INFANT FEEDING

Dr. Hossam Mohamed Khalil

Lecturer of pediatrics
:Objectives
• Patterns of Infant Feeding
• Milk production
• Advantages & disadvantages Of Breast Feeding
• Program of Breast Feeding
• Causes of difficult feeding
• Contraindications of breast feeding
• Artificial feeding
• Weaning
:Patterns of Infant Feeding
• Breast feeding from:
-Mother
-Wet nurse (healthy, has a child 2-5 months).
- Breast milk banks ~ not allowed in Egypt.
• Artificial feeding:
- Fresh fluid animal milk.
- Evaporated & condensed milk.
- Dried powdered milk.
• Mixed feeding:
- Complementary feeding.
- Supplementary feeding.
Control of milk production
• Maternal Reflexes:
1. Prolactin (Production) reflex
2. Milk ejection (let down) reflex
Both reflexes are initiated by Suckling of nipple
N.B: Maternal anxiety, stress and fatigue inhibits ejection
reflex.
• Infant Reflexes:
1. Rooting reflex
2. Suckling reflex
3. Swallowing reflex
N.B: Coordinated suckling and swallowing occur in babies
born after 34 weeks
Stages of milk production
A- Breast preparation during pregnancy:
• - Estrogen ~ stimulate duct system.
• - Progesterone ~ stimulate gland system.
B- Initiation of milk flow:
• After delivery prolactin milk secretion.
C- Maintenance of milk flow by:
• 1. Mechanical factors: The chief stimulus which is achieved by:
• -Suckling & Complete and regular evacuation of the breast.
• 2. Good maternal nutrition with plenty of:
• -Sugary fluids, Vitamins B complex & Lactagogues: e.g. Helba.
• 3. Good maternal psychological state and family support.
• 4. Hormonal balance:
• - Prolactin, Growth hormone, Thyroxin & Sex hormone.
• 5. Rooming in (keeping the baby in mothers room).
• 6. Demand feeding (feeding according to the infant desire)
• 7. Avoidance of bottle supplements
Disadvantages of breast milk
1- Breast milk protein Allergy ~ very rare (less than formula).
2- Breast milk jaundice.
3- Deficient Content of:
• *Vitamin K~ bleeding tendency; prevented by giving vitamin K
at birth
• * Vitamin D - risk of rickets .
• * Iron~ risk of iron deficiency anemia
• Both rickets & iron deficiency anemia can be avoided by
supplementing breast fed infant with iron from the 6th month
onwards and vitamin D since birth.
4- Some Drugs are secreted in breast milk.
5- Some viruses are Excreted in breast milk e.g CMV, HIV,
HBV.
Advantages Of Breast Feeding
To the mother
• Help involution of the birth canal and reduce risk of
postpartum hemorrhage.
• Natural method of contraception.
• Reduce the incidence of cancer breast.
• Always available without cost.
• Construct strong psychological bond between the mother
& the infant.
Advantages Of Breast Feeding
To the infant
1. General values of breast milk
• Sterile
• Soothing on the gastrointestinal tract.
• Adequate quantity & quality
• Allergy is extremely rare.
• Constant temperature.
• Colostrum is protective, nutritive and mild
laxative.
Advantages Of Breast Feeding
To the infant

