CF 85

WELCOME ALLWELCOME ALL

CF61

INFANT INFANT FEEDINGFEEDING

Dr Mohammad Nurul Huq

1.1. Feeding in Feeding in early 6 monthsearly 6 months2.2. ComplementaryComplementary feedingfeeding

KEY FACTSKEY FACTSChild has right to Child has right to good nutrition good nutrition (Convention on Child Rights)(Convention on Child Rights)

Undernutrition is associated with 45% of U-5 deathsUndernutrition is associated with 45% of U-5 deaths

2015: 2015: 156 million U-5 were stunted, 50m. wasted156 million U-5 were stunted, 50m. wasted

<40% are exclusively breastfed (EBF)<40% are exclusively breastfed (EBF)<25% get correct complementary foods (CF)<25% get correct complementary foods (CF)1 million lives could be saved/y, if BF started in 11 million lives could be saved/y, if BF started in 1stst h h

BM improves IQ, schooling, higher income as adult. BM improves IQ, schooling, higher income as adult. It It reduces health costsreduces health costs

Principles of IFPrinciples of IF

Counseling at ANC and after birthCounseling at ANC and after birth EBF first 6moEBF first 6mo Complementary feedingComplementary feeding BM for 2y BM for 2y NoNo bottle, bottle, nono machine machine NoNo animal milk in first 2y animal milk in first 2y NoNo commercial foods commercial foods

ANC: antenatal careEBF: exclusive breastfeeding. BM: breast milk

Principles of BFPrinciples of BF

EBF for first 6moEBF for first 6moDemand feedingDemand feedingEBM EBM SOSSOS BM for 2yBM for 2yCorrect position and attachmentCorrect position and attachmentBalanced family food for motherBalanced family food for motherNo pacifierNo pacifier

EBM: expressed breast milkEBM: expressed breast milk

World Breastfeeding Week World Breastfeeding Week (1-7 August)(1-7 August)

In >170 countries: to promote and support BF, improve In >170 countries: to promote and support BF, improve health of babies health of babies (Innocenti Declaration: 1990)(Innocenti Declaration: 1990)

– Making workplaces friendly to BF: a long way to go: Making workplaces friendly to BF: a long way to go: much has improved in 23y to make these BF-much has improved in 23y to make these BF-

friendlyfriendly– 'Breastfeeding and Work - Let's make it work!"'Breastfeeding and Work - Let's make it work!"

First 6 mo: Exclusive First 6 mo: Exclusive Breast FeedingBreast Feeding

Exclusive Breast Feeding…Exclusive Breast Feeding…

… … feeding the newborn with feeding the newborn with onlyonly BM (Mother’s BM (Mother’s

milk!); milk!); not even a dropnot even a drop of water of waterfor for 6 6 calendar calendar mo mo (180d)(180d)

Why no water?Why no water?

Composition of BM makes extra water unnecessaryComposition of BM makes extra water unnecessaryeven in dry and hoteven in dry and hot climates climates! ! No No

dehydration!dehydration!

Better avoid possible contaminated water!Better avoid possible contaminated water!

Is EBF Enough?Is EBF Enough?

Yes!Yes! It is proved!It is proved!

– mother fed her baby mother fed her baby in-uteroin-utero for 9mo; she can for 9mo; she can still do it for another 6mostill do it for another 6mo

– 2 breasts can support 2 breasts can support 2 babies!2 babies!– no mammal fails!no mammal fails!

Breast takes over the feeding roleBreast takes over the feeding roleof placenta after birthof placenta after birth

Is BM Enough? …Is BM Enough? …

Wetness testWetness testIf a baby voids urine If a baby voids urine 6 times/d 6 times/d

& sucks 8-12 times/d& sucks 8-12 times/d

Weight checkWeight checkFirst 6 mo: gains 125g/wFirst 6 mo: gains 125g/w

or 500g/moor 500g/mo

If mother says: BM If mother says: BM not enoughnot enough: check: check

– weight gainweight gain– feeding techniquefeeding technique– for illness in baby and motherfor illness in baby and mother– malnutrition in mothermalnutrition in mother– check for family supportcheck for family support– working placeworking place

When BM is not enough! When BM is not enough! Baby is not sucking effectively:Baby is not sucking effectively:

ActionAction: : position and attachmentposition and attachment Mother is very busy and suckles lessMother is very busy and suckles less

ActionAction: : increase frequencyincrease frequency Baby does not suck long enoughBaby does not suck long enough

ActionAction: : suckle longer, stroke cheek, any discomfort?suckle longer, stroke cheek, any discomfort?

