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Comparison between human milk and cow's milk
Material
Human milk
Cow's milk
Protein
gm/100ml
1 (30% casein, 70 %
whey)
3.3 (80% casein,
20% whey)
Fat
4 (6o % unsaturated, 4 (40%
40% saturated)
unsaturated, 60%
saturated)
Carbohydrate
(lactose)
7
4.5
Gallery
67 Kcl/100ml
67 Kcl/100ml
Mineral
0.2%
0.8%
Water
The same
Comparison between human milk cow's milk and Colostrums
Material
Human milk
Cow's milk
Colostrums
Protein
gm/100ml
1 (30% casein, 70 %
whey)
3.3 (80% casein,
20% whey)
2.7
gm/100ml
Fat
4 (6o % unsaturated,
40% saturated)
4 (40%
unsaturated, 60%
saturated)
2.9
gm/100ml
Carbohydra
te (lactose)
7
4.5
5.3
gm/100ml
Callery
67 Kcal/100ml
67 Kcal/100ml
Minerals
0.2 gm/100ml
0.8 gm/100ml
Water
The same
67
Kcal/100ml
0.5
gm/1ooml
NOTES :
The mature milk when secreted from
the breast compose of two parts, the
first part called (fore- milk) and second
part called hind milk, if the baby take
both breast by one fed he will take only
the (fore- milk) which contain more
lactose than water, so the baby develop
diarrhea so he should take only one
breast per fed but use both breast in
24h.
Colostrums :
It is the 1st milk produced after delivery
at 3rd-10th day of infant life, then
transform into the transitional milk and
finally to mature milk, the amount of
colostrums is 15-50 ml/day it is bright
lemon in color, more alkaline than mature
milk and has more specific gravity, also
have anti-infective and laxative effect
which is benefit to get rid from me
conium.
Casein :it's an alkaline, hard, and
difficult to digest and makes the milk
to be alkaline with little amounts of
lacto-albumin and lacto-globulin .
Minerals :Cow's milk has 3-4 times of
Na, K, and Ca more than human milk
and has 6 times of phosphorus more
than human milk that’s why never
advice to feed baby on cow's milk in
first days of life because :
Kidney is immature and difficult
to eliminate the minerals .
In the first days of life the baby
on cow's milk may develop
tetanus due to hypocalcaemia
because of high phosphorus
level suppress of calcium
• Vitamins: cow's milk is low in vit. C and D, breast milk
contain adequate vit. C and D provided that the
mother in good diet and exposed to some light, cow's
milk contain more vit. K than human milk, both types
contain adequate vit. A and B complex.
• Bacterial content: although human milk is essentially
uncontaminated by bacteria, pathogenic organisms in
significant number may enter the milk from mastitis.
Tubercle, typhoid bacilli, herpes, hepatitis B, rubella,
mumps, HIV and CMV may be found at times in the
milk of women infected by these organisms.
• Cow's milk however is good culture for pathogenic
bacteria, and many infections are milk borne including
streptococcal disease, diphtheria, typhoid fever,
salmonellosis and brucellosis, in addition to bacteria
that cause G.E and diarrhea.
Digestibility
• The stomach empties more rapidly
after human milk than after whole
cow's milk. The curd of cow's milk is
reduced in size by boiling and makes
less tough and much smaller by
evaporation or by add acid and alkali.
Formula feeding
• Technique of artificial feeding
• The mother and baby should be comfortable,
unhurried and free from distraction, the infant
should be hungry, warm and fully a wake and
should be held as if he( she ) is breast- fed. The
bottle should be held so that milk not air go
through the nipple of the teat, the bottle is
warmed to body temperature, the temperature
is tested by dropping milk on to the wrist. The
nipple hole should be of size so that milk drops
slowly, the eructation of air swallowed during
feeding is important to avoid regurgitation and
abdominal discomfort (this technique is the
same in breast feeding).
Indications of formula feeding
• All contraindications of breast
feeding , insufficient breast milk (this
is compose only 2% of breast feeding
mother), employment of the mother
outside home , metabolic disease
and twins.
• Types:
• 1- substitutive (no breast milk).
• 2- breast and formula:
complementary in each feed, and
supplementary one feed from
breast and the second feed from
formula.
Types of milk formula
• 1- liquid milk
• a- raw milk: this is not advised for infant feeding, it forms large
curds in the stomach is slowly digested and is easily contaminated.
