INFANT AND YOUNG CHILD FEEDING
Dr. Shiva Kumar Shrestha
Senior Consultant Pediatrician
Kanti Children’s Hospital
Nutrition during the first 2 years of life has long implications on the health of a person. Millions of under 5 childhood deaths in the world are often associated with inappropriate feeding practices and occur during the first year of life. In Nepal also, malnutrition is one of the major causes of childhood mortality. Optimal breast-feeding and complementary feeding during this period provide the best nutrition to the child and thus build a strong foundation for a healthy life. Optimal infant and young child feeding is important to alleviate both under nutrition among children as well as diet related chronic diseases like obesity, diabetes, high blood pressure and cardiovascular diseases in later life. Complimentary feeding and HIV and infant feeding are challenging to us. There are several feeding options for babies born to HIV positive mothers including breast-feeding which is known to transmit HIV.
Breast-feeding is the most effective feeding practice in infants especially during first 6 months period of life. Mother’s milk is the most appropriate of all the milks for the infant because it is uniquely adapted to his or her body needs. It contains all the nutrients for normal growth and development of a baby from the time of birth to the first 6 months of life. Breast-feeding should be started within 1 hour of birth.
Exclusive Breast-Feeding: Only breast milk, no other food or drink including water except vitamin drops or syrup and medicines when needed. Expressed breast milk can also be given. Exclusive breast-feeding for first 6 months of life reduces under 5 mortality rate by 13%.
Colostrum: It is the breast milk that is produced in the first few days after delivery. It is thick and yellowish or clear in color. Colostrum is antibody rich like secretory IgA, which protects against infection and allergy. It also contains many white cells which also protects against infection. It also has the property of purgative, contains growth factors and it is also rich in vitamin A.
Breast milk especially colostrum is also called first vaccine to the baby.
There are so many advantages of breast milk and breast-feeding practice which are mentioned below.
Ready to serve
Protects against infection as it contains antibodies and white blood cells
Protects against adult onset diseases (obesity, diabetes, hypertension and cardiovascular diseases)
Helps bonding and development
Helps in adequate growth and development
Enhances brain and visual development
Baby has higher I.Q. and so, more cognitive development
Reduces post delivery bleeding and anemia
Delays next pregnancy
Protects breast and ovarian cancer
Protects obesity and shapes body
Low cost involved
Human resource development
Risk of not Breast-Feeding
Infants who are not breastfed and receive formula milk and other replacement feeds have a 6 fold increased risk of dying in the first 2 months of life, a 4 fold increase between 2-3 months and a 2.5 fold increase between 4-5 months compared with those who are breastfed. Breast-feeding in the first 6 months of life significantly protects against deaths from diarrhea and ARI.
Mother should be calm, comfortable and tension free. Pain, worry, stress and doubt diminish milk production. Baby’s suckling at breast causes prolactin and oxytocin reflex thereby increasing milk production in the breast and milk flow into the baby’s mouth. She should be confident that her breast milk is adequate for her baby. She should have enough food and rest. Contrary to these things will have negative impact on milk production and flow.
Attachment: Signs of good attachment are—
The baby’s chin touches the breast
The mouth is wide open
The lower lip turned outwards
More of the areola above the mouth and less below
Causes of Poor Attachment:
Use of feeding bottle,
Lack of skilled support
Positioning: The mother can take any position that is comfortable to her and
her baby. Signs of good positioning are—
Baby’s head and body in straight line
Baby’s body turned towards the mother
Baby’s body close to mothers
Baby’s whole body must be well supported not just neck or shoulders
Breast Conditions and Problems
There are several common breast conditions which sometimes cause difficulties with breast- feeding:
Flat or inverted nipples and long or big nipples- Flat or inverted nipples can be manually stretched and rolled out several times a day. A breast pump or a 10 ml plastic syringe can be used to draw out the nipple.
Engorgement- Let the baby feed frequently or express the milk
Blocked duct and mastitis- Mastitis may form an abscess. Needs drainage of breast, frequent feeding, massage, warm compresses, antibiotics and analgesics.
Sore nipples and nipple fissure- Attachment should be improved, baby should feed frequently or express the milk. Candida infection should be treated. Breast should be washed only once a day and avoiding using soap, lotions and ointments. Hind milk should be rubbed on areola after feeds.
Infant Feeding and HIV Positive Mother
The epidemic of HIV/AIDS is a challenge on breast-feeding infants in many countries. If the mother is HIV positive, the risk of transmission of HIV during pregnancy, delivery and breast-feeding up to 2 years are 7%, 15% and another 15% respectively. In developing countries there is more risk of death of children if not breast fed than from HIV infection. But in developed countries breast feeding by a HIV positive mother is contraindicated. In our situation every such cases has to be individualized. Proper counseling about breast-feeding options should be done to the parents.
There are several feeding options available including breast-feeding which is known to transmit HIV. Expressed and heat treated breast milk can also be used for infant feeding which will reduce the chance of transmission of HIV.
Delivery should be done in a hospital where antiretroviral therapy Nevirapine 200 mg will be given to mother 4 hours before delivery and the baby 2mg/kg body wt within 72 hours of birth. It is estimated that Nevirapine can reduce HIV transmission by 30-50%.
Complementary food is given to the babies to fill the nutrient gaps. Complementary food is any food or liquid given when breast milk alone is no longer sufficient to meet the nutritional
requirements of infants. Complementary food should be rich in energy and adequate in good quality protein, vitamins and minerals. It should be soft to swallow easily, be safe and locally available. Exclusive breast-feeding for first 6 months of age helps in health and development of young children. However the period of 6 months to 2 years is also of critical importance in child’s growth and development. If emphasis for feeding of these children is not given then malnutrition occurs. Malnutrition in early age may contribute to health problems throughout life including adult onset diseases. Under nourished children do not grow and develop optimally, whatever amount of food they consume later in life. Malnutrition is also associated with micronutrient deficiencies like iron, vitamin A and other nutrients which affect their development. In female children it also affects reproductive functions. Children who do not grow well have increased risk of illness and takes longer time to recover from illness.
Complementary food should be started at 6 months of age 2 times per day 2-3 tablespoonfuls each time. It is increased to 3 times at 7-8 months and the amount gradually increased to 2/3 of a 250 ml cup or katori each time. At 9-11 months 3 meals plus 1 snack containing ¾ of a 250 ml cup or katori and at 12-24 months 3 meals plus 2 snacks of a full 250 ml cup or katori each time is offered. Throughout this period breast-feeding is continued.
Another important thing is we should also think of the mother’s health. She should eat enough food and have adequate rest. She needs more support from her family.