Feeding Practice in Infant and

Young Children

I Gusti Lanang Sidiartha

Spesialis Anak Konsultan Nutrisi dan Penyakit Metabolik
Bagian Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar

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Why feeding practice is

important?
WHO 2002

More than 50% of

under five deaths are
caused by under
nutrition
Over 2/3 of these
deaths are caused
by inappropriate
feeding practices,
especially in the
first year of life.

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Growth faltering by age

Growt
h
falteri
ng
occur
in
earlie
r life

Source:
Shrimpton et al. 2001
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Feeding practice recommendation

by
WHO, 2002
Start breast feeding earlier (within 1 hour after

birth)
Exclusive breastfeeding for 6 months
Start complementary feeding at 6 months with

continued breast feeding until 2 years or beyond

Provide appropriate complementary feeding:
Timely
Adequate
Safe
Properly
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Why breastfeeding ?
Breast milk is the best:
Contains all the nutrients an infant needs

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in the right amounts and in an easily

absorbable form;
Its composition changes as the baby
grows;
Contains growth factors and hormones to
assist development;
Anti infective properties: macrophages,
lymphocytes and polymorphs, secretory
IgA, lysozyme, lactoferrin (inhibits growth
of E. coli), anti-viral agents.

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Human milk vs Cows milk

Compon
ent
Protein
caseins
Fat

Human
milk
1 g/100 g

% of
energy
6

milk

% of
energy

3.4 g/100

21

0.4 g/100 g

2.4

17

3.8 g/100 g

52

2.8 g/100

51

7 g/100 g

42

28

Lactose

0.2 g/100 g

Minerals

66 kcal/100

100

Energy

Cows

3.7 g/100
g

100

4.6 g/100
g
0.8 g/100

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Early initiation of
breastfeeding
The principle is skin to skin contact after

birth
It is done within one hour after birth
It can promote exclusive breastfeeding

and ensure success breastfeeding

it can reduce infant mortality rate by 22%

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Exclusive breastfeeding
Definition:
Giving an infant only breast milk, with the

exception of drops or syrups consisting of

vitamins, mineral supplements or drugs;
No food or drink other than breast milk,
not even water.
WHO recommend for 6 months

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Long term benefits to infant

Reduced risk of atopic
Better dental health
Reduced incidence of later obesity
Improved neurological development
Reduced risk of SIDS (sudden infant

death syndrome)

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Maternal benefits
Reduced risk of premenopausal cancer;
Promotes weight loss after pregnancy;
Lactational amenorrhea
Cheaper, easier more convenient and

portable;
No other equipment to prepare.

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Breast milk always changes

Varies greatly according to:
Hindmilk or foremilk
Duration of lactation (reducing protein

concentration)
Gestational age of baby
Maternal diet

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Fore milk:
rich in prot
and CHO

Hind milk:
rich in fat

Colostrum and Mature Milk

Change during lactation

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The Baby-Friendly Hospital Initiative: ten

steps to successful breastfeeding
(UNICEF & WHO, 1992)

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Dangers of unmodified cows

milk
High renal solute load (RSL):
Hypernatremia
High blood urea and acidaemia
Hyper osmolality
Hypocalcaemia

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When formula milk is used

(contra indications to breast
feeding)
Galactosaemia
Maternal HIV infection
Anti-neoplastic drugs
Tetracycline
Lithium

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Infant formula composition:

The Codex Alimentarius (FAO & WHO)

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 The process of giving an

Complementary
feeding

infant other foods and

liquids along with breast
milk or non human milk
as breast milk alone is
no longer sufficient to
meet the nutritional
requirements
These foods should

complement rather than

replace breast milk

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Complementary Feeding (CF)

Infants are particularly vulnerable during the transition

period when complementary feeding begins. Thus,

foods should be:
Timely: introduced when the need for energy and

nutrients exceeds what can be provided through exclusive

breastfeeding;
Adequate: provide sufficient energy, protein and
micronutrients to meet growing childs nutritional needs;
Safe: hygienically stored and prepared, and fed with
clean hands using clean utensils and not bottles and
teats;
Properly fed: given consistent with a childs signals of
appetite and satiety, and meal frequency and feeding
method should be suitable for age.

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When complementary foods are needed?

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How much energy are needed?

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What kind of main micronutrient are

needed?

