PAEDIATRIC NURSING I

PNUR 309

INFANT AND CHILD FEEDING

MR JOSEPH N. SUGLO
suglojoseph@gmail.com
 Objectives
 By the end of the session, students will be able to
 Identify the types of infant feeding
 Describe the importance of exclusive breastfeeding and its
advantages
 Differentiate between complementary and supplementary feeding
 Describe the process of weaning and its related challenges
 Nutrition in Infants and Children
Adequate nutrition during infancy and early childhood is fundamental
to the development of each child’s full human potentials
It is well recognized that the period from birth to two years of age is a
“critical window” for the promotion of optimal growth, health and
behavioural development.
After a child reaches 2 years of age, it is very difficult to reverse
stunting that has occurred earlier (Martorell et al., 1994). The
immediate consequences of poor nutrition during these formative
years include significant morbidity and mortality and delayed mental
and motor development
Types of Feeding

This will be discussed under two headings namely:

• Breast feeding and

• Artificial feeding.
 Breast feeding
• Breastfeeding is natural but is a skill that need to be acquired
• Obstetrician, Pediatricians, nurses, midwives, certified lactational
consultant, peer counsellors need to assist mothers to breastfeed
• Babies and mothers need to practice. The more a baby sucks the more
breastmilk is produced
• Breast milk production is not dependent on size of breast
• How often should mothers breastfeed: 8-12times every 24hours
• If possible, breast feeding should be started within the first hour of birth
 Breast Feeding contd
Breastmilk is all your baby needs for the first six months of life. A breastfed baby
begins to learn about healthy eating — he decides when and how
much to eat and grows according to his/her nature.
Beginning at six months of age, introduce a variety of complementary*,
nutritious foods in addition to breastmilk.
Breastfeeding should continue for up to two years of age and beyond
 Composition of breast milk
Major nutrients
• Carbohydrates: Lactose and oligosaccharides
• Milk fat: including triglycerides, cholesterol, phospholipids, and steroid
hormones
• Proteins: including alpha-lactoalbumin, lactoferrin, secretory IgA, lysozyme
(found in the whey) and several caseins
• Minerals: including sodium, potassium, chloride, calcium, magnesium, and
phosphate
• Vitamins
Low vitamin D and vitamin K in breast milk to meet infant needs hence
supplementation required
• White blood cells
Proteins in breastmilk
• Protein in human milk
• 70% is whey (soluble , easily digestible)
• 30% is casein (insoluble)
• In contrast, bovine/cow milk protein contains
• 18 percent whey and 82 percent casein.
Exclusive breast feeding