Formulas are given: advise the mother about EBFFormulas are given: advise the mother about EBF(You can refer the mother to BBF)(You can refer the mother to BBF)

BBF: Bangladesh Breastfeeding FoundationBBF: Bangladesh Breastfeeding Foundation

FAQ by motherFAQ by mother

BM is not enough, baby cries a lot!BM is not enough, baby cries a lot! Shouldn’t I habituate him with a bottle?Shouldn’t I habituate him with a bottle? Can I use a bottle to feed BM?Can I use a bottle to feed BM?

Can I give water?Can I give water?

contd

He has diarrhea from BM!He has diarrhea from BM!

I am a working motherI am a working mother Can I feed him while I am lying?Can I feed him while I am lying? He has become v. windy on BFHe has become v. windy on BF He is passing lot of urineHe is passing lot of urine

FAQ …FAQ …

101 Benefits of Breast Feeding!101 Benefits of Breast Feeding!For Mother For Mother

Less obesity, may better lose wt.Less obesity, may better lose wt. Perfectly easy, cost effectivePerfectly easy, cost effective

(save >(save >$1,000/y). Convenient.$1,000/y). Convenient.You can breastfeed almost You can breastfeed almost anywhere anytimeanywhere anytime

No extra labor/toolsNo extra labor/tools Bonding. Birth spacingBonding. Birth spacing (98%) (98%) Formula bagFormula bag Reduces risks of breast and ovarian Ca, T2DM, Reduces risks of breast and ovarian Ca, T2DM,

postpartum depressionpostpartum depression

Benefits for Infant Benefits for Infant

It is the nature’s wayIt is the nature’s way EnvironmentallyEnvironmentally friendly friendly BM nutritional values are just parallel to actual needs BM nutritional values are just parallel to actual needs of the of the

baby baby The baby grows optimallyThe baby grows optimally

contdcontd

Benefits for Infant Benefits for Infant … …

Fresh and flows round the clockFresh and flows round the clock

Easiest: Easiest: no toolsno tools

Preferred by babies even when sickPreferred by babies even when sickGrowth factorsGrowth factorsDelays allergyDelays allergyAnemia, scurvy, rickets, etc. are rareAnemia, scurvy, rickets, etc. are rare

(infantile eczema)(infantile eczema)

Benefits for Infant Benefits for Infant … …

Solute load of formulas is much Solute load of formulas is much more than that of BM (120 vs more than that of BM (120 vs 88 mosm/l)88 mosm/l)

Enteral inf. is virtually nil Enteral inf. is virtually nil ARI, otitis media, UTI rareARI, otitis media, UTI rare Better IQBetter IQ

Uniques of BMUniques of BM

NoNo nutritional nutritional deficienciesdeficiencies StandardStandard growth growth Unique Unique combinationcombination of energy and nutrients of energy and nutrients Numerous Numerous anti-infectives:anti-infectives: Unique Unique bondingbonding Uniquely Uniquely cheap and cost effectivecheap and cost effective

Lack of bonding

Anti-infectives in BMAnti-infectives in BM

Prevent viruses, bacteria and parasites:Prevent viruses, bacteria and parasites:– Specific:Specific: antibodies (mainly IgA) antibodies (mainly IgA)

lymphocytes (humoral, CMI)lymphocytes (humoral, CMI)

– NonNon--specific:specific: lactoferrinlactoferrin lysozymelysozyme bifidus factorsbifidus factors complementscomplements

Lactoferrin: Lactoferrin: iron-binding protein: retards bacterial and iron-binding protein: retards bacterial and fungal growthfungal growth

Lysozyme: Lysozyme: bacteriolytic enzymebacteriolytic enzyme

Complements:Complements: with Ab. destroy particulate Ag.with Ab. destroy particulate Ag.

