Normal Nutrition

®
Program MCPS/MRCGP/CEFM CME ©
Course Pediatrics
Module Nutrition
Topic Breast feeding and supplementary diet
Credit Hours 2 CME credit hour
Total Educational hours 4 educational hours
MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition
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©
Prof. Nasir Shah
MCPS, FCPS, MRCGP [INT], FRCGP [INT]
Dean Family Medicine Faculty, College of Physicians and

Surgeons Pakistan
Convener National Family Medicine Committee of

Pakistan

KHEES: COLOSTRUM OF COW/BAFFALO ®
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HUMAN COLOSTRUM ®
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1. Antibody-rich, many white cells 5. Helps intestine mature; prevents
allergy, intolerance
2. Protects against infection and
allergy 6. Growth factors, Vitamin-A rich
3. Reduces severity of some 7. Prevents vitamin A-related eye
infection (such as measles and diseases
diarrhea)
4. Purgative, Clears meconium 8. Helps prevent jaundice

BREASTFEEDING | ADVANTAGES ®
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1. Encourages a strong bond between mother and baby
2. More convenient than bottle-feeding (warm, sterile)
3. Cheaper than bottle-feeding
4. Decreased postpartum bleeding
5. Protects the baby from infection
6. Decreased childhood obesity
7. Decreased risk of sudden infant death
8. Possible decreased in childhood atopy
BREASTFEEDING: REASONS FOR STOPPING ®

©
1. Lack of awareness, misguidance
2. Educating mother and baby - takes time and patience
3. Lack of support
4. Painful breasts/nipples
5. Concern regarding amount of milk the baby is getting

DIFFICULTY IN BREAST FEEDING ®
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1. Check for positioning
2. Check for attachment
3. Effective suckling
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BREASTFEEDING | IS MILK ENOUGH? ®

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1. Baby satisfied and leaves breast
2. Adequate urine output
3. Adequate growth

BREASTFEEDING | HIV, HBV, HCV ®
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• WHO recommends continuing breastfeeding by mothers
positive for
1. HIV
2. HBV
3. HCV
• Risk of death is higher if not breastfed
HOW TO INCREASE BREASTMILK ®

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1. Start to breast feed early
2. Take 500 calories/day extra
3. Take plenty of water

GALACTOGOGUES ®
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• Interact with dopamine receptors, resulting in increased
prolactin levels
• Metoclopramide remains the galactogogue of choice due to
documented efficacy and safety
• Sulperides and Chlorpromazine have interactions and side
effects
METOCLOPRAMIDE ®
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HERBAL GALACTOGOGUES ®
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• Anecdotal reports
• Lack of concrete evidence
• Culture based
CUMIN SEEDS & ANISEED ®

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• Crushed cumin and aniseed
• Taken with water

CARE FOR THE LACTATING MOTHER ®
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• Ask about mother
1. Milk/calcium intake
2. Water intake
3. Vitamin D intake
MILK IN LACTOSE INTOLERANCE ®

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• Permanent lactose intolerance is rare. Temporary lactose
intolerance is common, usually presents are persistent
diarrhea
• Lactose free formula temporary. But may continue to use it
for long

BREASTFEEDING: HOW LONG TO BREASTFEED ®
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• Preferably from birth until fully weaned or longer
• On demand till 6 months

Up to 6 months
• Exclusive till 6 months
• Scheduled After 6 months

• Supplementary diet after 6 months
SUPPLEMENTARY DIET: MESHED BANANA ®

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SUPPLEMENTARY DIET: RICE ®
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SUPPLEMENTARY DIET: PORRIDGE ®

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SUPPLEMENTARY DIET: MIXED SOFT DIET ®
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SUPPLEMENTARY DIET ®
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• Add one type of food at a time
• Let the child develop taste for that food
• Give diet before breastfeeding when child is hungry
• Don’t worry of the child spits food
• Let him learn how to swallow (breastfeeding is by suction)

FORMULA FEEDING ®
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Cow’s milk formula feeds
• Cow’s milk altered to simulate the composition of human
milk, with added iron and vitamins
• Prepare exactly as the manufacturer directs
• Wash feeding bottles/teats well and sterilize them until
>12mo of age
• Use a cup rather than bottle >6mo
FOLLOW ON FORMULA ®
Follow-on formula ©
• Contains more iron and casein
• Not essential
- Unless a child is not taking solids
- Is > 6 months old
• Baby milk suitable from birth can be used until a switch is

made to normal cow’s milk

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©
UNMODIFIED FRESH COW’S MILK ®