Exclusive breastfeeding is an infant’s consumption of human

milk with no supplementation of any type (no water, no juice,
no nonhuman milk, and no foods) except for vitamins,
minerals, and medications (Sizer and Whitney, 2011)
 Exclusive breast Feeding Contd
• Breastmilk is all your baby needs in order to grow well for the first six
months. Exclusive breastfeeding means that your baby receives only your
breastmilk and nothing else.
• Your baby needs no other fluids unless prescribed by your physician.
• That means no extra water, sugar water or formula. Babies who are
exclusively breastfed stay healthier than babies who receive formula and
breastmilk.
• Babies must always be fed on demand
 Signs that Baby is getting enough breastmilk
Age Wet diapers Bowel movements per day
per day
Days 1–2 (colostrum) 1-2 1 or more black to dark green, sticky
(tar-like)
Days 3–4 (milk coming in) 3 or more, pale 3 or more greenish-brown or yellow
urine, diapers feel (becoming lighter as baby takes in
heavier more breastmilk)
After 6 or more, pale 3 or more soft yellow, may be
first week (milk is in) urine, heavier loose or seedy
diapers
After 4 weeks 6 or more, pale Depends on your baby, some have 1
urine, heavy wet or more soft and large. Other babies
may go
several days without a bowel
movement.
Advantages of breast feeding
Benefits to the
1. Child
2. Mother
3. Family
 Benefits to infant and young child
Saves infants’ lives.
It is a complete food for the infant because it contains balanced
proportions and sufficient quantity of all the nutrients needed during
the first 6 months.
Contains antibodies that protect against diseases, especially against
diarrhoea and respiratory infections.
The infant benefits from the colostrum, which protects him/her from
diseases. (Colostrum is the yellow or golden [first] milk the baby
receives in his or her first few days of life. It has high concentrations of
nutrients and protects against illness. Colostrum is small in quantity
 Benefits to the infant and young child cont’d
Promotes adequate growth and development, thus preventing
stunting.
It is always clean.
It is always ready and at the right temperature.
It is easy to digest. Nutrients are well absorbed. Protects against
allergies. Breast milk antibodies protect the baby’s gut, preventing
harmful substances from passing into the blood.
Contains the right amount of water to meet the baby’s needs (up to 80
percent).
 Benefits of breast feeding to the mother
• Putting the baby to the breast immediately after birth facilitates the
expulsion of placenta because the baby’s suckling stimulates uterine
contractions.
• Reduces risks of bleeding after delivery.
• When the baby is immediately breastfed after birth, breast milk
production is stimulated.
• Immediate and frequent suckling prevents engorgement.
 Benefits to the mother cont’d
• It is economical.
• Stimulates the bond between mother and baby.
• Reduces the mother’s workload (no time is involved in boiling water,
gathering fuel, or preparing milk).
• Reduces risks of pre-menopausal breast and ovarian cancer.
• Breastfeeding is more than 98 percent effective as a contraceptive
method during the first 6 months provided that breastfeeding is
exclusive and amenorrhoea persists.
 Benefits of breast feeding to family
• No expenses in buying formula, firewood, or other fuel to boil water
or milk. The money saved can be used to meet the family’s other
needs.
• No medical expenses due to sickness that formula could cause.
Mothers and their children are healthier.
• As illness episodes are reduced in number, the family encounters
fewer emotional difficulties associated with the baby’s illness.
• Births are spaced thanks to the contraceptive effect
 DIFFICULTIES/Problems in
BREASTFEEDING

This may be due to

 Engorgement

 Sore or cracked nipples

 Mastitis and breast abcess

 Breast engorgement
Prevention
• Correct positioning and attachment
• Breastfeed immediately after birth
• Breastfeed on demand (as often and as long as baby wants) day
and night: 10–12 times per 24 hours
• Allow baby to finish first breast before switching to the second
breast
 Sore and crack nipples
Prevention
• Correct positioning of baby
• Correct latch-on
• Do not use bottles, dummies, or pacifiers
• Do not use soap on nipples
 Mastitis and breast abscess
• Prevention:
• Get support from the family to perform non-infant care chores
• Ensure correct attachment
• Breastfeed on demand
• Avoid holding the breast in scissors hold
• Avoid sleeping on stomach (mother)
• Avoid tight clothing
• Use a variety of positions to rotate pressure points on breasts
Contraindications to Breast Feeding (Relative)
HIV: RISK SHOULD BE WEIGHED AGAINST BENEFIT. IN Ghana breastfeeding is not
contraindicated
HEPATITIS B: Infant should receive immunoglobulin and hepatitis B vaccine. Do
not delay initiating breastfeeding
HEPATITIS C: No contraindication to breastfeeding
TUBERCULOSIS: If mother has active TB she should complete 2 weeks treatment
before breastfeeding. However she can express the breast milk for baby to be fed
CHICKEN POX: Baby will get infected if she comes into contact with lesions. So
mother can express milk for baby to be feed
To be continued
• CHEMOTHERAPY/RADIO THERAPY: Breastfeeding contraindicated
• SMOKING CIGARETTE Mother should be encouraged to stop but
smoking is not a contraindication to breastfeed
• ALCOHOL Mother should be encouraged to stop or reduce alcohol to
less than 2 glasses of wine or 2 cans of beer or 2 oz /60ml of liquour
 Contraindication cont’d

