FEEDING

Ekawaty Lutfia HaksariDepartment of Child Health, Perinatology,

Sardjito Hospital, Medical faculty, Gadjah Mada University

Infancy Age Period (Birth - 12 months)

Neonatal - Birth - 4 weeks

Infancy - 1 month - 12 months- fastest growth period

5 mos.= Double the birth weight 12 mos. = Triple the birth weight 12 mos. = increase of birth length by 50%

(Surjono, 2005)

GROWTH DURING THE FIRST YEAR

WEIGHTWeight gain is a sign of good health.First 6 months: Gain 750 g per monthLast 6 months: Gain 450 g per monthA babys weight doubles in the 5 months and

triples by the end of the first year.May differ depending on hereditary, feeding

habits, and level of physical activity

GROWTH DURING THE FIRST YEAR

HeightAvg. newborn is 50 cm longAvg. 1 yr old is about 75 cm long

Hereditary more strongly influences height than weight

GROWTH DURING THE FIRST YEAR

PROPORTIONThe size relationship between different parts of the body

What is the name of the space on the skull ofa newborn? FontanelsWhat do they do?

They allow the head to grow

FEEDING

Infant nutrition is important because growth is more rapid in infancy than during any other period after birth

Infants double their weight by four months; triple their weight by 1 year

Must consume large number of calories relative to weight

TO BREAST-FEED OR NOT?

Breast-feeding ensures proper nourishment Proteins, fats, carbohydrate, vitamins,

minerals Contains antibodies Better transition to solid foods

NUTRITION (Surjono, 2005) Growing research

supports nutrition programs for infants which will supply needed nutrients for proper physical, cognitive & emotional development

Breast/Bottle Feeding Breast-feeding is nutritional is better for infants

Malnutrition Infants who are malnourished in their 1styear may suffer marasmuswasting of body tissues severe protein-

calorie deficiency severe underdevelopment of childs cognitive, physical & emotional growth

TEN STEPS TO SUCCESSFUL BREASTFEEDING

Baby Friendly Hospital Initiative Every facility providing maternity services

and care for newborn infants should applyTen Steps To Successful Breastfeeding

TEN STEPS TO SUCCESSFUL BREASTFEEDING

1. Have written breastfeeding policy that is routinely communicated to all health care staff

2. Train all health care staff in skills necessary to implement this policy

3. Inform all pregnant women about the benefit and management of breastfeeding

4. Help mothers initiate breastfeeding within half an hour of birth

5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants

Early initiation of breastfeeding (UNICEF, 2003)

Opening his mouth, ready to suck (UNICEF, 2003)

Crying (Unicef, 2003)

Rooming in (Unicef, 2003)

ADVANTAGES OF ROOMING IN

Mother can respond to baby, helps bonding Baby cries less, less temptation to give bottle

feeds Mother more confident about breastfeeding Breastfeeding continues longer

Show mothers how to breastfeed (Unicef, 2003)

Rooming in (Sardjito Hospital, 1982)

Newborn by secarean (UNICEF, 2003)

TEN STEPS TO SUCCESSFUL BREASTFEEDING

6. Give newborn infants no food or drink other than breast milk,unless medically indicated

7. Practice rooming in; that is, allow mothers & infants to remain together 24 hours a day

8. Encourage breastfeeding on demand9. Give no artificial teats or pacifiers (also

called dummies or soothers) to breastfeeding infants

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital /clinic

Dangers of pre-lacteal feeding- REPLACE COLOSTRUM-greater risk of infection - risk of intolerance,

allergy-INTERFERE SUCKLING

- artificial feeds satisfy hunger

- bottles interfereattachment

- baby suckless- difficult to establishbreastfeeding

Too far, lack of attachment (Unicef,2003)

4. HELP MOTHERS INITIATE BREASTFEEDING WITHIN HALF AN HOUR OF BIRTH

Early initiation of breastfeeding Breast crawl is the natural instinctive

behaviour of the human newborn The mother & newborn dyad are mutually

responsive in the most sensitive period of half to one hour following delivery

This period is crucial for laying the foundation for successful breastfeeding

Significant in mortality, morbidity & malnutrition among the children

( Marshall (Klaus: Mother and Infant : Early Emotional Ties Ped 1998 UNICEF INDIA : The Breast Crawl 2007)5 stages behavior to breastfeed

In the 1st 30:Alert rest. Intermittent look at his mother. Adjusting to the environtment

30-40: producing sound,Sucking movement, putting hands Into mouth

(Utami Rusli 2007)

Delayed breastfeeding initiation increases risk of neonatal mortality

( Edmond KM et all, 2006)

16% neonatal death could be saved if all infants were breastfed from day 1, &

22% if breastfeeding started within the 1st hour

Breastfeeding promotion programs should emphasize - early initiation

- exclusive breastfeeding

SIGNS THAT BABY IS GETTING ENOUGH BREAST MILK

Passed urine at least 6 times/24 hours Hear the baby swallow when feeding The mothers breast feel softer after feed The baby gains weight over time (after the

first week) The baby seems contented after feeding. She

has times when she is hungry, quiet, awake & sleep during the day

EXPRESSED BREAST MILK

Premature Sick Unable to suck

feeding tubes, spoon, small glass

Expressing breast milk & premature baby drink by small glass (Unicef,2003)