Bifidus factor: Bifidus factor: prebiotic; stimulates growth of prebiotic; stimulates growth of L bifidus: L bifidus: lowers pH: suppresses pathogenslowers pH: suppresses pathogens

Together they make gut unsuitable for pathogensTogether they make gut unsuitable for pathogensAb: Antibody. Ag: AntigenAb: Antibody. Ag: Antigen

Nutrition in BMNutrition in BM

Energy Energy 70 kcal/100ml70 kcal/100ml Lactose Lactose 7g/100ml7g/100ml Fat Fat 4.2g/100ml4.2g/100ml Protein Protein 1.45g/100ml1.45g/100ml

MicronutrientsMicronutrients

Fe, Zn, Cu, iodine, Ca, Cl, Na, Mn, P, K, etc. Fe, Zn, Cu, iodine, Ca, Cl, Na, Mn, P, K, etc. BM binds Fe, Zn, etc. to ease absorption but BM binds Fe, Zn, etc. to ease absorption but

prevent them from use by bacteriaprevent them from use by bacteria All vitamins if mother is not deficientAll vitamins if mother is not deficient

EBF EBF Ensures:Ensures:

a virtually infection free normal a virtually infection free normal G&D of the infant and G&D of the infant and

bonding between baby and motherbonding between baby and mother

G&D: growth and development

Why Breast is BestWhy Breast is Best BF is the BF is the healthiesthealthiest for mom and baby for mom and baby BF is a wonderful way to BF is a wonderful way to bondingbonding BM naturally has all BM naturally has all nutrients optimallynutrients optimally It has It has Ab.Ab. It prevents allergies, tummy problemsIt prevents allergies, tummy problems

Breastfed babies are Breastfed babies are less obese/have less DMless obese/have less DM BF may help BF may help prevent SIDSprevent SIDS

BF is the natural, healthy choice for mom and babyBF is the natural, healthy choice for mom and baby

BF DifficultiesBF Difficulties

Lack of family support; Lack of family support; lack of confidencelack of confidence

Working motherWorking mother Multiple babiesMultiple babies Some diseasesSome diseases Breast engorgement, cracked/retracted nippleBreast engorgement, cracked/retracted nipple Breast inf.Breast inf. Breast tumor …Breast tumor …

Inverted NipplesInverted Nipples

Breastfeeding ChallengesBreastfeeding Challenges

not always easy for moms and babies:not always easy for moms and babies:Discomfort.Discomfort. Sore nipple is normal in the first weeksSore nipple is normal in the first weeksTimeTime.. Baby may take a huge time and effort. More Baby may take a huge time and effort. More

frequent than formulafrequent than formulaDiet.Diet. Baby may be sensitive to certain foodsBaby may be sensitive to certain foods

Most mothers find early struggles pass quickly, Most mothers find early struggles pass quickly, and they settle into BFand they settle into BF

Some Moms Can’t Breastfeed!Some Moms Can’t Breastfeed!

A few! But it does not make you a bad momA few! But it does not make you a bad momWork.Work. Not all mothers can pump (EBM). Certain jobs may Not all mothers can pump (EBM). Certain jobs may

make it hard to stick to a regular pumping schedule.make it hard to stick to a regular pumping schedule. Companies with >50 employees are required by law to Companies with >50 employees are required by law to

provide the time and place to pumpprovide the time and place to pumpNot enough milkNot enough milkHIV/AIDS, HIV/AIDS, medicines can make it unsafe to breastfeedmedicines can make it unsafe to breastfeedAddiction problems.Addiction problems. Alcohol/drug addict momsAlcohol/drug addict moms

Galactosemia/PKU.Galactosemia/PKU. They must be fed soy-based They must be fed soy-based formulaformula

Technique of BFTechnique of BFMostly Mostly naturalnatural; just feed on ; just feed on demanddemand

8-12 feeds/d8-12 feeds/d Some techniques Some techniques ensureensure success: success:

correct correct positioningpositioning and andattachmentattachment of the baby of the baby

Positioning the BabyPositioning the Baby Head and body is straight Head and body is straight Baby held close to bodyBaby held close to body Support baby’s whole bodySupport baby’s whole body Baby faces the breastBaby faces the breast

