Breast-Milk (for 1st 6 months of life)

Advantages Adequacy of milk intake

 Ideal nutrition for infants
 Reduce risk of GI infection & necrotising enterocolitis ( in
preterm)
 Reduce insulin dependent diabetes, HTN, obesity in later
life
 For long term neurodevelopment (IQ) in preterm
 Assess voiding, stooling pattern of infant (void 6-8 times/
day, pass >4 times/ day)
 Weight gain – weight gain regained 10 days after birth
 Feeding frequency: 8-12 times/ day
 Frequent feeding stimulate meconium passage & excretion
of bilirubin in stool
[breastfeeding jaundice: present often in breatfed infant
w elevated serum bilirubin,
breastmilk jaundice: after 1st week of life, prolong
elevated serum bilirubin d/t intestinal absorption of
bilirubin, last 1-2 weeks ]

Components
 Colostrum (high protein, phospholipid, cholesterol, immunoglobulin)
 IgA (99%): mucosal protection
 Bifidus factor: promote growth of Lactobacillus bifidus (lactose  lactic acid +acetic acid, low pH inhibit growth of pathogen)
 Lysozyme: bacteriolytic enzyme
 Lactoferrin: iron binding protein, inhibit growth of E.coli
 Interferon: antiviral
 High casein: whey ratio
 Lipid (rich in oleic acid): improve digestibility & fat absorption
 Calcium: prevent hypocalcemia tetany, improve calcium absorption

C/I Common breastfeeding problems

 Maternal infection: HIV, active TB, syphilis, varicella
 Use of phenycyclidine, cocaine, amphetamine: affect
neurobehavioral development
 Durg: antimetabolite, lithium, certain antithyroid drug
 Alcohol (>0.5mg): affect motor development
 Paediatric metabolic disorder: galactosemia, PKU
 Infant w cleft palate/ lip
 Breast tenderness, engorgement, cracked nipples
 Unknown volume intake by infant
 Transmission of infection
 Breast-milk jaundice: self limiting
 Transmission of drug
 Nutrient inadequacy
 Vitamin K deficiency: hemorrhagic disease

Formula-feeding

Cow milk Soy milk

 Low carbohydrate  X used <6m : has high aluminium, phytoestrogen (plant
 High protein, sodium, potassium, calcium, phosphate substance that mimic estrogen)

Complementary Food/ Weaning - 6th months

 Additional sources of nutrient :Protein, iron, zinc Delayed introduction of solid food
 Help identify possible allergy/ food intolerance  Nutritional deficiency
 C/I: honey (prevent infant botulism, give >1 y/o)  Oral sensory issue (texture, oral aversion)