SELECTED NUTRITION NEED IN A DAY

----------------------------------------------------------------------------NUTRIENT NORMAL NEED

FULLTERM PRETERM----------------------------------------------------------------------------ENERGYTotal (kcal/kg) 100 120Carbohydrat (g/kg) 10 12-14Fat (g/kg) 3,3 -6 4 - 7Protein(g/kg) 1,5-2,2 3,0 - 4,0----------------------------------------------------------------------------VITAMINA (IU/kg) 333 700 - 1500E (IU) 3 - 25 5 - 25

NUTRIENT NORMAL REQUIREMENTFULL TERM* PRETERM

------------------------------------------------------------------------Mineral & trace elements

100 120Sodium (mEq/kg) 1-3 2-4Potassium (mEq/kg) 1-2 2-4Calcium (mg/kg) 45-60 120-230Ortofosfat (mg/kg) 25-40 60 - 140Magnesium (mg/kg) 6-8 7,9 - 15Iron (mg/kg) 1 ** 2 - 4**

------------------------------------------------------------------------* Breastfed infant**Breast milk supplement starts at 2 weeks old

SUMMARYDIFFERENCE BETWEEN BREAST MILK & OTHER MILK------------------------------------------------------------------------

BREAST MILK COW MILK ARTEFICIAL MILK-------------------------------------------------------------CONTAMINATION no possible possibleBAKTERIA when mixed -------------------------------------------------------------------------------------------ANTI INFECTIOUS yes not available not availableFACTOR-------------------------------------------------------------GROWTH yes not available not availableFACTOR-------------------------------------------------------------PROTEIN good quantity too much partly improved

easy to digest difficult to digest-------------------------------------------------------------------------------------------

BREAST MILK COW MILK ARTEFICIAL MILK------------------------------------------------------------------------------------

LIPID Lipid esensial less enough less Lipase yes not available not available------------------------------------------------------------------------------IRONAmount small small addedAbsorbsion good not good not good---------------------------------------------------------------------------------------------------

VITAMIN enough not enough addedA & C

---------------------------------------------------------------------------------------------------

WATER enough need to added need to added ----------------------------------------

-----------------------------------------------------------

HORMON enough: not for human not availablecortisol & insulin

COMPOSITIONOF BREAST MILKFULL TERM & PRETERM

ASI CUKUP BULAN KURANG BULAN 1 minggu 4 minggu Energi (kkal) 700 670 700 Protein (g) 13 24 18 Karbohidrat (g) 70 61 70 Lemak (g) 42 38 40 Natrium(mMol) 6,5 22 13 Kalium (mMol) 15 18 16 Kalsium(mMol) 8,7 6,2 6,4 Fosfor 4,8 4,6 4,6 Rasio Ca:P 1,8 1,4 1,2

PRETORIA PASTEURIZATION( Jeffrey BS, et al. J Trop Ped 2001,2003)

Eliminatating HIV Killing pathogenic bacteria during breast

milk express Can be stored for 12 hours

out of refrigerator with less possibility of contamination

(Ramasethu J, 2004)

Pretoria Pasteurization( Jeffrey BS, et al. J Trop Ped 2000)

1 liter aluminium pot with 450 ml waterheated to boiling

Immerse glass bottle containing 75 to 150 ml of milk for 15 minutes

Keep temperature of breast milk on 56- 625 C for 15 menit

(Ramasethu, 2004)

STORAGE OF BREAST MILK

Room temperature: 250 C: 6 to 8 hours380 C: not safe

Insulated cooler with ice packs: 24 hours

Refrigerator 40 C 24 - 48 hours (up to 5 days?)

(Ramasethu, 2005)

Storage of breast milk

Deep freezer opened infrequently:-200 C : 6 to 12 months

(Ramasethu, 2005)

Refrigerator/ Freezer with separate doors: -180 C : 3 to 6 months

Freezer compartment inside the refrigerator: -150 C : 2 weeks only

INTERNATIONAL CODE OF MARKETING OF BREAST-MILK SUBSTITUTES

WHO,1981

General public & mothers5

Information & Educations4

Definitions3

Scope of the Code2

Aim of the Code1

CodeArticle

Implementation & monitoring

11

Quality10

Labelling9

Persons employed by manufactures & distributors

8

Health workers7

Health care systems6

REFFERENCE Surjono A. Kuliah IKAInternasional 2005 Premer DM Georgieff MK. Nutrition for ill neonates.

Neoreview e56-62, Sept 1999 WHO dan Unicef. Konseling menyusui, manual pelatih . Versi

Indonesia Departemen Kesehatan dan BKPPASI WHO danUnicef . 2002

WHO. International Code of Marketing of Breast-milk substitues. 1981

Sjaaf AC. Upaya implementasi International Code of Marketing of Breast-milk substitues di Indonesia. 2003

Walker M. Core Curriculum for Lactation Consultant Practice. Jones & Bartlett Publishers. Sudbury, Massachusetts, 2002

Pelatihan Laktasi & Manajemen menyusui. Modul 2. IBCLC Indonesia. 2008.