Good positioning Good positioning ensures comfortensures comfort

Attachment of the Baby Attachment of the Baby

Mouth is wide-openMouth is wide-open Lower lip is turned outwardsLower lip is turned outwards Chin is touching breastChin is touching breast More areola is seen above than belowMore areola is seen above than below

Correct position-attachment Correct position-attachment ensure comfort & success of BFensure comfort & success of BF

Mouth opening

MESSAGEMESSAGE

For 6mo BM is enough For 6mo BM is enough It protects the baby. It is It protects the baby. It is

ready to feedready to feedeasy to doeasy to docost effectivecost effectiverewardingrewarding

environmentally friendly!environmentally friendly!It is unique!It is unique!

Why Environmentally FriendlyWhy Environmentally Friendly Renewable sourceRenewable source No extra energy to make and process milkNo extra energy to make and process milk No plastic pollutionNo plastic pollution No extra man powerNo extra man power No inefficient land useNo inefficient land use No methane from cows!No methane from cows! No ads.No ads. No sterilizing No sterilizing No luggage of toolsNo luggage of tools

Inefficient land use

No trees, no crops!

Mother! Pl. rememberMother! Pl. remember

Breasts are attached to youBreasts are attached to you You can’t forget! You can’t forget! They serve the perfect food at perfect temp., no They serve the perfect food at perfect temp., no

matter where you are!matter where you are!

Infant formulasInfant formulasMade from Made from cow’s milk cow’s milk and modified as per formulaand modified as per formulaVarieties: vary in nutrients, calories, taste, digestibility, costVarieties: vary in nutrients, calories, taste, digestibility, cost

Standard milk-based formulas: Standard milk-based formulas: Almost all babies do well on these. Fussiness and colic are Almost all babies do well on these. Fussiness and colic are

common problems. No need to change the formulacommon problems. No need to change the formula Cow's milk protein has been modified. Vegetable oils, Cow's milk protein has been modified. Vegetable oils,

minerals, vitamins are also added minerals, vitamins are also added

Lactose-free formulas:Lactose-free formulas:For Galactosemia, alactasia (usually begins after a 12mo)For Galactosemia, alactasia (usually begins after a 12mo) In diarrhea: usually no need of lactose-free formulaIn diarrhea: usually no need of lactose-free formula

Soy-based formulas:Soy-based formulas:Soy proteins. No lactose. For parents who do not want Soy proteins. No lactose. For parents who do not want

animal protein, and for galactosemia or alactasiaanimal protein, and for galactosemia or alactasia They do not help milk allergies or colic. Babies may also They do not help milk allergies or colic. Babies may also

be allergic to them be allergic to them

Hypoallergenic IF (protein hydrolysate):Hypoallergenic IF (protein hydrolysate):may be helpful for allergies to milk protein, skin rashes or may be helpful for allergies to milk protein, skin rashes or

wheezing c/by allergies. Generally expensive wheezing c/by allergies. Generally expensive

Special formulas:Special formulas: used under supervision: used under supervision:Reflux formulas: Reflux formulas: thickened with rice starch. Needed only thickened with rice starch. Needed only

for reflux with FTT or who are v. uncomfortablefor reflux with FTT or who are v. uncomfortableFormulas for preemies and LBW Formulas for preemies and LBW have extra calories have extra calories

and minerals to meet the needs of these infantsand minerals to meet the needs of these infantsSpecial formulas for CHD, malabsorption Special formulas for CHD, malabsorption syn, and syn, and

problems digesting fat or processing certain amino a problems digesting fat or processing certain amino a Toddler formulas Toddler formulas are offered as added nutrition for are offered as added nutrition for

toddlers who are picky eaters. To date, they have not toddlers who are picky eaters. To date, they have not been shown to be better than whole milk and been shown to be better than whole milk and multivitamins. They are also expensive. multivitamins. They are also expensive.

Ready-to-useReady-to-useConc. liquid formulasConc. liquid formulas

Formulas Formulas

… … basically dried cow’s milkbasically dried cow’s milk… … notnot designed for our babiesdesigned for our babies… … devoid of the unique properties of BM devoid of the unique properties of BM

So we So we do not calldo not call these these ‘baby foods!’‘baby foods!’

