Running head: TOP FEEDING

Interview based report writing Assignment of CHN-II

Topic: Top Feeding

Submitted To: Ma’am Shumaila

Submitted By: Aamina Riaz (BSN-19S-0366)

Abdul Wahab (BSN-19S-0390)

Shifa College of Nursing, H/8, Islamabad.

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INTRODUCTION

Every infant and child has the right to good nutrition according to the “Convention on

the right of the Child” .And during first six month of infant life providing optimal nutrition is

critical as the consequences of inadequate nutrition can be very sever, So for better physical,

mental and psychological growth and development appropriate feeding practise of infants and

children is very foremost. Infants and children are introducing with two main methods of

feeding one is Top the Feeding and other is Breast feeding. Top Feed is the feed anything

apart from breast milk of the mother it include formula milk, cow or buffalo milk, sugar

water etc while breast feeding is the feeding of an infants or young child with breast milk

directly from female human breast via lactation rather than using infant formula from a baby

bottle or container. Mother’s own milk is the best source of infant nutrition. The World

Health Organization recommends that infants should be exclusively breastfed for the first six

month of the life. The American Academy Paediatrics also recommends breastfeeding for at

least 12 months. Globally, only 38% of infants are exclusively breastfed. In the United States,

only 75% of infants initiate breastfeeding from birth; however, by the age of three months,

67%, or 2.7 million, of them rely on infant formula .Among new mothers, the six month “any

breastfeeding” rate for the total U.S. population is 43%, with only 13% meeting the

recommendations to breastfeed exclusively for six month.

SELECTION OF TOPIC

This topic was assigned to us by our teacher. But when we searched and read about

the top feeding then we know its pros and cons and we came on a point that it is an

inappropriate method of feeding. Because it cause many diseases including gastrointestinal

problems, obesity, low immunity, allergy etc. . . . . The main reason to pursue this topic is to

encourage and educate the mother about the advantages of breastfeeding and disadvantages
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of bottle feeding because in Pakistan only 37.7% mothers practise exclusive breastfeeding for

six months.

SIGNIFICANCE

Despite the high cultural acceptance for breastfeeding in Pakistan, the country has the

highest bottle-feeding rate and lowest exclusive breastfeeding rate in South Asia. According

to the Demographic Health Survey, this percentage has risen only from 37.1 per cent in 2006-

07 to 37.7 per cent in 2012-13. However, when it comes to the bottle-feeding race, Pakistan

has no close competitors; bottle-feeding rate has risen from an already undesirable 32.1 per

cent in 2006-07 to an alarmingly high 41 per cent in 2012-13.Newly released joint WHO-

UNICEF report stated that no country in the world full meets the recommended breastfeeding

standards and that only 23 countries, out of 194 nations, have exclusive breastfeeding rates

above 60%. Pakistan stands at 18% for early initiation of breastfeeding. Statistics suggested

that 44% of Pakistan children are stunted. Compliance to to early initiation of breastfeeding;

exclusive breastfeeding and complimentary breastfeeding for 2 years could significantly

reduce stunting in Pakistan. Moreover evidence shows that children who are exclusively

breastfeeding for the first 6 months are 14 times more likely to survive than non-breastfed

children. It also prevent diarrhoea and pneumonia which are major cause of death in infants.

‘Breastfeeding gives babies the best possible start in life’, said Dr Tedros Adhanom.

NUMBER OF CLIENTS:

For data collection, we read different articles related to our topics & then developed a

questionnaire. In that questionnaire there are 30 questions on bottle feeding for example

reason to start bottle feeding, there method of preparation, are their children on bottle feeding

or breastfeeding etc. We filled this questionnaire by selected 25 mothers from Falahi OPD.
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TABLE ANALYSIS OF QUESTIONNAIRE

