‘The growth and development of infants. and children is mainly dependent on mute tion; proper feeding is therefore of utmost importance. This means that adequate amounts of the basie nutrients, carbohy- rates, proteins, fats, minerals, vitamins, water and roughage should be included in their diet at all times. During the first months of lifo, the main source of nutrition is milk. Depending on circumstances, solid food is introduced between 4 and 6 months. ‘As the baby grows older, solid food becomes the mainstay of nutrition, ‘Types and Methods of Milk Feed-1, gs. There are two types of milk: breast * milk or human mitk and milk other than breast milk (artificial feeding). Hence, in- fants may be purely on breast-feeding or artificial feeding and when both types of milk aro used, on mixed feeding. When artificial feeding immediately follows breast-feeding to make single feeding, itis called comple- mentary milk feeding. When artificial milk feeding alternates or replaces breast feed- ing, itis caled supplementary milk feding: Milk feeding may be given an infant in two ways: scheduled and “on demand!” (slf- régulation) feedings. The former is selfex- planatory and the latter means that the in- fant is allowed to feed when he so desires, “On demand” feedings mean that the baby is allowed to set his own pattern of feeding manifested by his erying or restlessness and not to feed him on a rigid schedile.It means hha may feed at intervals of 2 or 4 hours at tines, and 4 or 5 hours at other times within 2A hours. Thus, he establishes his own sched tle of 6-8 feedings per 24 hours, With this 154 . INFANT FEEDING method of “on demand” feedings, a voracious infant may be overfed while a lazy infant may be underfed. Feeding “on demand” may bbe the better method of feeding as it may provent the development of some feeling of insecurity or resentment in the infant when feedings are delayed. This will also prevent the development of gastrointestinal problems like tympanism or colic. On the other hand, scheduled feedings have advantages. This method of feeding ean guide the infant. in developing the proper habits of timing his feedings and in the process teach him to develop some form of discipline. ‘Whatever method of feeding is used will be decided by the mother in conformity with the desires ofthe infant. and under the guid- ance of the pediatrician. The orderly mother, the precise and the disciplinarian may choose the scheduled feedings. The complacent or the understanding parent will probably favor “on demand” feedings. ARTIFICIAL FEEDING FORMS OF COW'S MILK , Certified Milk, Cow's milk is said to be certified when there is striet supervision of dairies and their personnel, This eliminates the principal souree of contamination of milk, bovine tuberculosis, and infections resulting from handling like typhoid and other salmo- nella, dysentery, streptococcus and staphylococcus. After drawing the milk, itis cooled to below 7C immediately and kept at this temperature until delivery. Pasteurized Milk. Pasteurization isheat- ing the milk at 63°C:for 30 minutes or for15 secands at 72°C followed by rapid cooling {to 65°C. This procedure destroys all patho: genic bacteria but only 99 percent of suprophytes. The spores are not affected, ‘This proces destroys 20% ofthe vitamin C ‘and 10% of Usiamine, Standards for bacte- rial content. may be as high as 50,000 non- pathogenic bacteria per‘mL. or as low as 5,000-10,000 per mL. Pasteurized milk should be kept at 10°C and should not be used after 48 hours. Only fresh mill pasteurized as sour milk is curdled by the procedure. Homogenized Milk. Homogenization rmeans the processing of milk so thatthe fat lobules are broken into a fine emulsion by ‘passing milk through afine aperture at high pressure at pasteurization temperature. This fine emulsion will, prevent creaming and renders the fat mare easily assimilated. Ho- rmogenization is also the methed used to in corporate vitamin D in rik Evaporated Milk. This is cow's milk ‘evaporated in vacuo at 55:60°C to about 50% of its volume. This is then homogenized, sealed in cans and autoclaved at 116°C for some time to destroy spores. The striliza- tion process can cause some damage to the ‘quality ofthe protein. Ifthe can is unopened, it can keep for months without refrgera- tion. Its lactalbumin becomes les allergenic. ‘Thirty mL or one fluid oz equals 40 Kel. Condensed Milk. Ths is another form of cow's milk to which 45% of eane sugar is added making it nutritionally “out of bal- ance” for an infant. This makes the earbo- hydrate content about 60% when diluted 14 ‘The mixture will give a value of 67 caVéll and a percentage composition of protein 1.6%, fat 1.6% and disproportionately high carbohydrate content of 11% and minerals ‘of 0.36%, Because of this, condensed milk is ‘only used for a short period of time when a Digh calorie formula is needed. It has also less fat soluble vitaming and vitamin C. Its rain advantages are its keeping quality