Harms from FormulasHarms from Formulas

CMPICMPI Solute overloadSolute overload Chemicals, additives: flavoured, tastier Chemicals, additives: flavoured, tastier Dislike for breast milkDislike for breast milk No adequate bondingNo adequate bonding Expensive but never fresh!Expensive but never fresh!

CMPI: cow’s milk protein intolerance

FAQ on formulas FAQ on formulas

Which brand is the bestWhich brand is the bestAdd sugar?Add sugar?Boil?Boil?What water, mineral water?What water, mineral water?How long can be kept?How long can be kept?

Feeding BottleFeeding Bottle

The The worstworst invention! invention! Very dangerous for babiesVery dangerous for babies A A baby killer baby killer sp. in the LICssp. in the LICs Diarrhea and other ID are xDiarrhea and other ID are x88 : : Death is xDeath is x44So, you do not So, you do not advocate it advocate it for your baby!for your baby!

LIC: low income country

Bottle-fed babies get diarrhea moreBottle-fed babies get diarrhea moreDifficult to keep cleanDifficult to keep clean Easily contaminatesEasily contaminates Contaminated waterContaminated water

Bottle-fed babies get ARI moreBottle-fed babies get ARI more Sleep feedingSleep feeding VADX from frequent infx.VADX from frequent infx. ContaminationContamination

Harms from BottleHarms from Bottle

Easily Easily contaminatescontaminates Mortality and morbidity Mortality and morbidity v highv high Diluted feeds: Diluted feeds: malnutritionmalnutrition Extra sugar/thickened feeds: Extra sugar/thickened feeds: obesityobesity Plastic bottles release Plastic bottles release BPABPA Baby may refuse solids in time: Baby may refuse solids in time: late in solids: late in solids: Mn., Mn.,

behavioral and developmental problemsbehavioral and developmental problemscontdcontd

Bisphenol A: belongs to diphenyl methane

Feeding during sleep:Feeding during sleep:– overfeedingoverfeeding– indigestion, bloatingindigestion, bloating– throat/respiratory infectionthroat/respiratory infection– tooth decay tooth decay ((nursing bottle syn)nursing bottle syn)

Lactational failureLactational failure

Harms from Bottle …Harms from Bottle …

When giving ORS or EBM always use a cup and spoon, never a feeding bottle

EBM: expressed breast milk

BF and FigureBF and Figure

Does not lose her figureDoes not lose her figure Helps lose wt Helps lose wt Breasts regain shapeBreasts regain shape Breast changes in pregnancy, so BF or not BF does not Breast changes in pregnancy, so BF or not BF does not

make any difference!make any difference!

Advantages of Bottle Feeding!Advantages of Bottle Feeding!

Anyone can feed your babyAnyone can feed your babyYou can get round-the-clock restYou can get round-the-clock restYou can also pump BM and feed by bottleYou can also pump BM and feed by bottleYou feed less often: bYou feed less often: babies digest formula slowerabies digest formula slower

Everything you do as a mother, your love, attention, Everything you do as a mother, your love, attention, and care, will give baby the best start in lifeand care, will give baby the best start in life

ConclusionConclusion

Every mother can BF (<1% cannot)Every mother can BF (<1% cannot) Frequent suck keeps up supply of BMFrequent suck keeps up supply of BM Breasts of all sizes are equally goodBreasts of all sizes are equally good Shape of nipple does not matter, as long as baby Shape of nipple does not matter, as long as baby

takes the breast well into the mouthtakes the breast well into the mouth

MCQMCQ

EBF for 180 days Breast milk contains live cells Strict schedule is preferable Complementary feeding starts from 4 mo BM contains secretory IgA

Extra water is beneficial for EBF babiesExtra water is beneficial for EBF babiesBF in first hr can save 1 million babiesBF in first hr can save 1 million babiesFormula feeding doesn’t harm bondingFormula feeding doesn’t harm bondingFormulas are made from milk of millions of cowsFormulas are made from milk of millions of cowsMore risk of obesity with bottle feeding More risk of obesity with bottle feeding

MCQMCQ

SAQSAQ

What are the positioning and attachment for EBF?What are the positioning and attachment for EBF?How do you counsel to make BF a success?How do you counsel to make BF a success?What are the benefits of EBF?What are the benefits of EBF?What are the harms of formula feeding?What are the harms of formula feeding?What are the harms of bottle feeding?What are the harms of bottle feeding?

