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Infant and Young Child Feeding associate professor Kantemirova M.G. • Appropriate feeding are essential for the nutrition, growth, development and survival of infants and young children. Types of infant feedings (upto 4-6 months) I. Breastfeeding (natural or exclusive breastfeeding feeding > 80% ) II. Mixed-breast feeding (complementary feeding 20%-80%) III. Artificial feeding (> 20%) Breast-feeding (natural or exclusive breast-feeding ) • Exclusive breast-feeding means that except for breastmilk, no other food or fluids should be given to a child from birth to 4-6 months of age. Initiate breastfeeding within first hour of birth; • Natural breast-feeding means more than 80% of breastmilk (less than 20% of milk formular or substituters) are given to infants upto 4-6 months Mixed-breast feeding (complementary feeding) • It means that infants receive: 20% <breastmilk < 80% 20%< milk substitutes<80 cows Milk substitutes: cow’s-milk, goat's milk, diluted or powdered milk formular, acidic milk preparations Artificial feeding • It means that an infant doesn't receive breastmilk at all or less than 20%; more than 80% of milk substitutes Stages of lactation • I. 1st-4th day – colostrum • II. 5th-18th day – immature breast milk • III. After 18th day – mature breast milk (more watery) Colostrum • Content: the high content of proteins, less lipids and carbohydrates as compared with mature breast milk; active leucocytes – phagocytic bodies, IgA, lactoferrin; growth factors (fibroblast, epidermal, granulocyte-macrophagestimulating, vascular endothelia), amino acidtaurine, vitamins A,E. • Protection from infection and prevention of allergy, stimulation of defecation and growth. The composition of breast milk • Water (87-90%) • Proteins (1%) – albumin>casein ; essential amino acids: histidine, cysteine taurine (brain development) • Lipids (4%) – rich with unsaturated fatty acids (linoleic, linolenic, arachidonic) • Carbohydrates (7%) – β-lactose (80-90%), bifidus-factor • Minerals: Ca:P 2:1 ( blood serum proportion), Cu, Zn, Fe • Vitamins - A, D, E The composition of breast milk • Protein 0,9-1,3 g/100 ml • Lipids 4,0-5,0 g/100 ml • Carbohydrates 7,27,5 g/100 ml Biological active components of breast milk • • • • • • • • • • • • Ig A,M,G Secretary Ig A Lactoferin Lysozime Interferon C3, C4 Bifidus-factor B-lymphocytes Neutrophils Macrophages Lactoperioxidase RNA-factor Benefits to breastfeeding for the infant. • Bm less proteins (compared with Cm), albumin:casein 3:2 (Cm-2:8) Albumin is absorbed better,Bm casein is more easily degested • Cm proteins – foreign antigens caused allergy • Cm higher protein content – excessive load on the kidneys and immature membrane of intestines of 2-3 months aged infants. So up to 2-3 months Cm should be dilated: 1:1 up to 2 weeks; 2:1 – up to 3 months (5% cereal water) Bm – prevent IDDM, obesity Benefits to breastfeeding for the infant. • Active Bm lipase promotes digestion of fats and provides free fatty acids, facilitates absorption of Ca • Bm higher content of essential and unsaturated fatty acids • Bm proportion Ca:P 2:1– better absorption of these minerals • Bm is sterile • Bm can decrease the risk of development of infectious and other diseases. • Higher intelligence later in life • Close physical and emotional relations between mothers and child Bm can decrease the risk of development of infectious and other diseases • Viral infections (secretary IgA, specific inhibitory substances, interferon, IgM,G) • Intestinal infections (secretary IgA, lysozyme, antistaphylococcal factor, lactoferrin, bifidus factor, macrophagocytes) • Amoebic infections ( bile salt stimulated lipase) • Less chance of developing diabetes mellitus type 1 • Less childhood obesity • Less tendency to develop allergic diseases • Less necrotizing enterocolitis in premature infants • Malaria (para-amino-benzoic acid) • Less chance of deficient diseases Rules of successful breast-feeding • Early breastfeeding - in the half hour after birth the baby's suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding • Breastfeeding at least every two to three hours - helps to maintain milk production • Joint stay in the ward of mother and newborn • Exclusion of prelacteal feeding and water • Avoid any bottles Expressing breast milk • When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room temperature for up to six hours, refrigerated for up to eight days or frozen for up to four to six months. Expressing breast milk • Manual breast pump Breast feeding • Calculation of milk volume Newborns 1-10 days of age 1. Zaitsev’s method: daily milk volume= 2%Mbxn; Mb- birth weight in gram, n-day of age 2. Philkenshtain’s method: one-time volume of milk=10xn; n-day of age 3. Daily milk volume= 70xn if Mb<3200 g =80xn if Mb>3200g n-day of age Breast feeding • Calculation of milk volume 1. Volume method for infants above 2 weeks 2 weeks – 2 months = 1/5 body weight 2 months – 4 months = 1/6 body weight 4 months – 6 months = 1/7 body weight 6 months – 9 months = 1/8 body weight Daily volume of food for infants – not more than 1 liter (1000 ml) Breast feeding • Calculation of milk volume 2. Callorie method: 1 litre of milk provides about 700 kcal daily milk volume = (M×daily energy requirements):700 kcal M- infant’s weight Daily proteins, fats, carbohydrates, energy requirements of infants Nutrients g/kg Возраст, месяцы 0-3 3-6 6-12 Proteins 2.2 2,6 2.9 Fats 6.5 6,0 5.5 Carbohydrates 13 13 13 Energy kcal/kg 115 115 (100) 1 : 2,5 : 5 110 Proportion P:F:C 1:3:6 1 : 2 : 4,5 Breast feeding • The frequency of feeding 1. Up to 3 months of age – 7 times a day with 3 hours intervals and 6-hours night interval: 6.009.00-12.00-15.00-18.00-21.00-24.00 2. 3 – 5 (6) months of age – 6 times a day with 3,5 hours intervals and 6,5-hours night interval:6.00- 9.30-13.00-16.30-20.00-23.30 3. above 5 (6) months - 5 times a day with 4.0 hours intervals and 8-hours night interval:6.0010.00-14.00-18.00-22.00 Weaning • The World Health Organization recommends exclusive breastfeeding for the baby's first 6 months of life. • After 4-6 months of age Bm alone cannot provides all energy and proteins requirements of infants • Weaning is the process of introducing the infant to other food and reducing the supply of breast milk. • Weaning means accustoming the infant to the products differ from milk • Weaning foods provide solid food for development chewing organs and G-I-T Weaning foods • Correction of minerals and vitamins needs: fruit juices, mashed fruits (3-4 months) • 1-st weaning: mashed vegetables (vegetable soup; purees) - cabbage, cauliflower, squash, dark green leafy vegetables, carrot, potatoes (5-6 months) • 2-d weaning: porridge or gruel (5% than 10%) rice, semolina, lentils, corn, buckwheat porridge (gluten free) 6 months • 3-d weaning: meat - mashed, spam, meatballs (beef, rabbit, turkey)/fish (7-8/9 months) • 4-th weaning: kefir, yogurt (10 month) Corrections of microelements, vitamins • 1-st - fruit juices, mashed fruits (3-4 months) • 2-d - vegetable oil (5 months) • 3-d - curd, butter, yolk egg (6-6,5 months) • 4-th - crackers, cookies (8-9 month) All correction foods have to start by drops or tea-spoon (10xn, n-month of age) General principles of weaning introducing • Beginning with a single weaning food • Beginning with a 5-10 