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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.