Questions Option a Option b Option c Option d

1. What’s the age of your 0-1 year 1-2 year >3 years
baby?

100% 25% 55% 20%

2. Which type of feed you give Mother Top feed Goat/co
to your baby? If top feed then feed w milk
100% 26.4% 52% 21.6%
3. Why you give top feed to Mother and Because of
your baby? child disease work
Specify.
100%
4. At which age you started Right after After six After one
top feed to your baby? birth months year
100% 47% 33.3% 19.7%
5. Do you offer any other food Yes No
with top feeding?
If yes then specify
100% 63.3% 36.7%
6. Does your child have any Diarrhoea Vomiting Abdomin Indigestion
gastrointestinal problem? al distension
100% 9.1% 16.6% 11% 63.3%
7. Which top feed does your Goat/cow BF-1 Others
baby takes? If formula feed milk
then
100% 43.3% 31.7% 25
8. Do you know how to Yes No
prepare formula feed?
100% 70.1% 29.9%
9. How do you prepare According to According to By self
formula? Dr. Prescription written
instruction on
formula
100% 32.3% 54% 13.7%
10. Does your child have any Ear problems Respiratory Others No
health problem with formula? (Otitis media) problems
100% 14.3% 29.3% 7.7% 49.7%
11. Does your baby have any Yes No
allergic issue with any type of
formula? If yes then specify.
100% 18.8% 81.2%
12. What practices do you do Wash Wash bottles Others
before preparing formula? hands
100% 44.3% 40.3% 15.4%
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13. Do you know right amount Yes No

of formula to feed your baby?
If yes explain how?
100% 78.9% 21.1%
14. What type of water do you Tap water Filtered water Boil
usually use for the preparation water
of the formula?
100% 10.6% 40% 49.4%
15. Do you add any other Sugar Honey Others nothing
thing beside water in top
feed?
If yes then what?
100% 28.3% 14% 18.1% 39.6%
16. Do you warm top feed Yes No
before use?
100% 82.5% 17.5%
17. How do you warm top In oven Placing the bottle Others
feed? in warm water
100% 13.1% 35.2% 51.7%
18. How do you clean the With hot water Rising with water
bottle? and soap
100% 76.2% 23.8%
19. How many times do you After every Once daily Three times Two times
clean the bottle per day? feed per day per day
100% 42.8% 10.1% 16.1% 31%
20. How much top feed does 120-150ml 180-240ml According to
your baby take in each feed? the weight
100% 100%
21. How do you store At room air In refrigerator
formula/top feed?
21. How do you store At room air In refrigerator
formula/top feed?
100% 100%
22. How long do you keep top 12hrs 24hrs 48hrs No(0hrs
feed in refrigerator? )
100% 33.7% 7% 0% 59.3%
23. Roughly, how often does After every After every 3 After
your baby takes top feed in 24 2 hours hours every 4 hours
hours period?
100% 29% 41.2% 29.8%
24. Approximately how many Two or three Three or four No one
bottles does your baby feed at
night?
100% 5% 7.3% 44% 43.7%
25. What do you do with milk Store it Discard it Others
left in the bottle?
100% 26% 74%
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26. How do you wash bottle With hot water With tap water
after feeding? and soap and soap
100% 76.2% 23.8%
27. Do you know the pros and Yes No
cons of top feeding or bottle
feeding?
100% 32.8% 67.2%
28. Does you increase the Yes No
amount of the top feed with
the child age? If yes then
100% 100%
29. How much feed you According to Others
increase? child need
100% 100%
30. How long did you offer top Until the baby After one year After two
or bottle feeding? discontinue year
100% 78% 12% 10%
31. Is there any change in Yes No
baby’s weight? If yes then how
much weight gain or loss?
100% 56% 44%

Graphic analysis of questionnaire

100 Q1 Q3
90 Q4 Q5
Q6 Q7
80
Q8 Q9
70 Q10 Q11
60 Q12 Q13
Q14 Q15
50
Q16 Q17
40 Q18 Q19
30 Q20 Q21
Q22 Q23
20
Q24 Q25
10 Q26 Q27
0 Q28 Q29
Option A Option B Option C Option D Q30 Q31
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INTEGRATION
We conducted a survey in Shifa Flahi OPD about bottle feeding and after analysis

only 26.4% mother breastfed. 52% mothers give their child top feed and 21.6% give cow

milk.The child with formula and cow milk have different health problems like vomiting

(16.6%), indigestion (63.3%). There is possibility of health issues due to storage of formula

feed according to our analysis 26% mothers store formula milk.