Najat Vallaud-Belkacem (b. 4 Oct 1977) is the

first French woman Minister of Ed, (age 38).

Moroccan

COMPLEMENTARY COMPLEMENTARY FEEDINGFEEDING

(Family Foods Along with BF for 2 (Family Foods Along with BF for 2 years)years)

Principles of CFPrinciples of CF

Family foodFamily foodAffordable, balanced, locally availableAffordable, balanced, locally availableDemand feedingDemand feedingNo insistence, not ceremonialNo insistence, not ceremonialEasy preparationEasy preparationNo bottle, no machineNo bottle, no machineNo sleep feedingNo sleep feeding

Foods that keep parents healthy, also keep baby Foods that keep parents healthy, also keep baby healthy healthy

Why CF?Why CF?After 6 moMore calories (rapid growth, more activities )Calorie dense foodsExploration of foodsHabituation with family foodsVarieties of foodsSolid foods after tooth eruption Integration with the familyIntegration with the family

Less sugars Less sugars after tooth eruptionafter tooth eruptionProtective Protective foods (non-nutritional elements)foods (non-nutritional elements)Development of behavior and personalityDevelopment of behavior and personality Iron gap, vitamin A gapIron gap, vitamin A gap FitnessFitness

– teeth make the infant teeth make the infant functionally maturefunctionally mature!!

Why CF…Why CF…

Weaning!Weaning!

Means taking the child Means taking the child off the breast! off the breast! But avail benefits of BM as long as possible!But avail benefits of BM as long as possible!The term is The term is d i s c a r d e dd i s c a r d e dComplementary FeedsComplementary Feeds to complement BF to complement BF

CF: is it difficult task?CF: is it difficult task?

NoNo It cannot be ..It cannot be .. It should not be ..It should not be .. It is natural! It is natural! So it is easy!So it is easy!We should not make easy thing difficult! We should not make easy thing difficult!

Who make it difficult?Who make it difficult?

Profiteers! Profiteers! With fancy food names!With fancy food names!– Follow up-, catch upFollow up-, catch up– Grow up iron-, -sure, My Boy!Grow up iron-, -sure, My Boy!– All Vitamins, A-Z foods, etc.!All Vitamins, A-Z foods, etc.!

Promotion of bottle and blenderPromotion of bottle and blender

Trade promotion!Trade promotion!

Time of starting of CFTime of starting of CF

After 6 After 6 calendar mo (180d)calendar mo (180d)Why not earlier?Why not earlier?

Too early may cause diarrhea, Mn, IDAToo early may cause diarrhea, Mn, IDARisk of obesity, allergy, Risk of obesity, allergy, atherosclerosisatherosclerosisMay deprive the baby of May deprive the baby of uniqueunique BM BM

Why not late?Why not late?

Baby adopts family Baby adopts family foods best nowfoods best now

Delay may causeDelay may cause– rejection of solidsrejection of solids– faulty feedingfaulty feeding

Prolonged EBF causesProlonged EBF causesFTT FTT IDA, VADXIDA, VADXPoor resistance Poor resistance Developmental andDevelopmental and

behavioral problemsbehavioral problems

FTT failure to thriveFTT failure to thrive

VADX: vit A def and xerophthalmiaVADX: vit A def and xerophthalmia

FAQ FAQ

When to start When to start CerelacCerelac, , Junior HorlicksJunior Horlicks??What formula is the best?What formula is the best?Use blender?Use blender?What rice? What oil? ….What rice? What oil? ….What fruit? What banana? What fruit? What banana? Banana and orange cause cold?Banana and orange cause cold?Veggies cause gasVeggies cause gas

Boil formula?Boil formula?Times of feeds?Times of feeds? If no appetite?If no appetite?Add sugar?Add sugar?

