BB/PB -

1SD s/d median Klinis baik Diet: ASI + susus formula Status gizi baik + perawakan baik

2. Kebutuhan nutrisi: BB ideal 5,7 kg; usia PB 2-3 bulan Energi= 5,7 x 120 kkal = 684 kkal/hari = 977 ml ASI Protein = 5,7 x 2,5 g = 14,25 g/hari

3. Rute pemberian: Oral

4. Jenis nutrisi: ASI + susu formula dilanjutkan

5. Monitoring: Kontrol sebulan lagi saat imunisasi berikutnya

Soal:seorang bayi laki,diajak ibunya ke praktek untuk imunisasi, usia 3 bulan, BB 5,5 kg, PB 59 cm, saat ini minum ASI dan sudah diberikan susu formula sejak 2 minggu yang lalu, BBL 3,3 kg, BB 1 bl 4,2 kg, usia 2 bl 5,1 kg.

Konseling tehnik menyusui yang benar, jelaskan cara/penggunaan ASI simpan dan pertanyakan pemberian susu formula???1. Status nutrisi:

Antropometri: BB/U -2SD s/d -1SD; PB/U -1SD s/d -2SD; BB/PB -1SD s/d median

Klinis baik Diet: ASI + susus formula Status gizi baik + perawakan baik + risiko gagal tumbuh

2. Kebutuhan nutrisi: BB ideal 5,7 kg; usia PB 2-3 bulan Energi= 5,7 x 120 kkal = 684 kkal/hari = 977 ml ASI Protein = 5,7 x 2,5 g = 14,25 g/hari

3. Rute pemberian: Oral

4. Jenis nutrisi: ASI + susu formula dilanjutkan ???

5. Monitoring: Kontrol sebulan lagi saat imunisasi berikutnya

Optimal infant and young child feeding (rekomendasi WHO, 2002) Early initiation of

breastfeeding (within 1 hour after birth)

Exclusive breastfeeding (0-6 months)

Continuous breastfeeding for 2 years or beyond

Complementary feeding (6-24 months)

Why breastfeeding ?

Breast

milk

• Perpect nutrient

• Easily digested, efficienly used

• Protect against infectionBreas

tfeedi

ng

• Help bonding and development

• Help delay a new pregnancy

• Protect mother’s health

Cost

• Cost less than artificial feeding

Early initiation of breastfeeding

Skin-to-skin-contact Mother and baby feel more

calm. Reduced risk of infection Warmth, love, security and

food. Smell of nipple = amniotic Get first milk = colostrum Support growth and bowel

function without allergy substance

More successful of exclusive breastfeeding

Oxytocin release, reduced bleeding

Colostrum: first 3-5 days of life Low in fat, high in CH,

protein and antibodies. Easily digested, laxative

effect, prevent jaundice. IgA contents protect

mucous membranes in the throat, lungs and intestines: protection against GIT and respiratory tract infection.

Initiating breastfeeding reduced neonatal mortality rates by 22%

Oligosaccharides: 3-9 sugar units Polysaccharides – oligosaccharides – disaccharides

– monosaccharide. Fiber: those polysaccharides we are not able to

digest. Insoluble Soluble: oligosaccharides, digested by bacteria

(microbiome), into short chain carboxylic acids for enrgy by cells lining of intestines first prebiotic of breast milk.

Prebiotic = functional foods. Oligosaccharides concentration in colostrum more

than 20 g/L, mature milk 12-14 g/L, compare with cow’s milk less than 1 g/L.

Protein

Breast milk: whey protein dominant Whey protein: rich of α-lactalbumin Easily digested and absorbed

Cow’s milk: casein protein dominant Whey protein: rich of β-lactoglobulin, low

in amino acid tryptophan.

Positioning and attachment

Cara bayi mengeluarkan ASI

Tekanan positif ketika rahang naik untuk memfasilitasi gerakan peristaltik

lidah pada puting/payudara

Tekanan negatif dalam rongga mulut ketika

rahang terbuka

Suckling Hormonal Reflex Arc

Source: Lactation Education Program Nutrition Policy and Education

More prolactin Secreted at night

Inhibitor in breast milk

If breast remains full of milk, secretion stops

Marker of Successful Breastfeeding 7% or less weight loss in first few days after

birth Return to birth weight for at least 2 weeks Weight gain per day of 20 to 30 g during first

3 postnatal months Lactation established in mother by 2 to 4

days after birth At least eight breastfeeding events every 24

hours Baby is latching unto breast easily Three to six stools and four to six voids by 5 to

7 days of age

Damayanti Rusli Sjarif 2009

Complementa

ry foods

Pemenuhan kebutuhan nutrisi bayi

0 – 6 bulan : ASI Eksklusif

6 bulan : 65 – 80% ASI, sisanya MP-ASI

12 bulan : 65-80% MP-ASI, sisanya ASI

24 bulan : seluruhnya makanan keluarga

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200550

300

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Breast milk in the second year of life

Some Considerations in Complementary feedingsToo Early diarrheal disease

& risk of dehydration

decreased breast-milk production

Allergic sensitization?

developmental concerns

Too Late potential

growth failure iron deficiency developmenta

l concerns

WHEN??