and ing whole oF pasteurized milk into a hot chamber by using revolving drums at a very high speed so that the water is vluilized immediately or by freezedrying. Fine eurds 6, INFANT FEEDING 155 are produced because the protein is altered by the process of heating. Vitamin C is not affected by the drying process. Skirmed Dried Milk. In this prepara- tion, fat is removed before the milk is dried so that the fat content is only 05%. Half- skimmed dried milk has a fat content of 1.5%, This is useful for patients who have fat intolerance, for those recovering from diarthea, and for some prematures, Fermented Milk. The different types of fermented milk are buttermilk, fermented whole milk and protein milk. The acidity of the sour milks responsible forthe chang- ing of the casein curds, Buttermilk is made from milk that has been allowed to turn sour by nature and its fat removed by churning, ‘This process is very frequently contaminated. ‘To prevent this, sterile skimmed milk is now ‘inoculated with some lactic acid- producing, organisms (Lactobacillus acidophilus, L. bulgaricus, or Streptococcus aticus). In fe- ‘mented whole milk, after inoculation, the rilk is incubated at 27.30°C for 6-12 hours after which itis refrigerated for several days. Protein milk was introduced by Finkelstein, etwas considered quite valuable in the treat- ment of diarrheas. Lately, it has ben proven ‘that the putrefuetion flora it produces is of no value ‘Acid Milk, This is prepared by the addi- tion of dilute mineral o organie acids tothe milk, Marriott popularized the lactic acid milk, Ths type of milk overcomes the buffer value of cow's milk besides producing a bac- Loreal effect inthe slomach and dundenurm Filled Milk. To produce ths typeof milk, the fat content of whole mi is replaced by vegetable ol. Coconut ol, which is the most widely used inthe Philippines because ofits low oxidative deterioration and availabilty, lacks the proper types of fay acids, par- ticularly linolvie acid. To increase the sup- ply ofthe latter to better-level, com al is added, but the mixture of eoeonut oil and ‘corn oil increases the amount of saturated falty acids. This milk con be used for alder infants who ean be given other fat contain- ing foods. Recombined Milk, When separated nonaqueous ingredients are mixed together with or without reincluson of water, there156 PEDIATRICS AND CHILD HEALTH is a recombination, For example, in con. densed milk recombination, the butterfat and the non-fat milk solids are put together again, Actually these butter and non-fat. milk solids are a single entity in fresh milk or whole cow's milk, Reconstituted Milk. The remaking of any rill product to approximate the composi: tion of fresh cow's milk results in reconsti tuted milk. Hence, if powdered milk made diretly from fresh milk is being used, all that needs tobe done is to add water. Standards for mill have been set by the Food and Agricultural Organization (FAO). Infant formulas, Generally used as breastmilk substitutes, these are usvally based on cow’s milk which have been al- « tered to make it more liko broastmilk, As such, they ae sometimes called humanized nik When prepared properly and these will differ according to the manufacturer's speci fication, these formulas will provide 20 clo ries/z. (See table for example of locally avail able infant formula) Tn recent years, follow-on formulas were introduced in the market and have since been widely used all over the world. These », were intended to replace the use of cow's nik during infaney and childhood. tt fined 25 a “ood intended for use asa liquid part of the weaning diet for the infant from the 6th month on and for children Between 12 and 36 months of age”. There are ques- tions raised about the high protein content of these formulas which together with the supplementary foods gives the child a pro- tein intake not far from that on cow's milk. Also there is the risk of hypematremic de- hydration due to a high potential renal sol- ute load. However, in parts of the world where supplementary foods are low in pro- tein, a fllow-an formula may be used. Special formulas. ‘These are formulas where either the carbohydrate, protein, fat or all these components have been altered to.address the specific needs ofeetain meta- boli or gastrointestinal problems. Examples of these would be a pheriylalanine-free for- ‘mula for infants with phenylketonuria, the protein hyidrlysates for infants with cow's milk allergy and the lactose-free formulas for those with lactose intolerance. ‘There are some types of milk which are ~at recommended for infant feedings. Whole cow's inilkis generally not recommended for the infant less than 1 year Its protein eon- tent is much higher than that found in breastmilk (21% vs 7-16%) thus increasing its renal solute loud. Whole cow's milk is low in iron and its use may also result in occult blood loss in the stools. Skimmed milk and low fat milk are unacceptable as feed- ing alternatives in infancy