Grapes?Grapes?How much water?How much water?How to give eggs?How to give eggs?

FAQ… FAQ…

What types of food?What types of food?Family foodFamily food is really goodis really good; the baby deserves it!; the baby deserves it!Fresh and soft, balancedFresh and soft, balancedConsider food value: Consider food value: no poor/rich foodno poor/rich foodVaried in texture and flavorVaried in texture and flavorNot 1 or 2 foods only. Not 1 or 2 foods only. Not monotonous!Not monotonous!Energy dense; more roughage/fiberEnergy dense; more roughage/fiberMore vitamins, mineralsMore vitamins, mineralsNo animal milk!No animal milk!Don’t forget water!Don’t forget water!

Why Family Food?Why Family Food?

Always fresh!Always fresh!Cheap, affordableCheap, affordable Foods vary dailyFoods vary daily Integrity and discovery of familyIntegrity and discovery of familyBondingBondingFood varies from country to countryFood varies from country to country

No international food!No international food!

International food?International food?

NoNo Local foodsLocal foods Family foodsFamily foods Mother’s foods for her baby!Mother’s foods for her baby!

Be careful! Be careful! They like to rob away your kitchenThey like to rob away your kitchen

Why not commercial foods?Why not commercial foods? Not natural; not fresh, costly!Not natural; not fresh, costly! Monotonous!Monotonous!Many Many chemicals!chemicals!

– preservatives, additives, tasting salt, flavors, etc.preservatives, additives, tasting salt, flavors, etc.It may be old, contaminatedIt may be old, contaminated Risk of obesityRisk of obesity … … using bottleusing bottle … … constipationconstipation … … late starting of solidslate starting of solids … … addictionaddiction

How to start CF?How to start CF?

Start foods from plant; first a Start foods from plant; first a CHO CHO preferably rice preferably rice ((suji); suji); add sugar, oil, spiceadd sugar, oil, spice

At 1-2w intervals add others (At 1-2w intervals add others (khichurykhichury, soup, etc) , soup, etc) Mix egg in small amounts and increase graduallyMix egg in small amounts and increase gradually Give fruits, vegetables, waterGive fruits, vegetables, water

Schedule of CFSchedule of CF

3 times a day for 6-9 months3 times a day for 6-9 months 4 times a day for 9-12 ,,4 times a day for 9-12 ,, 5 times a day for 12-24 ,,5 times a day for 12-24 ,,

Up to 12mo: BF first, then CFUp to 12mo: BF first, then CF1-2 years: CF first1-2 years: CF first

Foods for 6-9 monthsFoods for 6-9 months

Suji, rice Suji, rice Khir or payeshKhir or payeshKhichury, fruits, vegetablesKhichury, fruits, vegetablesEggEggWater Water

Foods for 9-12 monthsFoods for 9-12 months

Khichury, rice, dal, sKhichury, rice, dal, soupoup Fruits, vegetables, eggs Fruits, vegetables, eggs Home made sweetsHome made sweets

Foods for 12-24 moFoods for 12-24 moMore solids, more variedMore solids, more variedRegular foods taken with parentsRegular foods taken with parents

Favour for fruitsFavour for fruits

Seasonal fresh fruitsSeasonal fresh fruits Vitamins, minerals, fiberVitamins, minerals, fiber ProtectantsProtectants Fresh vs processedFresh vs processed How much juice a day?How much juice a day? Fruits in diarrheaFruits in diarrhea

A banana a day A banana a day keeps the Dr awaykeeps the Dr away

Energy, protection, stimulant, relaxant (tryptophan)Energy, protection, stimulant, relaxant (tryptophan) Number 1 fruit for athletesNumber 1 fruit for athletes Better academic performanceBetter academic performance Contains all vitamins Contains all vitamins Good calories (2 bananas=90 min workGood calories (2 bananas=90 min work)) PrebioticPrebiotic moremore

A banana a day …A banana a day …

All 3 sugars (fructose, sucrose, glucose)All 3 sugars (fructose, sucrose, glucose)Fiber, iron, laxativeFiber, iron, laxativeExtremely high in KExtremely high in K++, low in salt: , low in salt: regulates BP. regulates BP. Low risk of strokeLow risk of strokeAnti-irritant for skin Anti-irritant for skin

Well protected, tasty! Well protected, tasty! Available year roundAvailable year round

Grapes are sour!!Grapes are sour!!

