Infant and young child feeding practices.

Infant and young child feeding practices.

Few things engender more anxiety than symptoms associated with feeding. Early difficulties can influence a mothers relationship with her baby for months or even years

Where do mums get info on feeding? Mother, in-laws- 60% Other relatives- 10% Friends, contacts- 5% Medical professionals-10% Others- internet, books, etc 5% Unclear-10% ( WHO 2010)

A Short Term Issue? Suggested that nutritional state in infancy exerts a long term effect on health and development through metabolic programming (Lucas 1994)

Statistics By 2 months <30% on exclusive b/feeding By 7 months >50% were giving cows milk as the main milk drink. By 3 months >70% on solid foods + milk (Research done in Nairobi 2011)

Breast is best? Contains all the nutrients an infant needs in the right amounts and in an easily absorbable form. Its composition changes as the baby grows. Contains growth factors and hormones to assist development Anti infective properties: Macrophages, lymphocytes and polymorphs, Secretory IgA, Lyzozyme, Lactoferrin (inhibits growth of E.coli.), anti-viral agents.

Long term benefits to infant Reduced risk of atopy Better dental health Reduced incidence of later obesity. Improved neurological development Reduced risk of SIDS

Maternal benefits Reduced risk of premenopausal cancer. Promotes weight loss after pregnancy Lactational amenorrhoea Cheaper, easier more convenient and portable. No other equipment to prepare.

Breast milk Varies greatly according to: Hindmilk vs foremilk Duration of lactation (reducing protein concentration) Gestational age of baby Maternal diet.

Composition of breast milk vs formula milk Colostrum: For 2-4 days post delivery. Has high protein and mineral content but less carbohydrate and fat. Mature breast milk established by 4th week. Water: Equal amounts Calories: Approx 67kcal/100ml. Protein: Human milk 1-1.5% protein(70% whey protein) Cows milk 3.3% protein due to greater content of casein

Composition of breast milk vs cows milk Carbohydrate: Fat twice Minerals Vitamins Human milk 7% (10% glycoproteins) Cows milk 4.5% lactose Approx 3.5% both principally triglycerides Olein is more easily absorbed and there is as much in breast milk. Cows milk contains more of all the minerals (esp sodium, calcium and phosphate) except iron and copper. There is more iron in breast milk and it is more easily absorbed. Cows milk is low in vitamin C and D but more thiamine and riboflavin.

Factors Affecting Prevalence Of Breast Feeding in Kenya Favourable: -Social class 1 -Mother educated -Mother >25 years -Live in Nairobi -first baby -breast fed previous baby Against : -Low social class -Low education <8yrs Living with relatives Resuming formal employment

Dangers of Unmodified Cows Milk High renal solute load: Hypernatraemia High blood urea and acidaemia Hyperosmolality Hypocalcaemia

Contraindications to breast feeding Galactosaemia Anti-neoplastic drugs Tetracyclines Lithium????HIV

Baby Milks Infant formulas are suitable from birth and are usually based on cows milk. Composition controlled by EU and FDA legislation. Whey based milks are usually first choice if not breast feeding. Casein based milks are suggested for hungrier babies Soya infant milks Follow on formulas: Higher iron content than cows milk. Composition less controlled Specialised formulas for those who are preterm or have medical conditions

Soya Infant Formula Recommended for use on medical advice but should not be the first choice for the management of CMP intolerance. Similar to cows milk but protein derived from soya with lactose replaced with other carbohydrates (glucose syrups).

Preterm Requirements The aim of feeding premature babies is to achieve a rate of growth which is similar to intra-uterine growth at the same gestational age. Preferably the feed should be of constituents that do not load the metabolism and promote development of gastrointestinal function. Special Needs 1)Glycogen stores are small. Minimal fat stores. Reduced response to hypoglycaemia. 2)Increased energy requirements (100-120 kcal/kg/day) 3)Higher protein synthesis than term infants. 3)Nervous system potentially at risk if inadequate nutrition provided.(lcps)

Bottle feeding Start with small amounts 20-60ml/kg/day Increase to 150ml/kg/day by day 4-5. Usually given 3-4 hourly. Follow instructions: risk of hypernatraemia Hygiene issues.

Normal Growth All babies tend to lose 5-10% of birthweight over first few days and regain it by about 10 th day. Feeding requirement is 150ml/Kg/day Normal weight gain 30g/day for first 6 months. Most babies double their birthweight by 4-5 months and treble by one year.

Statistics again By 10 weeks, 50% of mothers had introduced solid food. At 6 months 50% will use commercially prepared food. At 9 months <30% using commercial food. (Nairobi 2011)

Weaning For the first 6 months babies cannot properly digest solid food. Commence weaning at 6months old and increase so that by 12 months solids are the main part of the diet with milk to drink along side. Do not rush or force-feed. Full fat cows milk can be used from 12 months.

Foods to avoid in weaning Foods with gluten eg wheat,rye,barley and other foods made from such. Tea Honey Nuts: Do not give any type of whole nut to children under 5 yrs due to risk of choking. Serious nut allergy affects less than 1% of the population. Those most at risk have FH of atopy. Avoid giving peanuts and peanut products until the child is 3 yrs old if FH of atopy.

Weaning Finger foods promote chewing practice and independence. Soft lumps are often manageable from 6-8mo months. Chewing encourages development of speech muscles. Feeding should always be supervised. The bottle should be phased out by 1 yr of age. Avoid fruit juice until >6months.

Weaning guide 0-6mo B/feeding 4-6mo- add single cereal 6-7mo- add cereal based and fruits 7-8mo- add veggies/starch 8-9mo- plant and animal proteins >12mo- cow-milk By 12mo- family menu - Formula supplement if b/milk not possible

Vitamins Vitamin K deficiency results in HDN If still breast feeding > 6months of age use Vitamin A,C and D drops. Not required if taking > 1pt of formula/day. Vit A every 6 months Give vitamin drops to all children of 1-5 years. Half an hour playing outside is sufficient to meet daily Vit D requirements.

Vitamins continued Iron deficiency anaemia is a common problem in toddlers worldwide, particularly in urban populations(10-30%) Kenya. It has been shown to be associated with developmental delay and increased susceptibility to infection. Iron supplemented milk and foods are recommended until at least the age of 2 years in all infants. BMJ 13/3/99, Archives Feb 99.

Failure To Thrive Occurs when child s growth fails to meet expected potential for age. A single plot on a chart is of limited value Need to consider parental height Not a diagnosis but a term which describes the end result of a number of different conditions which may be organic (gastrointestinal or non gastro), nonorganic (psychosocial) or mixed.

Failure to thrive Four basic reasons -Inadequate intake -Abnormal losses from vomiting/diarrhoea -Underlying illness eg CF -Abnormal baby (dysmorphic)

Approach to FTT Check weight against centile chart. Check type, amount and making up of feed. Dietary assessment. Observe a feed and infant response Assess stool Examine for underlying illness. Consider admission to observe response to feeding

Any questions?