SATYA NURSING COLLEGE ROHTAK

SEMINAR
ON
ARTIFICIAL
FEEDING

Submitted To Submitted By
 INDEX

Sr. No. CONTENTS Page No.

1. ABSTRACT
2. Introduction of Artificial 3-4
Feeding
3. Difference in constituents of 4-5
Human and Cow’s Milk
4. Methods of Artificial Feeding 5
5. Bottle Feeding 5-6
6. Katori and spoon Feeding 7
7. Cup Feeding 7
8. Gavage Feeding 8
9. Problems Associated with 8
Artificial Feeding
Artificial Feeding
Choosing whether to breastfeed or formula feed the baby is one of the
first decisions expectant parents will make. Although experts believe that breast milk is the
best nutritional choice for infants, breastfeeding may not be possible for all women. For many
women, decision to breastfeed or formula feed is based on their comfort level, lifestyle and
specific medical considerations that they might have. For mothers who are unable to
breastfeed or who decide not to breastfeed, infant formula is a good alternative. Feeding the
child milk, other than breast milk is known as ‘artificial feeding’. It includes use of cow’s
milk, buffalo’s milk or commercially available dried whole milk.

Indications for Artificial Feeding

The main indications for artificial feeding are:
 Death or absence of mother
 Prolonged maternal illness
 Failure of breast milk production
 Mothers who have active tuberculosis (TB) and human immunodeficiency virus
(HIV) positive mothers
 Working mothers
 The baby is adopted and mother who has adopted the baby is not lactating.

Artificial Formulas/Feeds
A baby who is not breastfeed is fed on artificial formulas. Most infants
are fed on cow’s milk, buffalo’s milk, and commercially available dried milk.
 Cow’s Milk:
It is a cheap alternative which is well within the reach of many Indian
families. Cow’s milk contains three times more protein than breast milk, but the protein in
cow’s milk is not fully digested and used. The carbohydrate content of human milk is higher
as compared to cow’s milk. The amount of fat is same in both cow’s milk and breast milk.
The fat in breast milk is better emulsified and digested than cow’s milk fat. Cow’s milk may
cause strain on infant’s kidneys because of its high sodium content. It is therefore
recommended by the pediatricians and WHO to dilute cow’s milk for first 6-8 weeks in ration
of 3 or 4:1 (three or four parts of milk and 1 part of water). On an average, an infant requires
150 ml of milk per kg body weight per day to get about 100 kcal energy per kg body weight.
After 3-4 months of age, undiluted milk should be given.
  Buffalo’s milk:
Buffalos milk can also be used in place of cow’s milk. It should be
skimmed and then given in same proportion as cow’s milk for first 6-8 weeks.
 Dried milk formulas:
The commercially available dried milk formulas are either cow’s milk-
based or soy protein based. It must be reconstituted according to the recommendations of the
manufacturer. The general principle of manufacturing powdered milk is to reduce proteins to
1.5-2.5g/100 mL, increase lactose content to 6g/100mL, reduce minerals like sodium and
phosphates and modify fats by homogenization and substituting part of saturated animal fat
with unsaturated vegetable oil. In spite of all these changes, this milk is biologically inferior
to breast milk.

Difference in constituents of Human and Cow’s Milk

 Protein:
Protein content of human milk is three times less than cow’s milk.
Human milk contains more cysteine and lactalbumin and less methionine and casein than
cow’s milk. Breast milk protein is completely digested and utilized for growth whereas much
of cow’s milk protein is excreted by infant, undigested producing whitish curdy stool. So, it is
important to modify casein present in cow’s milk by partial digestion. This can be achieved
by diluting milk and by boiling it.
 Fat:
Although total content of fat in cow’s and human milk is almost same,
there are differences in types of fatty acids contained in fat which renders cow’s milk a bit
irritating and less easily digestible.
 Carbohydrate:
The same form of carbohydrate is present in both milk (i.e., lactose) but
its concentration is higher in breast milk which is good for growing brain.
 Vitamin D and Minerals:
Human milk contains vitamin D in water-soluble form. It contains more
vitamin A and C than cow’s milk. Both human and cow’s milk are deficient in iron which
must be given as a supplement to the baby. Human milk contains less sodium than cow’s milk
and does not put any unnecessary strain on infant’s kidneys. Cow’s milk contains more
phosphorus than human milk due to which babies fed on cow’s milk are prone to tetany as
higher phosphorus of cow’s milk has detrimental effect on its calcium.
 Constituent Breast milk(g/L) Cow milk (g/L)
1. Protein 11 33
Casein 4 28
Soluble Proteins 7 5
Lactalbumin 3.5 1.5-1.8
B-Lactalbumin 0 3.7
Lactoferrin 1-2 0.2-0.5
Immunoglobulin 1-2 0.5
Lysozyme 0.5 Traces

Non Protein nitrogenous Substances 0.32 0.32

2. Lipids 35 35
Linoleic acid 3.5 1
3. Carbohydrates 70 50
Lactose 62 50
Oligosaccharides 8 0
4. Minerals 2 8
Ca 0.33 1
P 0.15 1
Fe 0.4-1.5mg 0.3-0.5mg
5. Vitamin
60mg 20mg
C
50IU 25IU
D
6. Energy 640-720 kcal 650 kcal

Methods of Artificial Feeding

Babies can be fed artificially be following ways:
 Bottle-feeding
 Katori and spoon-feeding
 Cup-feeding
 Gavage or nasogastric or gastric feeding

1. Bottle-feeding
Bottle-feeding is a common practice in India, to which babies become addicted. A
prolonged bottle-feeding may lead to “Baby Bottle Tooth Decay”. Also it is difficult to wean
bottle fed babies. At times bottle is contaminated or inadequately cleaned resulting in
gastrointestinal infection causing diarrhea. Despite of these negative factors, if bottle feeding
is practices, it must be done cautiously.