LITERATURE REVIEWS

The bottle feeding ratio differs from country to country, to explain it further we can

take examples of countries like in Nigeria the ratio of bottle feeding is around 15% and in

Iraq that’s almost of 64%. When the mothers were asked for the reasons behind the use of

bottle feeding, they mentioned that because of certain illnesses it was done so. There were

different illnesses mentioned like, Breast problem, insufficiency of mothers’ feed. Unlike the

problems mentioned by the mothers, WHO does recommend mother’s feed in severe diseases

like HIV (Rocha 2002).

Blackburn, G. (2016) studied that was conducted in Kassala in July to September 2017,

exposed that the use of bottle feeding was found in almost of 39% to 40% of the children

involved in the study. Community based study in Kassala showed high usage of bottle-

feeding among mothers with children aged between 6 and 24 months. That was much higher

than the previous study in the same area. If we look at different ratios of bottle feeding in

different countries we can come up with a list like; Sudan 20.5%, Namibia 35.7%, Ethiopia

19.6%, Nigeria 15%, Ghana 30.1%, Yemen 55%, and in Iraq 64%. In all the above

mentioned bottle feeding results, one of the common reason was insufficient mothers’ feed

36/96 (37.5%), hot weather 20/96 (20.8%), maternal illness 14/96 (14.6%), work-related
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issues 12/96 (12.5%), child illness 9/96 (9.4%), and other reasons 5/96 (5.2%). The most

common reason that was mentioned and researched by the researchers was the breast feeding.

Along with above mentioned reasons, Cultural reason were also found in the study.

The mothers feel ashamed to feed their children specifically in a surrounding where they do

not have the privacy (Mahgoub HM 2012).

The American Academy of paediatrics recommends to breastfeed the children till 12

months at least. Along with that the Academy of Nutrition’s and Dietetics explains that the

breastfeeding is one of the major source of natural nutrition’s and protection from many

diseases in the first six months of the children and after that time span the mothers must

include supplementary foods to boost their children’ health. Breastfeeding is not only

inexpensive but also a factor that creates bond between the mothers and infants.

Furthermore it was noted that in United States of America only 38% of the children

were breastfeed and out of that only 75% of the infants start their breastfeeding from birth

and almost after three months they are shifted to unnatural formulas. It was noted that only

13% of the researched mothers recommended breastfeed for six months exclusively.

CONCLUSION

According to our survey and after the analysis of questionnaire which we filled from

25 mothers. Only 8 out of 25 mothers give breast milk to their child and 17 are those who

give top feed to their child. So according to this analysis and on the basis of research articles

we come to a point that less breastfeeding and the use of bottle feeding is the main cause

of childhood health problems like diarrhoea, malnourished and underweight children,

obesity and other health issues. Globally in 2019, 144 million children under 5 were
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estimated to be stunted, 47 million were estimated to be wasted, and 38.3 million were

overweight and obese (WHO).

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Reference

Rocha, N. M. N., Martinez, F. E., & Jorge, S. M. (2002). Cup or Bottle for Preterm Infants: Effects on

Oxygen Saturation, Weight Gain, and Breastfeeding. Journal of Human Lactation, 18(2),

132–138.

Martin, C., Ling, P.-R., & Blackburn, G. (2016). Review of Infant Feeding: Key Features of Breast

Milk and Infant Formula. Nutrients, 8(5), 279. doi:10.3390/nu80502

 UNICEF. Nutrition's lifelong impact. 2016 

 Mahgoub HM, Adam I. Morbidity and mortality of severe malnutrition among Sudanese children in

New Halfa Hospital, Eastern Sudan. Trans R Soc Trop Med Hyg. 2012;106(1):66–

 Onsa ZO, Ahmed NMK. Impact of exclusive breast feeding on the growth of Sudanese children (0-

24 Months) Pakistan J Nutr. 2014;13(2).