Nutrition in fetus and babies

Notes

## Basic introduction

  • Breastfeeding is a gold standard option for babies

## Benefits of breastfeeding a,b,c,d, g, h,,i

  • Infants who are not breastfed are 6-10 times more likely to die in the first months of life than infants who are breastfed.
  • Exclusive breastfeeding protects against common childhood diseases such as:

_Diarrhea

_Acute respiratory infections

_Otitis media

_Haemophilus influenzae meningitis

_UTIs

_ Necrotizing enterocolitis

  • It provides the following long-term health benefits to a child and her/his adulthood,

_Reduced risks of:

||| Obesity

||| Allergies (including asthma)

||| Heart diseases

||| Diabetes

||| Breast cancer

||| Ovarian cancer in women

||| Anaemia in women

||| Postpartum haemorrhage (reduced by breastfeeding soon after delivery)

||| Low cognitive function/intelligence

_Support child spacing

## Anti-infective and bioactive factors in breast milki

  • Secretory immunoglobulin A (sIgA)
  • White blood cells
  • Whey proteins (lysozyme and lactoferrin) which kill pathogenic microorganisms
  • Bile-salt stimulated lipase that facilitates the complete digestion of fat
  • Epidermal Growth Factor (EGF) that stimulates maturation of the lining of the infant’s intestine

## Regulating the marketing of breast milk substitutes:

  • In 1981, the World Health Assembly adopted a resolution WHA34.22 to regulate the marketing of breast milk substitutese
  • This resolution has been adopted by various nations, an example being:

_The Kenyan “National Strategy on Infant and Young Child Feeding 2007 to 2010”a that has formulated the Code of Conduct for the manufacturers and marketer of infants’ formula.

_This Code of Conduct prohibits:

||| Advertising of infant formula to the public

||| Giving free samples to mothers

||| Promotion of products in Health Care Facilities

||| Company representatives to advise mothers

||| Gifts or personal samples to health workers

||| Use of words or pictures idealizing artificial feeding, including pictures on the labels of products

||| Information to health workers should be scientific and factual

||| Use of information on artificial feeding, including the labels, that does not explain the benefits of breastfeeding, and the costs and hazards of artificial feeding

||| Promotion and use of unsuitable products, such as sweetened condensed milk.

||| Manufacturing and marketing of low quality products that do not take into account the climatic and storage conditions of the country where they are used.

## Statistics

  • Globally, breastfeeding prevents about 13% of all deaths of children under 5yrs oldf
  • Also, globally, the right complementary feeding practices are known to reduce the under-5 mortality rate further by 6% (complementary feeds are given when breast milk is no longer enough to meet the nutritional needs of the infant).
  • Globally, it is only about 34.8% of infants who are exclusively breastfed for the first 6 months of life as recommended by WHOh

## Recommended feeding plan for babiesa,g

  • Birth to 6 months:

_Fed strictly on breast milk;

||| The baby needs to be fed as much as the baby is willing to feed

||| Breastfeeding should be > 8 times per day

||| The baby should NOT be fed on other food, milk or even water

  • 6 - 12 months:

||| The baby needs to be breastfed as much as the baby is willing to feed

||| If the baby is not breastfeeding, give 500mL of cow milk daily

Also, introduce the following enriched complementary food:

||| Porridge (uji) mixed with sugar, milk or oil

||| Mashed green vegetables and proteins

||| Mashed fruits or fresh fruit juice

||| In breastfed baby, feed 3 times daily

||| In non-breastfed baby, feed 5 times a day

  • 12 - 24 months:

||| The baby needs to be breastfed as much as the baby is willing to feed

||| In non-breastfed baby, feed 5 times a day with enriched complementary food as presented above

  • The Kenyan “National Strategy on Infant and Young Child Feeding 2007 to 2010”a and Global strategy for infant and young child feedingg:

_Discourages the feeding of babies using breastfeeding bottle and/teats (cup feeding is encouraged)

_Mothers should be shown how to breastfeed at Maternal and Child Health (MCH) services

_Also at MCH, mothers should be encouraged to breastfeed their babies for > 24 months

## Contraindication of breast feeding:

  • Painful and/infective breast diseases/conditions:

_Mastitis

_Breast abscess

_Psychiatric illness (postpartum psychosis and schizophrenia)

  • Medications:

_Antineoplastic agents

_Immunosuppressants

_Amphetamines

_Antithyroid drugs

_Gold salts

_Psychotropic drugs

## Agreed criteria for use of alternatives to mother’s milk include the following situations when the mother is:

  • Not a live
  • Unavoidably absent
  • Very ill
  • Relactating
  • Tests HIV positive and chooses to use a breast milk substitute
  • Rejects infant
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