• b-pasteurized milk: pasteurization destroys pathogenic bacteria and
modified casein, raw milk is heated at 37cº for 15 sec. then rapidly
cooled, pasteurized milk should be boiled when used for infant
feeding, it is allowed to stand in the refrigerator for as long as 48h.
• c- homogenized milk: in this milk the fat globules are broken into
minute particles , so smaller and less tough curd produced in
stomach
• d- evaporated milk: the advantage it can kept for months without
refrigerator, casein and fat become softer so less curd in stomach ,
this milk can be feed in higher concentration (one ounce → 44 KCL)
• e- condensed milk: about 45% cane sugar has been added, more
sweetened milk → CHO content increased to 60%. Although readily
digested, it has no use in infant feeding for more than short periods
when a high calorie diet is desired.
• 2- dried milk:
• prepared by evaporating water from milk , to
dry ; each 100cc of liquid milk is transformed
into 12.5gm powder (1:8).
• a- dried whole milk: fat content is 3.5%.
• b- dried skim milk: non fat skim milk, fat
content o.5% , in half skim milk fat content is
1.5% , are available for infant with fat
intolerance , should not be used in 1st 2 y. of
life, it's high protein and mineral content may
cause sever dehydration.
Advantages of dried milk
•
•
•
•
1- sterile and highly soluble
2- composition is constant.
3- can be stored for a long period.
4- effect of heat on protein make it
easily digested (casein is destroyed).
• 5- can be modified to different children.
• 6- less expensive.
Modified formula
• 1- low lactose milk.
• 2- lactose free milk ( e.g. isomil ) for
galactosemia.
• 3- hypo allergic milk ( e.g. isomil ) contain no
milk protein, replaced by Soya protein
completely .
• 4- phenylalanine free milk (lofenalac) for
phenylketonuria.
• 5- low calcium milk for hypercalasemia.
• 6-Low Na milk for congestive heart failure.
3- acidified milk
• these milk require less hydrochloric
acid for gastric digestion done by:
• a- chemically: adding lactose, citrus
or acetic acid to milk.
• b- biologically: adding lactobacillus
How much to feed?
• 80-120 kcal/kg/24 h. (110 kcal/kg/24h.),
each 30 mol = 1oz = 20 kcal.
• e.g infant has weight 6 kg . how much to
feed ?
• 6 x 110 = 660 kcal / day . 660/20=33 oz
/ day 33/7(number of feeds per day) =
nearly 5 oz per each feed
• preparation:
• Bottle is rounded not angled, teat is
suitable in size, material and flow.
• Sterilization: boiling 5-10 min., or with
Na hypochloride tablet .
• how to reconstitution:
• ratio 1:8 ; one scoop = 4gm
reconstitute in 30 ml . ( American
scoop = 8gm )
Weaning
• Aim:
• 1- the child can not tolerate more than 1
liter/day, so with increasing needs for
energy, more solid food should be added.
• 2- with growth, babies requires more food
items, such as mineral and vitamins that
can not be supplied by milk.
• 3- to train G.I.T. digest starch and other
solid food.
• 4- to induce child dependence using spoon
and cup by himself.
Basis and technique of weaning:
• 1- should start at the age of 4-6m.
• 2- weaning should be gradual to prevent G.I.T
upset, also sudden weaning cause psychological
upset.
• 3- do not start at summer.
• 4- should not be start at convalescent period of
any disease
• 5- replacing one meal for milk feed: any new food
should be initially offered once a day with small
amount (1-2 teaspoonful) new food are generally
best accepted if fairly thin or dilute.
• 6- it is usually wise to offer the same food daily
until the baby become accustomed to it, and not
introduce new food more after than every 1-2w.
• e.g. of food item:
• a- fruit: mashed banana is readily digested and
enjoyed by most infants
• b- vegetables: should be freshly cooked, vegetables
are usually added to infant's food by 7m. of age
• c- eggs: the yolk of the eggs is used initially, egg white
should be introduced with caution from allergy.
Potato start at the 2nd 6m. of life, rice, bread added
at 6-8m. of life, meat can use by about 6m. of age.
Citrus food after 1y., fish after 1y., tomato after 1y.
• food additives: artificial flavors and colors have been
associated with respiratory allergies, urticaria and
angioderma.