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MBBS MEDICINE NOTES FOR MCQMED ///
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Infant feeding and nutrition
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Infant feeding and nutrition

Breast feeding and complimentary
nBreast feeding up to 2 years ( 6 months exclusive)
nComplementary feeding with semisolids from 6 months .
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FORMULAR FEEDING
INDICATIONS FOR FORMULA FEEDING
nMother dead
nMother ill
nMother unavailable
nMother does not wish to breast feed
nBreast milk inadequate
Indicators for iadequate lactationDESIRABLE CHARACTERISTICS OF AN INFANT FORMULA
nAvailability
nAffordability
nEase of preparations
nClear instructions
nSterility
nStorage
nConformity to standards
DESIRABLE CHARASTERISTICS OF CHEMICAL COMPOSITION
nCHO: fat: protein ratio as in BM
nCHO to be lactose (40 - 50%) of total energy
nProtein - casein: lactalbumin (2.5g / kg / day) Curds: whey ratio to be 60:40
n amino acid composition to simulate BM
nFat 35 - 45% of energy
Less butter fat (saturate)
More PUFA
Linoleic acid 1% of energy
nTotal solute load ¯
nCa:PO4 ratio like in BM
nTotal Na to be ¯
nFortify with essential vitamins minerals vitamins A, B, C, D.
Minerals Ca, Mg, Ph, Fe, Zn, Cr, I, Fi, Mn, Cr, Se
TYPES OF FORMULA
nModified infant formula 0-6 months, 0-12 months.
nFollow on formula 6 - 12 months.
nTherapeutic formula.
nUnmodified full cream milks
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COMPLEMENTARY FEEDING
nCommence between 4 - 6 months
nSemi solids
nBy cup & spoon
nCleanliness / palatability / digestibility
nMeeting nutritional needs
nCereal/pulses / vegetable / fruit / fish / meat / egg
nReady made weaning foods
nLow salt / sugar
nAvoid artificial flavoring additives
nVitamin & iron
nAdd fat. Supplements
nVariety of texture / taste
nGradual ­
nAim - normal family diet by 12 - 18 months
DESIRABLE CHARACTERISTICS OF A READY TO EAT COMPLEMENTARY FOOD
nAdequate calorie / protein density
nMicronutrient adequately
nSterility
nShelf life ­
nRight fiber content
nPalatability
nLow salt / sugar / additives
nLow in allergenicity
nAffordability
nAvailability
Malnutrition problem stats
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NUTRITION TRANSITION
Shift from
indigenous staple grains /starchy roots locally grown legumes other vegetables and fruits limited amount of foods of animal origin
To
pre – processed foods
more foods of animal origin
more sugar and fat
more alcohol
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FOETAL PROGRAMMING OF ADULT DISEASE
  • Barker Hypothesis
  • Thrifty Genotype
Importance of Infant nutrition
  • Childhood malnutrition is a global problem
  • It is especially common in Asia
  • It has a major impact on survival & quality of life
  • It commences within a narrow “age window” in infancy.
  • Foetal & Infant nutrition is a major determinant of survival, health and quality of life.
Recommendations for infant feeding
  • Start breastfeeding within one hour of birth
  • Breastfeed exclusively for six months
  • From six months, add adequate complementary foods.
  • Continue breastfeeding up to two years or beyond.
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Recommendation for practice
The Expert Consultation recommends exclusive breast feeding for 6 months, with introduction of complementary foods and continued breast feeding thereafter. This recommendation applies to populations. The Expert Consultation recognizes that some mothers will be unable to, or chose not to, follow this recommendation. These mothers should also be supported to optimize their infants’ nutrition.International initiatives in infant feeding
International code for marketing of breast-milk substitutes (1981)
  • Innocenti declaration on protection, promotion and support of breast feeding (1990)
  • Baby friendly hospital initiative (1991)
  • Global strategy for infant and young child feeding (2003)
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International Code of Marketing of Breast-milk substitutes
  • No advertising or promotion to the public
  • No free samples to mothers or families
  • No donation of free supplies to the health care system
  • Health care system obtains breast-milk substitutes through normal procurement channels, not through free or subsidized supplies
  • Labels in appropriate language, with specified information and warnings
Baby Friendly Hospital Initiative (BFHI)
  • 10 steps to successful breast feeding
  • 47 hospitals (70% births) declared BFH by 1995
Infant feeding in emergencies
  • Need to protect breast feeding
  • Avoid violations of code
  • Ensure cleanliness
  • Support for breast feeding mothers
Problems of artificial feeding in emergencies
  • Lack of water
  • Poor sanitation
  • Inadequate cooking utensils
  • Shortage of fuel
  • Daily survival activities take more time and energy
  • Uncertain, unsustainable supplies of breast-milk substitutes
  • Lack of knowledge on preparation and use of artificial feeding
  • Inappropriate donations of infant feeding products
Infant feeding policy in emergencies
Communicate a clear policy to all staff
  • Support breastfeeding
  • Identify infants who truly need artificial feeding
  • Reduce risks of artificial feeding as much as possible
  • Prevent indiscriminate supply of bottles & formula
  • Support energy/nutrient dense complementary feeding
Breast feeding and MTCT
  • Risk of vertical transmission through BF (14%)
  • Risk is more with mixed feeding than EBF
  • There is no global recommendation
Options
  • If formula is available, affordable and safe recommend formula
  • If not : recommend EBF with AZT for mother
Sri Lankan policy :
Mother is given the choice
Formula feeding supported by MOH
Complementary feeding strategies
Optimizing nutrient intake from locally available foods using a home made multimix
  • Fortified processed complementary foods
  • Micronutrient supplements
  • Continuation of breast feeding on demand
Home made multimix
  • Present strategy in Sri Lanka
  • “Masa pahen habun katak”
  • Is the recipe adequate in calorie / nutrient density?
  • Need for greater variety more recipes
  • Kitchen improvement
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Low cost processed weaning food
  • Thriposha
problems of supply and delivery
Identification of beneficiaries
  • Bilindu posha
  • Poshitha
  • Social marketing
Commercial processed weaning foods
  • price
  • inclusion of milk
  • fibre content
Strategies to combat iron deficiency
  • Iron deficiency is a problem in infancy
  • Known relationship to cognitive impairement
  • Inclusion of haem iron in home made multimix
  • Iron fortification of CF
  • Iron supplements Tablets
Syrup / drops
Sprinkles
Food refusal / Responsive feeding
  • Feed infants directly
  • Assist older children to feed themselves
  • Sensitive to hunger and satiety
  • Slow and patient
  • Encourage but don’t force
  • Refusal : experiment with variety
  • Avoid distractions
  • Talk to children / make eating a pleasant exercise