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Guiding principles for infant and

young child feeding practices

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Guiding principles for feeding

breastfed and non-breastfed
children, 6-23 months
Breastfed Child

Non Breastfed Child

Introduce complementary Not applicable

foods (CF) at 6 m with
continued breastfeeding;
exclusive breastfeeding
from birth to 6 m
Continue breastfeeding
Not applicable
frequently and ondemand until 24+ months
Not applicable

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Fluid needs:
+400-600 ml/day of fluids
in a temperate climate
+800-1200 ml/day of
fluids in a hot climate 6/1/14

Guiding principles for feeding

breastfed and non-breastfed
children, 6-23 months
Breastfed Child

Non Breastfed Child

Practice responsive
feeding

Practice responsive
feeding

Safely prepare and store

CF

Safely prepare and store

CF

Start with small amounts

of food at 6 m. Increase
quantity of food as child
gets older

Provide adequate
amounts of food.
Increase quantity as child
gets older

Increase food consistency Increase food consistency

and variety as infant gets and variety as infant gets
older
older
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Guiding principles for feeding

breastfed and non-breastfed
children, 6-23 months
Breastfed Child

Non Breastfed Child

Frequency of feeding:
Min # meal/day CF =
- 2-3 for children 6-8 m
- 3-4 for children 9-23 m

Frequency of feeding:
Min # meal/day =
- 4-5 for children 6-8 m
- 4-5 for children 9-23 m

Nutrient content of foods:

feed a variety of:
- meat, poultry, fish or
eggs daily
- Vit A rich fruits and
vegetables daily

Nutrient content of foods:

feed a variety of:
- meat, poultry, fish or
eggs
- Vit A rich fruits and
vegetables
- Milk and milk products
from acceptable
sources

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Guiding principles for feeding

breastfed and non-breastfed
children, 6-23 months
Breastfed Child

Non Breastfed Child

Use vitamin-mineral
supplements or fortified
complementary foods as
needed

Use vitamin-mineral
supplements or fortified
products as needed

During illness: Increase

fluid intake, including
breast milk. Encourage
child to eat.
After illness: increase
amount and frequency of
feeding

During illness: increase

fluid intake. Encourage
child to eat.
After illness: increase
amount and frequency of
feeding

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Disadvantages of adding foods too soon or too

late
Too soon
Decrease the intake

of breast milk
resulting in low
nutrient diet
Increase risk of

illness esp. diarrhea

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Too late

Growth and

development slows
down or stops
Risk of deficiencies

and malnutrition

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How to start complementary feeding?

Iron fortified infant rice cereal as 1 st food
Should be a single food (not combination) nutritious,

smooth texture and thin consistency

Best to offer after feeding some BM or formula, except

who repeatedly no interest offer before

Precautions:
Beets, carrots, spinach and turnips: high in nitrates cause

methemoglobinemia should not be fed babies < 6 months

Honey: may contain C. botulinum, so should not be fed to
infant < 1 year of age
Infant < 1 year should not get whole cows milk: high renal
solute load (Na, K, Cl, protein)

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Exclusive
breastfeeding

Family foods

6
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24

month
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What nextafter 2 years

food rules to children beyond infancy
Scheduling:

Regular mealtimes, only planned

snacks added

Procedures:

Small portions

Mealtimes no longer than 30 min

Solids first, fluids last

Nothing offered between meals

except water

Self-feeding encouraged
as much as possible

Food removed after 10-15

min if child plays without
eating

Meal terminated if child

throws food in anger

Wiping childs mouth and

cleaning up occurs only
after meal is completed

Environment:
Neutral atmosphere (no forcing
of food)
Sheet under chair to catch mess

No game playing

Food never given as reward or

present

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UU Republik Indonesia Nomor 36 Tahun 2009

Tentang Kesehatan

Pas
al
128

Setiap bayi berhak mendapat air susu ibu eksklusif

sejak dilahirkan selama 6 bulan kecuali atas indikasi
medis
Selama pemberian ASI, pihak keluarga, pemerintah,
pemerintah daerah, dan masyarakat harus
mendukung ibu bayi secara penuh dengan
penyediaan waktu dan fasilitas khusus
Penyediaan fasilitas khusus sebagaimana dimaksud
pada ayat (2) diadakan di tempat kerja dan tempat
sarana umum

Pas
al
200

Setiap orang yang dengan sengaja menghalangi

program pemberian ASI eksklusif sebagaimana
dimaksud dalam Pasal 128 ayat (2) dipidana penjara
paling lama 1 tahun dan denda paling banyak 100 juta
rupiah

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Thank you for your

attention

Any question ?
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