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Slide 1: 

Nutrition Update:Infants

Characteristics of Infants : 

Characteristics of Infants Digestion, absorption & metabolism is similar to older children except: Pancreatic amylase deficient until around 4th month Fat absorption is inadequate Stomach acidity is low

Calories : 

Calories Milk : sole source 110-120 Kcal/kg/day = 0-2 mos. 8.5 Kcal/kg = 2-6 mos. 105 Kcal/kg BW = 6-12 mos. Cow’s/Human milk = 67 kcal/100ml Infant formula = 64-72 kcal/100 ml

Calories : 

Calories Reasons for increased need: Rapid growth rate Great heat loss due to large body surface area Activity of the infant

Protein : 

Protein RDA: 6 mos = 2.2 g/kg 12 mos = 2.0 g/kg Human milk = 1.2 gms/100 ml Cow’s milk = 3x more CHON Disadvantage: increase blood urea high renal solute load AA pattern different from human milk

Protein : 

Protein Deficiency: Marasmus Mental retardation irreversible Poor reading/writing skills Less able to grasp knowledge

Carbohydrate : 

Carbohydrate Prevent hypoglycemia & ketosis Lactose: sole source Improves CHON, Ca 2+ & Mg 2+ absorption Provides galactosides: brain & nerve cell formation Laxative Human milk = 42% of total caloric value Cow’s milk = 20%

Fat : 

Fat Must constitute 35-55% of TER Essential fatty acids: linoleic & alpha-linolenic acid (omega 3 series) EFA: retina & brain Ratio of lenoleic to alpha-linolenic : 5-15 Breastmilk = 30-40 mg/ml Cow’s milk = 10-15 mg/ml

Vitamins : 

Vitamins Vit.A RDA is 325 g retinol equivalents Adequate: 850 ml BM w/ 170 IU/100ml Formulas: 750 IU/100 kcal Vit.C Gen low content in both CM & BM BM: 5 mg/ml Vit. C –rich beverages @ 6 mos to get at least 30 mcg daily

Vitamins : 

Vitamins Vit. D Sunlight exposure Thiamine RDA: 0.4 mg/day Riboflavin Same as thiamine Niacin 0.25/100 kcal

Vitamins : 

Vitamins Vit B12 0.5 mcg during 1st 5 mos. Of life Vit. E 1/3 of adult RDA 0.7 IU/100kcal for artificially-fed infants Vit. K All infants: single IM/oral dose ASAP post-partum

Minerals : 

Minerals Iron 0.15-0.2 mg/100 ml 4th month: RDA 15 mg/day Iron fortification of milk formula after 4-6 mos. Calcium BM = 33mg/100ml; Ca:P ratio is 2.3 Milk formula = 1.2 only Phosphorus Intake of infants is quite low

Water & Electrolytes : 

Water & Electrolytes 70-75% of BW Mostly extracellular: prone to dehydration Special attention: fever, polyuria, diarrhea & during hot weather Na+ : K+ not ≥ 1.0 Na+ : K+ = at least 1.5 Cl-

Premature Infant : 

Premature Infant Exteremly rapid growth rate Immature organs e.g. liver, kidneys higher Basal Metabolism: 30-50% more than full-term Small & frequent feedings: parenteral/tubes 120-140 kcal/kg & 3-4 gm CHON/kg BW EAA & ascorbic acid

Premature Infant : 

Premature Infant Vits. = 2x dosage for full terms Ca:P = 2.0 Iron supplements @ 2 mos. = 2 mg/kg/day Milk from own mother: more appropriate than term milk/pooled human milk Pre-term HM = higher CHON, Na,Cl, Mg & Fe content but lower Ca & P content

Factors Affecting Nutritional Status : 

Factors Affecting Nutritional Status Mother’s attributes State of nutrition during pregnancy Feeding pattern Weaning & supplementation Illness BM: rich in long-chain polyunsaturated fatty acids LCPUFA – component of structural lipids in membranes of all organs

Breastfeeding : 

Breastfeeding 3 Ways: Breast,Bottle,Mixed 1st 4-6 mos. BM is sterile Colostrum & Mature milk: anti-viral Thru secretion of interferon Thru direct phagocytosis Thru secretory IgA

Breastmilk : 

Breastmilk Contains antibodies vs. bact 3000x more lysozymes than CM 49% Fe is absorbed vs. 4-10% in MF Easily digested Non-allergenic Beneficial to mother’s health Lactoferrin,Transferrin,Lactoperoxidase system Economical & convenient

Bottle Feeding : 

Bottle Feeding Risk of contamination Prone to over-dilution infective diarrhea nutritional maramus heightened susceptibility to respi. infections Costly Asso. w/ infantile obesity or “protein-calorie malnutrition plus”