Partly rotten! Difficult to cleanPartly rotten! Difficult to cleanChance of contamination Chance of contamination Not protectedNot protectedMainly sugarMainly sugarExpensive!Expensive!

Vibrant Rainbow VegetablesVibrant Rainbow Vegetables

Non-nutritious parts: fiberNon-nutritious parts: fiberProtectantsProtectantsRich in vitamins and mineralsRich in vitamins and mineralsPrebioticPrebioticSome can be taken freshSome can be taken fresh

60% drugs are derived from plants

The egg storyThe egg story

• After 6moAfter 6mo• First class protein First class protein • Must be: Must be: well cooked/hard boiled/friedwell cooked/hard boiled/fried

• NeverNever poached or half boiled poached or half boiled • Cooking destroys 70% allergenicityCooking destroys 70% allergenicity

Semicooked eggs contains bugs from poultry unless pasteurized!

The ‘khichury’The ‘khichury’

The basic foodThe basic foodReally tasty. Can add anythingReally tasty. Can add anythingUnique!Unique! All essential amino acids All essential amino acidsDifferent taste from different ingredientsDifferent taste from different ingredientsDaily newDaily newNot monotonousNot monotonous

The chips storyThe chips story

No outdoor foods: chips, biscuits, candies!No outdoor foods: chips, biscuits, candies!Chance of contaminationChance of contaminationAre mainly sweets, not balancedAre mainly sweets, not balancedSalt overloadSalt overloadMay not be of good qualityMay not be of good quality AdditivesAdditives

Non-nutritious: empty Non-nutritious: empty caloriescalories

How to offer?How to offer?

Breast feed firstBreast feed firstMake the session enjoyableMake the session enjoyableNo bottle/blender: use cup n spoonNo bottle/blender: use cup n spoonTemporary withdrawal of rejected foodTemporary withdrawal of rejected foodPostpone foods causing V&DPostpone foods causing V&D

The blender storyThe blender story

Risk of contaminationRisk of contamination Solids may be rejectedSolids may be rejected Risk of habituationRisk of habituation Expensive!Expensive!

How frequently?How frequently?

On demand!On demand!Don’t force/insist!Don’t force/insist!Don’t expect eating the whole amountDon’t expect eating the whole amountDon’t feed in sleep Don’t feed in sleep (only possible with bottle)(only possible with bottle)

Adopt the baby to family foodsAdopt the baby to family foods

After suji give khichury, soup, etc.After suji give khichury, soup, etc.Don’t hurry! Give a slice of orange/lemon or a Don’t hurry! Give a slice of orange/lemon or a

piece of carrot! S/he explores it!piece of carrot! S/he explores it!Keep the baby with all at the dinning tableKeep the baby with all at the dinning table

– offer something on dish. S/he will spill some!offer something on dish. S/he will spill some!– don’t be upset!don’t be upset!

Working mother Working mother

Not a problem Not a problem Problem not with working statusProblem not with working status The attendant should be convincedThe attendant should be convinced Cup and spoon feedingCup and spoon feeding Adequate maternity leaveAdequate maternity leave

Conclusion Conclusion

Family foods Family foods are:are:scientific, hygienicscientific, hygieniccheap, cheap, naturalnaturalsimple, easysimple, easy really good!really good!

enjoyableenjoyableevery day new!every day new!no problem with no problem with

working mother!working mother!

We do not make feeding difficultWe do not make feeding difficult

Mom must be Mom must be beside me!beside me!

MCQMCQ

CF started after 6moCF started after 6moBlending makes food more digestibleBlending makes food more digestibleVegetables have non-nutritional protectantsVegetables have non-nutritional protectantsBefore 1 y CF should be given firstBefore 1 y CF should be given firstBest age to adapt family foods is 8 moBest age to adapt family foods is 8 mo Rich foods are the best foodsRich foods are the best foods

Next lectureNext lecture

E. P. I. TARGET E. P. I. TARGET DISEASESDISEASES