Maternal conditions that may justify temporary avoidance of

breastfeeding
• Severe illness that prevents a mother from caring for her infant, for
example sepsis.
• Herpes simplex virus type 1 (HSV-1): Direct contact between lesions
on the mother’s breasts and the infant’s mouth. Feeding should be
avoided until all active lesions have resolved.
 Contraindications breast feeding cont’d
Maternal medication:
Radioactive iodine-131 is better avoided given that safer
alternatives are available - a mother can resume breastfeeding
about two months after receiving this substance.
Cytotoxic chemotherapy requires that a mother stops
breastfeeding during therapy.
 ARTIFICIAL FEEDING

This is giving food other than human milk to an infant.

Complementary feeding

Supplementary feeding
 Complementary feeding

Complementary feeding is defined as the process starting when breast

milk alone is no longer sufficient to meet the nutritional requirements
of infants, and therefore other foods and liquids are needed, along
with breast milk.

It is breastfeeding with the addition of appropriate foods

 Supplementary Feeding

Supplementary feeding: Feeding provided in place of

breastfeeding. This may include expressed or banked breast milk
and/or breast milk substitutes or formula.

Also, it is term as any food given prior to the recommended 6

months exclusive breast feeding duration.
 Infant indications for supplementary feeding
• Asymptomatic hypoglycemia documented by laboratory blood
glucose measurement that is not responsive to appropriate frequent
breastfeeding.
• Symptomatic infants are treated with intravenous glucose.
• Clinical and laboratory evidence of significant dehydration (e.g., 10%
weight loss, high sodium, poor feeding, lethargy, etc.) without
improvement after proper management of breastfeeding.
• Delayed bowel movements or continued meconium stools by day five
 Infant indications for supplementary feeding

• Weight loss of 8–10% accompanied by delayed lactogenesis for 5

days or later.

• Breast milk Jaundice when levels reach 20–25 mg/dL (mol/L) in an

otherwise thriving infant and where a therapeutic interruption of
breastfeeding may be helpful
 Maternal indications for supplementary feeding
• Delayed lactogenesis: 3–5 days or later after birth and inadequate
intake by the infant
• Sheehan’s syndrome (postpartum hemorrhage followed by absence of
lactogenesis)
• Primary glandular insufficiency, occurs in less than 5% of women
(primary lactation failure), as evidenced by poor breast growth during
pregnancy and minimal indications of lactogenesis
• Breast disease or breast surgery resulting in poor milk production
• Intolerable pain during feedings unrelieved by interventions
 Methods of Providing Supplementary
Feedings
• cup feeding

• spoon or dropper feeding,

• finger-feeding

• syringe feeding

• bottle feeding
ADVANTAGES AND DISADVANTAGES
OF COMPLEMENTARY AND
SUPPLEMENTARY FEEDING
FIVE EACH; Class discussion
Disadvantages of Commercial Infant Formula
• Infant is more likely to get sick
• Need reliable formula supply
• Formula is expensive
• Requires clean water
• Must be made fresh each time
• Not breastfeeding may raise questions about mother’s HIV status
/health status
Advantages

• No risk of transmitting HIV

• Made especially for infants
• Includes most nutrients an infant needs
• Others can feed infant
Infant Formulas
Available as
• Ready to feed,
• concentrated liquid
• powder
• Powdered formulas can come in Single or multiple servings
• In Ghana the multiple serving powders are common
PREPARATION OF FEEDS:

Formula 75 (F75)

Formula 100 (F100)

Ready-to-used Therapeutic Foods (RUTF)

 F75
• Formula 75 (75 kcal/100ml) is the milk-based diet recommended by
WHO for the stabilisation of children with SAM in inpatient care.
• Ingredients:
• Oil – 20g
• Milk – 35g
• Sugar – 100g
• Zincovite – 20mls
• How to Prepare F75
• Mix the above ingredients into one litre container and add water to
make one litre. (Note: for two litres, the ingredients must be doubled
 Formula 100 (F100)
• Formula 100 (100 kcal/100ml) is the milk-based diet
recommended by WHO for the nutrition rehabilitation of
children with SAM after stabilisation in inpatient care and was
used in this context before RUTF was available. It contains;
• Oil – 30g
• Milk – 110g
• Sugar – 50g
• Zincovite – 20mls
 Ready-to-Use Therapeutic Food (RUTF)

• RUTF is high-energy, nutrient-dense food used for nutritional

rehabilitation in outpatient care and in combination with systematic
medical treatment. It should not be used alone to treat SAM.