Mixed Feeding : 

Mixed Feeding Combination of BM & BF, either one predominating a. Complemental: bottle is given because mother’s milk is insufficient b. Supplemental: bottle is given to replace 1 or more feeding when mother is away for periods longer than feeding intervals; given at 4-6 mos

Breastmilk Substitutes : 

Breastmilk Substitutes Two types a. Whey-adapted b. Casein-predominant Fat mix of infant formula Butterfat w/ vege oil Mixture of vege oils Animal fat (oleo) w/ vege oil

Breastmilk Substitutes : 

Breastmilk Substitutes Infant formula: Starter = one intended to cover all the nutritional needs of the infant during the 1st 6 mos. of life Follow-up = mixed feeding scheme for 6 mos. Onward; higher in CHON, Ca & Fe

Formula Preparation : 

Formula Preparation Aseptic Ingredients & equipment are separately sterilized; Contamination can occur during pouring stage Terminal Formula is poured in clean bottles & sterilized Scum formation possibly can clog nipple holes

Feeding Time : 

Feeding Time Should be regular 2.5-2.7 kg = every 3 hrs 3.6-4 kg = every 4 hrs 2 mos. = baby sleeps thru the night after 10 pm feeding 2-3 mos = 4-5 feeding sched Best clock: baby’s hunger

Feeding Time : 

Feeding Time 6 months & below: As often as the child wants (D & N) At least 8x in 24 hrs Hunger signs: Begins to fuss Sucking fingers Moving the lips

Weaning : 

Weaning Gradual change from an all-milk diet to a diet composed of a variety of foods(6 mos) Early abrupt weaning Maramus Infections kwashiorkor Late weaning PEM Home-made food: multimix = cereal, animal/vege CHON , dark green leafy vege

Supplementary Feeding : 

Supplementary Feeding 6 mos = scraped banana, lugaw, iron-rich foods High-calorie CHON supplements(FNRI): MRCF (monggo-rice-coco flour-fish) Nutri-pak (ground rice, shrimp/dilis, monggo,cooking oil,*skim milk ) Nutri-mix (cereals, MARC, RMS) Commercial: Cerelac/Ceresoy

Supplementary Feeding : 

Supplementary Feeding Teething: chewy foods 7-8 mos = porridge w/ soft cooked egg, boiled fish, mashed liver, peanut- banana mash 9-12 mos = whole tender foods (chopped) 1 yr = 3 meals & in-between feedings 1-2 = same food w/ family but different consistency, texture 7 flavor *Other list of supplementary foods: handouts

Common Disorders : 

Common Disorders Diarrhea Vomiting Constipation Colic Measures: Determine underlying cause Maintain water & electrolyte balance Modify milk formula

Indications of Good Nutrition : 

Indications of Good Nutrition Body weight gain BMI: wt. in kg/ height in m2 MUAC(mid upper arm circumference) Behavioral development Bowel movements Sleeping habits

Indications of Good Nutrition : 

Indications of Good Nutrition Developed motor coordination Well-formed muscles Grave’s study Vigor in any activity Establishes interaction w/ mother at a distance Less irritable

RDA @ 1 year : 

RDA @ 1 year Green leafy = 2 & ½ cups; yellow = 2 tbsp Vit C-rich foods = 2 tbsp Other fruits & vege = 2 tbsp each for both Fat = 2 tsp Meat, fish, poultry = 1 matchbox size Milk = 2 cups

RDA @ 1 year : 

RDA @ 1 year Eggs = ¼ Dried beans = ¼ cup Nuts = 2 tbsp Rice (lugaw) = 2 ½ cups Rootcrops (mashed) = 2 tbsp Sugar = 6 tsp *RDA : pls refer to handouts

Advantages of Breastfeeding : 

Advantages of Breastfeeding Contains exactly needed nutrients Nutrients: more easily absorbed from BM BM protects infants vs. infections BF helps foster close relationship between mother & baby Helps protect mother’s health

NUTRITION IN PRESCHOOL AGE : 

NUTRITION IN PRESCHOOL AGE

Slide 36: 

Early preschool age Toddler 1-3 years old Late preschool age 4-6 years old

RDA by FNRI : 

RDA by FNRI

ENERGY : 

ENERGY 55% - metabolic activities 25% - physical activities 12% - growth needs 9% - fecal loss (90- 100Kcal/kg) FNRI estimate 1350 Kcal/day – 1-3 yr old children 250 Kcal/day – 4-6 yr old children

Protein Energy Malnutrition (PEM) : 

Protein Energy Malnutrition (PEM) Marasmus Kwashiorkor

Protein : 

Protein FAO recommendation - 1.5- 2g/kg body wt. Deficiency symptoms Retarded growth Anemia Pigmentary changes of hair and skin Edema (kwashiorkor)