Principles of Bottle feeding

The Following principles must be kept in mind while bottle feeding the baby:
 After washing the bottle with brush and clean water, it should be boiled for about 10
minutes. The milk or cream sticking to nipple can be easily removed by rubbing with
common salt.
 Hands should be washed thoroughly before touching the bottle and preparing the feed.
 The hole of teat should be such that drip rate is one drop/second. A hole smaller than
this makes feeding difficult, exhausts the child and results in swallowing of air leading
to vomiting and abdominal distention. A big hole, on other hand, will result in
choking, vomiting, and abdominal distention.

Quantity of reconstituted or cow’s milk Frequency of feeds

120-150 mL/kg/day 7 times/day * 1st 2 Months
6 times/day * next 2 months
5 times/ day * next 3 months

Technique of Bottle feeding

 After cleaning the teat and bottle, it should be sterilized and kept covered.
 Prepare the formula as per requirement, when the baby is hungry.
 Change the soiled diaper and make the baby comfortable.
 Wash hands and test flow of milk and its temperature, by sprinkling a few drops on
inner aspect of wrist.
 Sit in a comfortable position with baby in lap. Head of the baby should be higher than
rest of the body.
 If any medication is to be administered, it should be given before feeding.
 The teat should be touched to the corner of baby’s mouth and when baby opens
mouth, teat should be inserted in mouth.
 The bottle should be held at an angle that teat is completely filled and there is no air in
the teat.
 The baby should be burped during and after the feeds.
 After burping, make the baby lie in right lateral position.
 2. Katori and Spoon Feeding
When the neonate cannot suck on the breast due to prematurity or any congenital
malformation or when breast milk is obtained from sources others than mother, feeding with
katori and spoon is the best method.

Technique of Katori and Spoon Feeding

 The Katori and spoon should be washed thoroughly and boiled for 10 minutes.
 Take required amount of feed in the cup and keep it covered.
 Change soiled diaper.
 Wash hands and hold the baby semiupright in lap and wrap a bib or soft cloth around
the neck.
 Touch the spoon to the corner of the mouth and when the baby opens mouth, feed is
given. The first bolus is allowed to swallow, before the next is given. Feed from the
corner of the mouth and constantly observe the baby to prevent aspiration and control
feeding.
 After feeding, burp the baby, wipe the mouth and make him/her lie in right lateral
position.

3. Cup feeding
Another good method of feeding the baby is directly by cup. A baby who is cup fed
needs to be given 5mL extra at each feed to allow for spillage from cup.

Technique of Cup feeding

 Wash the cup thoroughly and boil it for 10 minutes.
 Take the required amount of feed with 5mL extra to allow for spillage from the cup.
 Hold the baby in lap after changing of soiled diaper, supporting his/her head and
shoulders.
 Hold the cup of milk resting on the lower lip so that the rim of cup touches the baby’s
upper lip.
 Tilt the cup so that the milk just reaches baby’s lip.
 A term baby will suck the milk, spilling some of it.
 Do not pour the milk into baby’s mouth, let him/her suck it.
 When the baby has had enough, he/she closes the mouth and stops taking feed.
 Wipe off the face and burp the baby.
  Make the baby lie in right lateral position.

4. Gavage feeding
For gavage feeding, size for 5 feeding catheter is required for nasogastric or orogastric
placement. For nasogastric insertion, the catheter is measured from external nares to the
tragus of the ear and from there to it xiphisternum. This length of tube should be inserted
from nose. For orogastric insertion, distance is measured from angle of mouth to the tragus
and from there to the xiphisternum. During nasogastric or orogastric tube insertion, the head
is slightly raised and a wet (not lubricated) catheter is passed gently though the nose or mouth
into the esophagus and then to stomach. Position of the nasogastric tube is verified by
aspirating the gastric contents. The tube is then fixed through an adhesive tape. At the time of
feeding, a 5 or 10mL syringe without plunger is attached to the tube and milk is given
through it. After feeding, place the baby in right lateral position. There is no need to burp the
baby after gavage feed. A nasogastric or orogastric tube can be left in situ for up to 7 days.

Problems Associated with Artificial Feeding

The problems associated with artificial feeding are:
 Constipation due to undigested protein. This can be relieved by adding sugar to the
milk.
 Underfeeding
 Overfeeding
 Aerophage (swallowing of air) leading to distention of abdomen, colic and aspiration.
 Low pH formulas may lead to acidosis.
 Malnutrition, if feeds are over diluted
 It is expensive and its preparation is tedious.
 High incidence of infection if hygiene is not maintained.
 Cow’s milk contains higher sodium and phosphorus leading to increased solute load
on kidneys which predispose babies to hypertonic dehydration.
 Artificially fed infants are at higher risk of gastroenteritis, anemia,
hyperphosphatemia, hypocalcaemia and latent or clinical scurvy.