Unmodified cow’s milk ©
• Not recommended until the baby is >1y old
• Less digestible
• Contains little iron

DILUTION OF COW’S MILK? ®
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• Cow milk is not tolerated well without dilution
• Mothers add water
Cow’s milk is already diluted
• Decreases its calories by the milkman…….
• Calcium also diluted
COW’S MILK ALLERGY ®

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Soya protein-based formula
• Not recommended for babies <6mo of age because of
concerns regarding phytoestrogen content
• Prescribe only on consultant advice

GOAT MILK? ®
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• Very deficient in folic acid
• Close to cow’s milk rather than human milk
USE OF NIDO? ®
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• Nido is not recommended under one year of age
• Fortified formula
• Now comes with ALA (Alpha Linolenic Acid)
• Bunyad fortified with iron

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NORMAL NUTRITION ®
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1. Balanced: All 5 food groups
2. Adequate calories for activities and growth
3. Adequate variety to provide all nutrients
4. One year old child may eat with the family

5. Two years old child should eat with the family

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BALANCED DIET ®
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• Balance diet is;
1. Carbohydrate 55 %
2. Fats 20 to 25 %
3. Protein 15 to 20 %

INDIAN THAALI ®
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CHOPRI ROTI ®
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FRENCH TOAST: ®
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PARATHA ®
©

CHURI ®
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PANJIRI ®
©

HALWA ®
©
GAJAR KA HALWA ®
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VERMICILLE ®
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FRENCH FRIES ®
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MIXED DAAL ®
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MIXED BEANS ®
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MIXED BEANS ®
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PALAK GHOSHT ®
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BOILED EGG ®
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Dried Yogurt ®
(Rich Calcium)
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SALAD ®
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HEALTHY CHATNI ®
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FOODS TO AVOID ®
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FOODS TO AVOID ®
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DON’T FORCE FEED ®

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HUNGER TRAINING ®
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HUNGER TRAINING ®
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HUNGER IS THE BEST APPETIZER ®
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HUNGER TRIAL: EMPATHY ®

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• Send you child to school without lunch deliberately
• Ask him not to ask for food
• Ask him how did he feel when he was hungry, and others
were eating

SUMMARY ®
©
1. Promote giving colostrum
2. Promote breastfeeding with correct technique
3. Increase breastmilk production if inadequate
4. Advise calcium vitamin D for the lactating mother
5. Start supplementary diet at 6 months (4 months if FTT)
6. Promote balanced diet
7. Promote food hygiene and hand hygiene
8. Don’t force feed, make the child hungry and introduce new
foods
REFERENCES ®
©
• https://www.nice.org.uk/guidance
• https://www.patient.co.uk
• https://www.aafp.org
• https://www.medscape.com
• https://www.who.int
• Oxford Handbook of General Medicine, 5th edition

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®

Program MCPS/MRCGP/CEFM CME ©

Topic Breast feeding and supplementary diet

Credit Hours 2 CME credit hour

Total Educational hours 4 educational hours

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

Dean Family Medicine Faculty, College of Physicians and

Convener National Family Medicine Committee of

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

BREASTFEEDING: REASONS FOR STOPPING ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

2. Check for attachment

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

BREASTFEEDING | IS MILK ENOUGH? ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

• Risk of death is higher if not breastfed

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

HOW TO INCREASE BREASTMILK ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

CUMIN SEEDS & ANISEED ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MILK IN LACTOSE INTOLERANCE ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

• On demand till 6 months

• Scheduled After 6 months

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

SUPPLEMENTARY DIET: MESHED BANANA ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

SUPPLEMENTARY DIET: PORRIDGE ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

• Baby milk suitable from birth can be used until a switch is

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

UNMODIFIED FRESH COW’S MILK ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

COW’S MILK ALLERGY ®

• Prescribe only on consultant advice

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

4. One year old child may eat with the family

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition

MCPS-MRCGP[INT]-CEFM | Pediatrics | Nutrition | Normal Nutrition