2. Adequate composition than animal milk.

3. Anti-infective properties of breast milk
• Breast milk contain Antibodies
• Anti staph factor
• Anti protozoal
• Bitidus factor
• Anti-inflammatory agents
• Interferon
• Immuno modulating agents
3. Convenient composition for premature:
4. Growth factors & hormones
5. Enzymes: digestive & transport.
 Program of Breast Feeding
Maternal instructions
• Nipple care to avoid retracted nipples.
• Suckling should be initiated as soon as possible.
• No extra fluids except for cooled boiled tap water in 1st
4months.
Technique of nursing:
• Mother sit comfortable.
• Nipples & hands are cleaned.
• Baby held semi sitting.
• Breast held with nipple fitting in baby mouth.
• Both breasts are given.
• After nursing ~ eructate the baby.
 Program of Breast Feeding
Intervals between feeds
• Ideally 3 hours intervals (gastric emptying time)
• 2 hourly feeding for
1st 2 weeks of life.
Premature (weak sucker)
Scanty milk flow.
• 4 hourly feeding for
After the 4th month.
Overweight and strong suckers.
Liberal milk flow.
Program of Breast Feeding
• Adequacy of breast feeding
Maternal causes of difficult feeding
1. Scanty milk supply
2. Milk engorgement
3. Retracted nipples
4. Painful nipples
5. Acute mastitis & breast abscess
6. Work and lactation
7. Contraception and lactation (progesterone pills and
intrauterine device are more suitable)
8. Pregnancy and lactation
9. Twins and lactation
• N.B: Expressed breast milk : Can be stored in freezer for
up to 1 month and in refrigerator for 48 hours
Infant Causes of difficult feeding
1- Congenital anomalies
• Bilateral cleft lip I cleft palate & Macroglossia or micrognathia
2- Painful mouth
• Stomatitis, Oral ulcers & Moniliasis
3- Weak suckling
• Prematurity(< 32 weeks), Sepsis (especially in the neonatal
period), Sleepy infant e.g. Hypothyroidism & Neurologic insult.
4- Nasal obstruction
• Bilateral choanal atresia & rhinorrhea.
5- Dyspneic conditions
• Pulmonary e.g. pneumonia & Cardiac e.g congenital heart
diseases with increased pulmonary blood flow.
Contraindications of breast feeding
Contraindications of breast feeding
II- Infant Causes
• Temporary
1. Breast milk jaundice (withhold for 24-48 hours).
2. Respiratory distress (to avoid aspiration).
3. Very low birth weight(< 1.5kg or< 32 weeks); but can be
fed with expressed breast milk with nasogastric tube.
• Permanent
1. Milk protein allergy
2. Lactose intolerance
 Artificial Feeding
• Indications
1. Complementary feeding (Breast feeds are completed by
bottle feeds) Indicated when breast milk is not enough.
Breast milk should be given first, then the feed is completed
by bottle.
2. Supplementary feeding (some breast feeds are replaced by
bottle feeds) for: working mother, twin delivery (breast and
bottle given to each baby alternatively)
3. Substitutive feeding (all breast feeds are replaced by bottle
feeds)
• Absent breast milk secretion
• Maternal illness: making the mother unfit to feed her baby
• Infant illness: permanent contraindications
 Types of formulas
• Humanized milks – dried powdered milk (Bebelac I)
• Predigested formulas (pregestmil)
• Lactose free milks (LF)
• Hypoallergenic milk (Isomil, HA, FEH, neocate)
• Premature formula (Bebelac premature)
• Phenylalanine free formula (Phenolac)
• Low salt milks
: Number of feeds per day

According to age;
• 0-4 months ~ every 2-3 hours (::::: 8 feeds).
• 5-8 months ~ every 4 hours (::::: 6 feeds).
• 9-12 months ~ every 5 hours (:::::5 feeds).
 weaning
• Definition:
Introduction of semisolid and solid foods besides breast
milk or formula.
• Values:
1. Increase energy, vitamin and mineral density of the diet
to match infant needs that can not be fulfilled by breast
milk alone.
2. Train the gastrointestinal tract and train the baby to use
cup and spoon.
3. Increase social interaction with carers
4. Encourage tongue and jaw movements in preparation
for speech
 Guidelines of WHO for weaning
• Exclusive breast feeding for the 1st 4 - 6 months of life
• Introduce complementary foods from 4 – 6 months while continuing
breast feeding as beyond 6 months there is:
Maturation of digestive enzymes for starchy foods occur
Decline of minerals and vitamin stores (e.g. Iron , zinc, vit D)
Caloric value of breast milk become inadequate.
• Continue frequent on demand breast feeding until 12 - 24 months of
age.
• Safe foods:
Serve foods immediate after preparation
Use clean spoons ,cups & utensils
• Amount:
Foods are introduced once at a time at weekly intervals before new
food is given
Stepwise weaning ; small amount of one food is started and increased
gradually.
 Guidelines of WHO for weaning
• Food consistency:
Start with pureed, mashed and semisolid foods
Gradually increase consistency as the child get older
By 12 months most children can eat family foods
• Feeding manner:
Feed slowly, do not force; many trials may be needed as spitting can
occur.
If feeding refused , try different food combinations, tastes & attractive
presentation.
• Frequency:
Start with 2-3 times per day at 4-6 months then increase gradually
• Feeding during illness:
-Increase fluid intake (frequent breast feeding)
- Give soft , appetizing , favorite foods
- Increase food intake after the illness.
:How to start weaning
• Cereals , pureed rice given first
• Vegetables soups and fruits next
• Followed by strained meats, fish
• Finally egg yolk
• Whole cow milk should not be given below I year while
milk products as
• cheese and yogurt may be used from 9 months onwards.
:Foods to avoid during weaning
• Canned foods
• Salt and spices
• Use of whole cow milk below 1 year
• Excess sugary drinks
• Chocking foods( e.g. nuts, grapes, raw carrots)
• Allergenic foods e.g. Egg white
Problems with weaning
• Allergies: may follow some new foods e.g eggs, .....
• PCM: sudden weaning on starchy foods-- Kwashiorkor
(KWO).
• Colic: especially with excess sugary fluids &early
aggressive weaning.
• Diarrheal disorders: gastroenteritis due to contaminated
foods.
• Dental caries: associated with excess carbohydrates and
bottle feeding.
• Delayed weaning may predispose to: Marasmus, Iron
deficiency anemia & Rickets.
• Some Diseases may manifest during period of
weaning :e.g.- Favism.