because of the very low fat content. It is also deficient in vitamin C and iron. Goat's milk was used in the past as an alternative to cow's milk if the child was allergic to cow’s milk. How- ever, ithas been found to be just as antigenie ‘as cow's milk and therefore a poor substi tute, Also its high protein eontent also re- sults in an increased renal solute load. It is also deficient in folie aeid, irom and its ear- bohydrate content is only 25% as compared to 35-65% in breastmilk. WEANING ‘Weaning has been defined in many ways, changing from breast to bottle, changing from milk to solids, from breast to cup or from bottle to cup. The most widely accepted definition of weaning is “the proces of in troducing any non-mik food into the infant diet, irespective of whether or not breast or bottle feedi- continues”. Wenning is a time of great change for the meine and child, It is a dangerous time for the infant. I is well-known that higher rates of infection, particularly diarrheal dis- eases oceur during the weaning peried be- cause of food contamination during prepa- ration, Malnutrition is also more common daring this period because weaning foods given may be of poor nutritional value. ‘The intvoduetion of solid foods is usu- ally done at about 4 to 6 months of age, During this time, breastmilk supply or vol: umes of intake of milk formula may no longer meet the energy requirements for growth. Vitamin and mineral deficiencies ‘may also begin to develop inthe fully breast- fed infant. The infantlso exhibits develop- mental readiness-has better head controland oral motor coordination that allows him * onrticipate appropriately in the feeding pro-ess. The intestinal tract is better able to ht-tle foreign proteins and the kidneys better nhle to tolerate the increased protein Touds. ‘The initial weaning foods are usualy ce- reals, fruit juice, pureed fruits and vegéte- bles. They should be wellmashed, strained or homogenized. Theré is-no fixed rule as to the order of introduction but it is wise to start with the least antigenic. It is impor- tant to give a varity of food so as to avoi trace element deficiencies. When the infant develops chewing motions, lumpy solids bis- cuits which soften readily in the mouth and chewable, suckablo solids may be introduced. As the child learns effective chewing move- ‘ments, a more textured diet is given, ‘Tps oa How to Introduce Weaning Foods 1. Give small amounts atthe start, about 1 to 2 tsp. to accustom the child to the new food. 2. Give the food after a feed. If he is relue- tant, you may try to give the food before the feed when the child is hungry. 3. Wait for about 3-4 days before introdue- ing a new food. 4. Use a spein to feed the child and position him properly. Never feed the child lying down 5. Do not force the child to eat and do not worry if he spits out the food. Koep try- ing until the infants takes the food well. 6, Once a fod is accepted, give it fairy fre. quently so that it becomes familia. 7. Gradually increase the amounts of food offered, Within 2 weeks, basic mies and then multi-smixes should be introduced, ‘The frequency of feéding is also increased 50 that by 6 months, the child is feeding solids 2-3 times a day. 8. As the infant grows, allow him to handle the food and feed himsel. These however, should be supervised lo ensure that the infant takes enough food. 9, Avoid large volumes of fluids in between ‘meals since these may depress the child's ‘appetite for food. Offer drinks at the end of the meal. Weaning is an important period for the infant since lifelong dictary habits may be - 6. INFANT FEEDING 187 come established at this time. Excessive salt ‘and sugar intake during this time should be discouraged. Misinterpretation by the mother ofthe child’ natural reluctance to a 1 new food as food refusal may establish strong likes and dislikes fr food. ‘The foods suitable for infants and young children vary from place to place and de- pend on cost, culture, availability, prefer- ences, ete. Foods to be used for weaning should be available locally, affordable and used frequently in most households. The weaning food must have at least four main ingredients: a staple which may be a cereal; 4 protein souree which ean be derived from plant or animal sources; an energy supple- ment in the form of oil fat or sugar to in. srease caloric content and a vitamin and rineral source usually from fruits and veg- elables. Such a combination is called a “molti-mis” ‘SOME SELECTED LOW-COST SUPPLEMENTARY FOODS AVAILABLE LOCALLY Foods for Infants (4-12 months) Mashed papaya (ripe) or banana Leafy vegetables puree with liver paste Soft cooked egg with rice porridge ‘Soft cooked rice with mashed fish (boiled) ‘Mungo puree (or peanut butter) with soft cooked rice Carrot puree (or yellow camote) with fish or meat broth Yellow squash puree with soft cooked egg yolk Peanut-banana mash Misua soup with beaten eggs Foods for Toddlers (1-4 years) Boiled munggo with leafy vegetables (malunggay leaves, camote leaves, and others) Ripe mango or tesa Fish sinigang with leafy vegetables (kangkong, sitao leaves, ete.) Soy/munggo guisado with leafy vegetables (ampalaya leaves or pepper leaves) ‘ripe (goto) arroz caldo158 PEDIATRICS AND CHILD HEALTH Gulaman with: fruits (bananas, oranges, ‘mango, and others) Foods for Pre-School and School Children (6-12 years) ‘Soy/munggo guinataan ‘Mungo guisado with leafy vegetables (ampalaya leaves, malunggay leaves, camote leaves, ete) oiled munggo/soy with broiled fish and lealy vegetables (pepper leaves, kulitis, of angkong) ‘Turron munggo Boiled munggo-Glutinous rice with grated saconut and sugar Butchi Peanuts, boiled or roasted. Cashew, roasted Chicken arroz ealdo. SIIPPLEMENTARY FEEDING RECIPES. Supplementary Foods for Infants (4-12 months) MunggolRice Porridge ‘U4 cup toasted munggo flour V4 cup toasted ordinary rice our, 2eups water 2 tablespoon brown sugar 1. Blend munggo and rice flour in 1/2 cup of cold water, 2. Bring to a boil remaining 11/2. cups water, 3. Add mixture and stir continuously to pre- vent scorching. 4. Cook for § minutes to a soft custard con- sistency, 5, Serve warm to infants 4 months of age and above. Preparation of Munggo and Rice Flour 1. Toast 1 cup munggo over medium heat for 15 minutes or until golden brown, 2. Pound or grind to afine flour. Set aside. 3. Toast 1 cup ordinary riee over medium heat for 30 minutes or until galden brown. 4, Pound or grind to fine flour, Set aside in clean tightly covered containers. may be sed io dof toating, the beans shoold be beled ati sot, mashed ‘and paased through aarsine te make a poee. Ground or Pounded Peanute 1. Select mature, well dried peanuts. Shell and dry thoroughly. (Do not use any nuts contaminated with mold), 2, Bake or roast peanuts until golden brown. Remove skin 3. Pound or grind the roasted peanut until very fir 4. Place in clean tightly covered containers. 5, Serve to infants 6 months and over. Peanut-Banana Mash Mixture ‘V/A cup toasted peanuts: 14 cup banana (latundan or Inkatan) approximately 1 regular size « 1. Toast peanuts over slow fire until golden brown, 2, Pecl banana and mash smoothly. Blend with the finely ground peanuts. NOTE: Goo! for infnts 4.6 monthe od. For infants elon 4 month, odd Tile bled water or silk ode mitre Small mounts may be served aecrdig Lo the age ofthe infant, Supplementary Foods for Pre-School and School Children (G12 years) Soybean Guinataan 2 cups soybeans cup glutinous rice Leup ordinary rice 9 cups thin coconut milk Leup thick coconut milk 1 1 cups brown sugar 5 cups hot water 1. Toast the scybeans in medium heat for 18 minutes until golden brown, 2. Grind the roasted soybeans to break them into halves, or in the absence of a grinder place toasted soybeans in a winnowing bosket and roll a bottle to break them into halves, Winnow to remove the husks. 3. Extract the milk from the grated. ‘coconut, add 2/3 cup water if the first extract too thick to make 1 cup of coconut milk. Strain and set aside. Repeat the process by adding 8 cups water to measure 9 cups when finished, 4, Place the 9 cups of thin coconut milk in a kettle and bring to simmering point, Add the toasted soybeans and cook until tender.5. When the soybeans are tender add the glitinous and ordinary rice, Stir the mix- ture to prevent scorching. 6. When the mixture thickens, add 5 cups hhot water to dilute 17, When the rice is cooked, add the sugar and cook for 5 more minutes. 8, Serve with the thick coeqnut milk. Munggo-Rice Maya ~ ‘Leup munggo, dried 1enp glutinous rice 4 VR eups water 3/4 cup sugar, brown 1 cup grated coconut (not very mature) 1. Wash rice and put in a kettle with 1122 cups water, Cook for 20 minutes 2, Wash munggo and putin a kettle with 3 ceups water. Cook until soft and of thick consistency. 3, Blend cooked rice and munggo and pack tp to U2.cup fll to mold 4, Put molded mixture on a tray or plate and garnish with grated coconut and sugar. Munggo with Leafy Vegetables 1 cup myngeo, dried ‘5 cups water or rice washings 43 pes. small fish, roiled or fried W2inch square ginger 1 cup malunggay or any other leafy veg- tables 1. Clean and wash munggo 2 Heat 5 cups water or rice wushing. Add rmunggo and bring to boil. Lower the heat and simmer until soft 3, Add fish and ginger. Cook 2 minutes longer. 4, Bring to a boik Add malunggay leaves or any other leafy vegetables. Cook 5 min- utes more. NOTE: Mung wth lay vegetables may be given a3 supplementary fad for ales. ‘Th shave compilation ia by the Nutrion Foun- Anton ofthe Philipines Ine Elizabeth P. Gabriel Perla D, Santos Ocampo . 6, INFANT FEEDING 159 ‘ABC’ of etic nfnt fending, (1972). Clin Peo, 11) ‘Adebonojo PO, (1872) Artifcial beet feeding. Clin. Pediatr, 11:2, ‘ArnilGC Metco, (1985) PoiatricNutrion, Boson: Butterworth, Aly HE, Donald EA, Sinpton MH, (1971), Oral ‘nlracetves and viamin B, metabolism, Am J (lin Nutr, 24297 Baker H, Frank D, Fone 9 el (1964). 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