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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.