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The first two years of life: a critical window of opportunity ensuring children’s appropriate growth and development through optimal feeding
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Ezy Barnita
Introduction
Nutrition
Poor Adequate
Morbidity & mortality ↑Directly or indirectly Ensure growth, health
and development ~ potential2006: ⅓ of 9,5
million deaths in children <5 yo,
Inappropriate
Obesity
…introduction
The first two years of life: a critical window of opportunity ensuring children’s appropriate growth and development through optimal feeding
Optimal breastfeeding prevent 13% of deaths in children <5 years of age, appropriate complementary feeding practices an additional 6% reduction in underfive mortality
Malnutrition during the 1st 2 yrs of life
Short stature (stunting)
Impaired intellectual performance (adult)
Reduced capacity for physical work
Affected reproductive capacity in ♀(LBW)
Implication of national development
Global strategy for infant and young child feeding (2002)
Exclusive breastfeeding for 6 months (180 days)
Complementary feeding starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond.
1
2
Definition
Infant receives only breast milk or expressed breast milk, and
no other liquids or solids, not even water, with the exception of oral rehydration solution, drops or syrups consisting of vitamins, minerals supplements or medicines
Exclusive breastfeeding
process starting when breast milk is no longer sufficient to meet the nutritional requirements of infants, and therefore otherfoods and liquids are needed, along with breast milk.
Complementary feeding
Evidence for recommended BF (1)
Mortality 6-10 times higher at 1st month of life
Diarrhea and pneumonia are more common and more severe even with adequate hygiene, as well as other acute infections (otitis media, Haemophilus influenzae meningitis, UTI)
↑ risk diseases with an immunological basis, (asthma and other atopic conditions, type 1 diabetes, celiac disease, ulcerative colitis and Crohn disease
No breastfeeding
Evidence for recommended BF(2)
Greater risk of childhood leukaemia
Obesity in later childhood and adolescence is less common among breastfed children dose response effect
↑risks to cardiovascular health (hypertension, cholesterol level, atheros-clerosis in later adulthood)
A meta-analysis of 20 studies: cognitive function on average 3.2 points higher among children who were breastfed
Exclusive and partial BF
Exclusive BF
Partial BF
Diarrhea : 8,6 times higher
Mortality: 4,2 times higher
Exclusive and no BF
Exclusive BF
No BF
Diarrhea : 25 times higher
Mortality: 14,2 times higher
Complementary feeding
After 6 month old:
It becomes increasingly difficult for breastfed infants to meet their nutrient needs from human milk alone
Most infants are developmentally ready for other foods at about 6 months
In many countries, the period of complementaryFeeding (6–23 months) peak incidence of growth faltering, micronutrient deficiencies and infectious illnesses
inadequate nutritional qualitygiven too early or too latein too small amounts or not frequently enoughpremature cessationlow frequency of breastfeeding
Ten guiding principles for complementary feeding of the breastfed child
1. Introduce complementary foods at 6 months of age (180 days) while continuing to breastfeed.Six months old doubled his or her birth’s weight and more active exclusive BF is no longer sufficient to meet baby’s energy and nutrient needs
Digestive system is mature enough to digest the starch, protein and fat in a non-milk diet.
Tongue thrust and rooting reflexes begin to disappear infants can receive and hold semi-solid food in their mouths
2. Continue frequent on-demand breastfeeding until 2 years of age or beyond
higher quality nutrients
protective factors
reduces the risk of acute and chronic diseases
3. Responsive feeding
Feed infants directly & assist older children feeding themselves. Feed slowly,patiently, and encourage children to eat, but do not force them
If children refuse experiment with different food combinations, tastes, textures and methods of encouragement.
Minimize distractions during meals
Feeding times are periods of learning &love
4. Practise good hygiene and proper food handling
5. Start with small amounts of food, increase the quantity as the child gets older
Amount of energy
Breastfeeding 0.7kcal/ml
Complementary feeding
0.6-1kcal/ml
Dilute food ~0.3kcal/ml
Complementary foods should have a greater energy density than breast milk, that is, at least 0.8 kcal per gram
Practical guidance of complementary food
6. Increase food consistency and variety gradually
The most suitable consistency for an infant’s or young child’s food depends on age and neuromuscular development
6 months
8 months
12 months
pureed, mashed or semi-solid foods
finger foods
family food
delayed beyond 10 months of age may ↑ the risk of feeding difficulties
7. Frequency of complementary food
How much energy the child needs to cover the energy gap
The amount that a child can eat at one meal stomach capacity (~30ml/kg)
The energy density of the food offered at least 0.8kcal/g (>BF) or need greater volume need to be divided into more meals
8. Feed a variety of nutrient-rich foods to ensure that all nutrient needs are met
such as:
Animal source
Pulses
Fats & oil
Fruit and veg
Dairy
There are no controlled studies that show that restrictive diets have an allergy-preventing effect
Vegetarian (plant-based) complementary foods do not by themselves provide enough iron and zinc to meet child’s needs
9. Fortified complementary foods or vitamin-mineral supplements as neededIn settings where little or no animal-source foods are available to many families, iron-fortified complementary foods or foods fortified at the point of consumption with a multinutrient powder or lipid-based nutrient supplement may be necessary
10. Increase fluid intake during illness
During illness the need of fluid often ↑
child’s appetite for food often decreases
desire to breastfeed increases
breast milk may become the main source of both fluid and nutrients
give more frequent, smaller meals
Take home message
After 6 months yo start complementary feeding due to energy gap along with maturity of digestive tract and
feeding skills development
Breastfeeding is the best
Thank you