ml • Gradually increase the volume from 5-10 ml to the volume of one feeding (180-200 ml) during 2 weeks • Between every weaning 1 month interval • Weaning food is given before Bm The approximate menu of 4,5-5,5 months aged breast fed infant • 6.00 – breast milk180 – 200 ml • 10.00 - breast milk180 – 200 ml • 14.00 – mashed vegetables– 5 ml. to 200г+ breast milk (195 ml to 0 ml) • 18 - breast milk180 – 200 ml • 22 - breast milk180 – 200 ml • Between main feeding– fruit juices – 1drop - to 40-50 ml, mashed fruits– 1 tee spoon to 40-50 ml (V = 10 х n (n – months of age) The approximate menu of 5,5-6,5 months aged breast fed infant • 6 –breast milk 200 ml • 10 – porridge rice 5% (than 10%) 1 tee spoon-150 ml + breast milk till 180 – 200 ml • 14 - mashed vegetables 180 – 200 g + vegitabal oil 3 – 5 g+ yolk 1/4 • 18 - breast milk 200 ml • 22 - breast milk 200 ml • Between feeding - fruit juices – 50-60 ml, mashed fruits– 50-60 ml (V = 10 х n (n – months of age) • • • • • • The approximate menu of 7-8 months aged infant 6 –breast milk 200 ml 10 – porridge 5%-10% 200 g+ butter 5,0 g 14 – mashed vegetables 200-150 g+ mashed meat –5 g to 50 g+ yolk ½ + vegitabel oil 5.0 g 18 – curd – 40 g + breast milk 22 – breast milk 200 ml Between feeding– fruit juices – 60-70 ml, mashed fruits– 60-70 ml (V = 10 х n (n – months of age) ,crackers, cookies The approximate menu of 8-12 months aged infant • 6.00 – breast milk 200 ml • 10.00 – porridge 10% 200 g+ butter 5,0 g+yolk ½1,0 • 14.00 - mashed vegetables 200-150 g+ mashed meat or meat balls 50 g+ + vegetebl oil 5.0 g • 18.00 – curd– 50 + kefir (jogurt) 150 ml + crackers, cookies 5-10 g • 22.00 - breast milk 200 ml • Between feeding– fruit juices – 80-120 ml, mashed fruits– 80-120 ml (V = 10 х n (n – months of age) ,crackers, cookies • \ Mixed-breast feeding Additional foods Milk substitutes: cow’s-milk, goat's milk, diluted or powdered milk formula, acidic milk preparations Adopted and non-adopted milk preparations. Non-adopted milk preparations –different dilutions of cow’s-milk, goat's milk (1:1-1st month, 2:1 – 1st-3d month) Adopted: powdered milk formula( Nan, Nutrilon, Frisolac , Humana …) General principles of mixed-breast feeding • Additional food is given after Bm • Small volume of additional food is given by a spoon • If additional food is given in a bottle the nipple should be a small hole (milk flow out by drops) • Every feeding should be combination breast milk and milk formula (it stimulates lactation) Free breast-feeding (on demand) • Put to the breast on baby’s demand when hungry (not often than in 2-2,5 hours -1012 times, Bm is evacuated from stomach after 2 hours) • Don’t confuse – hungry or exited. Babies may also nurse (sucking) when they are lonely, frightened or in pain • Without bottles or other supplements and additional food (even water) Free breast-feeding (on demand) • Night feeding • If additional foods are necessary – to use spoons, cup • Don’t wash the breast nipples before and after feeding • Without pumping after feeding • Duration of sucking is determined by a baby (not 15-20 minutes) • Weigh the child, not more than 1 time per week Indications to pumping • Lactostasis • Lack of breast milk – stimulation of lactation • If mother have to leave the baby fore more than 3-4 hours • Additional food for sick baby, premature, tired of sucking Algaritm the decision of tasks • Determination of body weight according the age • Determination of the needs in the P, F, C, kcal/kg • The definition of the daily volume of food • Determination of the frequency of feedings • Definition of a single volume of food • The diet of the day based on the introduction of weaning foods