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GI readiness: 3-4 months

Developmental readiness: varies, between 4 and 6 months

Nutritional needs beyond breast milk : not before 6 months, after that varies

Need for variety and texture: within first year, order not

important

Fluid Needs

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Offer plain, clear water several times per day once infants are eating solids.

Additional fluids needed: • 400 - 600 ml / day in temperate

climates • 800 - 1200 ml / day in hot climates.

Without additional water dehydration becomes a threat.

Food Consistency

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Increase food consistency and variety as infant gets older.

Infants can eat pureed, mashed and semi-solid food

from 6 months.

By 12 months, family foods suitable.

Responsive Feeding

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Practice responsive feeding, applying the principles of

psychosocial care.

Remember that: Feeding times are

periods of learning and love - talk to

children during feeding, with eye to eye contact.

The 1st “Test Feedings”

Iron fortified infant rice cereal as 1st food

Should be a single food (not combination), nutritious, smooth texture and thin consistencyBest to offer after feeding some BM or Formula, except who repeatedly no interest offer before

Basic guidelines

• AAP : no special order to follow• The key : make sure foods are safe,

nutritious, suitable texture

Sequence of solid foods :

• smooth texture and thin consistency

• increase the texture and consistency gradually

Texture :

• start with a small amount (1-2 tsp)• gradually work up to tbsp or more

Serving amount :

Basic guidelines• introduce every 4-7 days between

each new foods• watch for signs of an adverse

reactions• before trying mixed foods, try each

of the food individually.• best to offer a new food early in the

day plenty of time to watch for any reaction

Time between

new foods :

• parents should wash their hands, the baby’s hands, any utensils dishes, etc.

• parents shouldn’t share eating utensils with the baby or pre-chew food before giving it to the baby

Food safety :

Precautions when introducing solid food

Home-prepared beets, carrots, collard greens, spinach and turnips :• high in nitrates

methemoglobinemia• should not be fed babies < 6 monthsHoney :• may contain C.botulinum causing

infant botulism

Cow’s milk :• infant < 1 yr should not get cow’s milk low

in Fe, high in Na, K, Cl and other minerals

Safety Issues Regarding Feeding Infants:

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Honey and corn syrup, are the only food sources in infants diet of Clostridium botulinum spores, which lead to Botulism. They

should not be fed to infants less than 1 year of age.

Cook eggs and chicken well to avoid salmonella.

Small, hard, round , and sticky solid foods may lead to choking and

aspiration

AAP: Specific Recommendations

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Home prepared spinach, beets, turnips, carrots, collard greens not recommended due to high nitrate levels Methemoglobinaemia

Canned foods with high salt levels and added sugar are unsuitable for preparation of infant foods

Honey not recommended for infants younger than 12 months Botulism

Help baby become more independent:

• Give finger foods

• Drink from cup since 6-8 months of age

• Hold his/her own cup or bottle

• Make feeding schedule so that baby will feel hungry and full regularly

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Codex Standard for Infant Formula and Formulas for Special Medical Purposes for Infant (CODEX STAN 72-1981) Infant formula, like no other food, is regulated by its

own law, the Codex Standard for Infant Formula and Formulas for Special Medical Purposes for Infant.(CODEX STAN 72-1981)

The act sets upper and lower limits on important nutrients

It requires that the formula supports normal growth and that contents are clearly labeled.

Manufacturers are required to follow “good manufacturing practice,”

Codex Standard for Infant Formula and Formulas for Special Medical Purposes for Infant (CODEX STAN 72-1981)

Section A refers to Infant Formula Section B deals with Formulas for Special

Medical Purposes Intended for Infants means a substitute for human milk or infant formula

that complies with Section 2, Description, of the Codex Standard for the Labelling of and Claims for Foods for Special Medical Purposes (CODEX STAN 180-1991) and is specially manufactured to satisfy, by itself, the special nutritional requirements of infants with specific disorders, diseases or medical conditions during the first months of life up to the introduction of appropriate complementary feeding.

FORMULA FOR SPECIAL MEDICAL PURPOSES INTENDED FOR INFANT AND YOUNG CHILDREN

Formula for premature infant Fortified human milks Premature infant formula Premature-discharged formula

Formula for cow-milk allergy "predigested" formulas Extensively hydrolyzed formulas Amino-acid based formula

Formula for inborn errors of metabolism Phenylalanine free formula (PKU), branc-chain amino acids

free formula (MSUD, MMA), etc Formula for gastrointestinal disorders

Acid Reflux: Thickened Formulas Lactose-free formulas: lactose intolerance, Enteral nutrition

World Health Organization 2009

Cleaning

Sterilizing

How to prepare a bottle feed (1)

How to prepare a bottle feed (2)

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