Eg of RUTF – ‘Plumpy’nut, BP 100

 Characteristics of RUTF

• Energy and nutrient dense 500 kcal/92g

• Same formula as F100 (except RUTF contains iron and is about

five times more energy-nutrient dense)

• No microbial growth even when opened and Ideal for outpatient

care because it does not need to be cooked or mixed with water
 RUTF Rations in Outpatient Care: Plumpy
Nut (92 g packets containing 500 kcal
Weight of Child (kg) Packets per Day Packets per Week
3.5 - 3.9 1.5 11.0
4.0 – 5.4 2.0 14.0
5.5 – 6.9 2.5 18.0
7.0 – 8.4 3.0 21.0
8.5 – 9.4 3.5 25.0
9.5 – 10.4 4.0 28.0
10.5 – 11.9 4.5 32.0
≥ 12.0 5.0 35.0
 WEANING AND RELATED PROBLEMS
It is the process of introducing the infant to other food and reducing the
supply of breast milk.
Sometimes called beikost, or "weaning foods")
• Weaning is a process by which a baby slowly gets used to eating family or adult
foods and relies less and less on breast milk
Weaning contd
The psychological factors involved in the weaning process are crucial
for both mother and child including their closeness and separation
during this stage.
Weaning can bring both physical and emotional change for both
mother and baby, so one may experience conflicting feelings as well as
some changes to the body
Variety of foods to use in weaning period
• Cereals ( rice maize wheat sorghum millet)
• Roots ()yam cocoyam cassava potatoes sweet potatoes
• Starchy foods (banana, plantain)
• Peas and beans (groundnuts, beans)
• Food from animals(meats, fish, liver, milk, eggs)
• Green leafy vegetables
• Orange vegetables(carrots, pawpaw
• Oils and fat (corn oil, palm oil, sunflower oil, groundnut oil, coconut oil)
• Fruits(juice or puree- clean thoroughly)
• Plus breastfeeding
 Weaning foods
• Single ingredient foods should be introduced first ( cereals eg corn koko,
rice, pureed meats) mixed with milk and offered at the end of
breastfeeding
• Once accepted, strained or pureed fruits and vegetables may be added
• Avoid giving sugar and salt ( helps set a lower threshold for sweet and salty
tastes later in life
• Introduce one food at a time
•  Start with small amounts and gradually increase
 Foods to avoid
For infants less than one year:
• Hard, round foods such as nuts, grapes, raw carrots and round candies which
can lead to choking
• Unmodified cow milk should be avoided
• Fruit juice should not be offered to children younger than 12months, rather use
mashed or pureed whole fruits
• Fruit juices may cause under or overnutrition, diarrhoea, flatulence, abdominal
distension and dental caries
 Problems During weaning
• Depression and mood swings: Prolactin is the hormone that
stimulates milk production, but also produces feelings of calm and
relaxation. When levels of Prolactin drop, you may discover you're
feeling the blues.
• Mastitis
• Engorgement breasts: When weaning, your breasts will still want to
produce the amount of milk it is accustomed to, which can cause
breasts to become engorged.
• Acne: Similar to post-pregnancy acne, your changing hormone levels
can take center stage on your face in the form of pimples.
 Health education of parents and significant
others in relation to feeding
The health education should cover the following areas;
• Positioning of the baby during feeding
• Cleanliness of infant feed
• How to prepare infant feed
• Significance of infant feeding
• Feeding on demand
HA
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