PRINCIPLES OF ARTIFICIAL FEEDING

ByV.Janarthanan Pre-final year, M.B.B.S
Draw attention to the role of the Ten Steps in improving breastfeeding rates.

INDICATIONS
HIV HTLV-1 MOTHER TAKING ANTIMETABOLITE DRUGS MOTHER TAKING THERAPEUTIC DOSES OF RADIO PHARMACEUTICALS MOTHER TAKING DRUGS OF ABUSE

Draw attention to the role of the Ten Steps in improving breastfeeding rates.

OTHER INDICATIONS
‡ "Infectious (contagious) tuberculosis: Breastfeeding is safe after the mother has undergone treatment and is no longer contagious. ‡ Hepatitis A: Breastfeeding is safe after the mother receives a dose of gamma globulin. ‡ Hepatitis B: Breastfeeding is safe after the baby receives a dose of Hepatitis B immune globulin (HBIG). The baby should also be started on the first of three doses of Hepatitis B vaccine. ‡ Herpes simplex: Breastfeeding is safe if there are no lesions on the breast. ‡ Chicken pox: Breastfeeding is safe as soon as the mother is noninfectious, meaning all spots are crusted over. ‡ Lyme disease: Breastfeeding is safe as soon as the mother initiates treatment.
Renew action by health systems, health care providers and communities to make breastfeeding the easy choice for women.

OTHER INDICATIONS
‡ CMV (Cytomegalovirus): Low birth weight premature infants may have problems with CMV in their mother's milk and heat treatment and/or freezing and re-warming may help - very preliminary research on this. ‡ Recommendations are often different in developing countries, where the risk of infant mortality is higher if the baby does not breastfeed. ‡ Although certain prescribed drugs can preclude breastfeeding, the vast majority of moms on meds don't even need to interrupt breastfeeding. ‡ If the mother has a common illnesses such as a cold or flu or mastitis she should continue to breastfeed her infant. Such illnesses are not passed through breast milk and breastfeeding continues to provide immunities to the infant.
Inform people everywhere of the risks of artificial feeding, and the role of breastfeeding for children s development and lifelong health and the health of mothers.

INFANTS NEEDS
‡ ENERGY : 100 kcal/kg body wt./day ‡ PROTEINS : FIRST 6 MONTHS 2g/kg body wt./day END OF 1 YEAR 1.5g/kg body wt./day ‡ 8 10 % energy from proteins ‡ -CHO requirement : 10g/kg body wt./day ‡ After 4 months undiluted, boiled &cooled milk ‡ Frequency : 6 8 times/day (5 times/day : older children) ‡ Increased calorie need during illness
Enable mothers to enjoy full support for breastfeeding in health care systems and beyond.

COMMERCIAL PRODUCTS
‡ Dried milk ‡ Cow s milk ‡ Infant feeding formulas

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

DRIED MILK
‡ ‡ ‡ ‡ ‡ ‡ ‡ Scientifically prepared for infant feeding Free from bacteria Little danger from flies Does not become sour Simple to reconstitute Fortified with vitamins Expensive
2. Train all health care staff in skills necessary to implement this policy.

COW S MILK
‡ Cheaper alternative ‡ Widely used ‡ Diluted milk during first 2 months WHO and Govt. of India recommendation ‡ Hazardous in poor homes - risk of contamination - risk of overdilution
3. Inform all pregnant women about the benefits and management of breastfeeding.

DILUTION
INFANT S WEIGHT

CONSTITUENT
3 COW S MILK (ml) WATER (ml) SUGAR (g) kcal PROTEIN (g) 70 20 5 64 2.1 4 100 20 10 103 3.0 5 150 0 10 135 4.5 6 180 0 10 153 5.4

- PLACE MILK, WATER AND SUGAR IN PAN - BRING TO BOIL AND COOL - POUR INTO FEEDING UTENSIL

Breast milk Vs Cow s milk
CONSTITUENT BREAST MILK (g/l) 11 4 7 3.5 0 1-2 1-2 0.5 COW MILK (g/l) 33 28 5 1.5 -1.8 3.7 0.2-0.5 0.5 Traces

Proteins Casein Soluble proteins Lactalbumin Beta - lacto globulin Lactotransferrin Immunoglobulin Lysozyme

Breast milk Vs Cow s milk
CONSTITUENT BREAST MILK (g/l) COW MILK (g/l)

Non protein nitrogenous substances Lipids Linoleic acid Carbohydrates Lactose Nitrogenous oligosaccharides

0.32

0.32

35 3.5 70 62 8

35 1 50 50 0

Breast milk Vs Cow s milk
CONSTITUENT Minerals Ca P Fe Vitamins C D Energy 60 mg 50 IU 640-720 kcal 2670-3000 kJ 20 mg 25 IU 650 kcal 2717 kJ BREAST MILK (_/l) 2g 0.33 g 0.15 g 0.4-1.5 mg COW MILK (_/l) 8g 1g 1g 0.3-0.5 mg

BREAST MILK - PROTEINS
‡ ‡ ‡ ‡ ‡ ‡ ‡ Lower than in most animals More cystine Less methionine Rich in taurine Immunoglobulins Cow s lactalbumin maybe immunogenic Cow s casein large curdles
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BREAST MILK - FATS
‡ ‡ ‡ ‡ 35-50 % total energy value Essential PUFA are higher Easier to digest and absorb Cow s milk volatile fatty acids produces GIT disorders ‡ Cow milk larger fat globules in emulsion delays gastric emptying and induces digestive upsets (common cause)
. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants. 

BREAST MILK - CARBOHYDRATES

‡ More lactose ‡ Promotes Lactobacillus bifidus growth

6. Give newborn infants no food or drink other than breast milk unless medically indicated.

BREAST MILK - VITAMINS

‡ Vit D as water soluble form ‡ More Vit A & Vit C

7. Practise rooming in - allow mothers and infants to remain together - 2 hours a day. 

BREAST MILK - MINERALS
‡ ‡ ‡ ‡ ‡ Iron has high bio-availability Appropriate zinc and copper Richer in copper, selenium and cobalt Less sodium Calcium/phosphorus ratio is high

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

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