Vitamins : 

Vitamins vitamin A vitamin C vitamin B1 vitamin B2

Minerals : 

Minerals Calcium and iron Trace elements - iodine - fluoride -zinc Zinc deficiency Dwarfism Retarded sexual development

TYPES OF AT- RISK FACTOR : 

TYPES OF AT- RISK FACTOR BIOLOGICAL Mother Young child ENVIRONMENTAL Cultural Socio- economic Geographic- climactic Miscellaneous EARLY WARNING SIGNALS Community Individual

Reasons for nutritional vulnerability : 

Reasons for nutritional vulnerability His mother may have another baby to whom she lavishes more attention He gets a small share of whatever food is on the table in proportion to his size He may choose from a common dish at the table foods that are not Nutritionally protective The previous major source of his protein intake in which is breast milk maybe suddenly withdrawn from him because mother is pregnant Mother may go back to work and he is left in the care of others

Food Recommended : 

Food Recommended

SCHOOLCHILD : 

SCHOOLCHILD

CHARACTERISTICS : 

CHARACTERISTICS Between 7 and 12 years Slow steady growth Increase body proportions Enhanced mental capabilities More motor coordination Body reserves are being laid down in preparation for the increased needs during the adolescent stage Growth rates vary within this period

NUTRIENT ALLOWANCES : 

NUTRIENT ALLOWANCES His nutritional needs differ from that of an adult on the ff. points He is actively growing (girls at prepuberty stage experiences Spurts of growth) He is constantly active He is changeable in his attitudes towards food He cannot afford to eat foods poor in essential nutrients RDA classification of Filipino school children 7 – 9 years old 10 – 12 years old / pre- adolescence

FEEDING THE SCHOOL CHILD : 

FEEDING THE SCHOOL CHILD Psychological factors Let him feel responsible for his own well-being Make him accountable for his diet Parents should take time out and spend time with the children “ A HAPPY CHILD IS A HEALTHY CHILD”

Slide 51: 

Goals of School feeding programs To improve the nutrition of school children by furnishing them wholesome food at the lowest possible cost To aid in strengthening the nutrition and health education program of the public schools To foster proper eating habits 3. Food Preference 2. School environment

FEEDING PROBLEMS : 

FEEDING PROBLEMS Inadequate meals Poor appetite Sweet tooth Fast foods

INDICATIONS OF GOOD NUTRITION : 

INDICATIONS OF GOOD NUTRITION Clinical examination EENT test SE UA PE Dietary analysis Diet history/food record General Eating habits Nutrient intake 3. Anthropometric examination Weight-for-age Height-for-age Weight-for-height

FOODS TO BE INCLUDED DAILY : 

FOODS TO BE INCLUDED DAILY

Slide 58: 

Milk Ejection Reflex The milk ejection reflex actually is a neuroendocrine reflex. The reflex has an afferent pathway (neural) and an efferent pathway (hormonal, blood-borne). Afferent Pathway: The greatest amount of innervation in the mammary gland is in the teats, where there are pressure sensitive receptors in the dermis. Mechanical stimulation of the teats activates pressure sensitive receptors in the dermis where the pressure is transformed into nerve impulses which travel via the spinothalamic nerve tract to the brain. The nerves synapse in the paraventricular and supraoptic nuclei in the hypothalamus. [A cluster of nerve cells in the brain is often called a nucleus. This is different from the nucleus of a single cell.] Hypothalamic Nuclei and Oxytocin Synthesis Neurons in these hypothalamic nuclei synthesize the oxytocin precursor and package it into vesicles. Oxytocin (an 9 aa peptide) is initially synthesized as a large molecular weight precursor which also contains the oxytocin-carrier peptide neurophysin. The precursor is proteolytically cleaved in the vesicle to yield oxytocin bound to neurophysin. The oxytocin-neurophysin complex is the intracellular storage form of oxytocin. The oxytocin-containing vesicles are transported from the cell body (which is in the hypothalamus), down the axons to the neuron endings in the posterior pituitary. [This is called the hypothalamo-neurohypophysial tract.] The oxytocin-neurophysin is stored in neurosecretory granules called herring bodies in the axon ending. The synthesis of oxytocin in the cell bodies and its transport to the axon endings occur separately from the milk ejection reflex. When the cell bodies of the oxytocin-containing neurons are stimulated by impulses originating in the teat, an action potential moves down the axon to the neuron ending in the posterior pituitary, causing release of oxytocin and neurophysin (no longer bound together) into the blood. The efferent pathway starts at this point. Efferent Pathway: The efferent pathway begins with the release of oxytocin into the blood. The oxytocin then travels to the mammary gland via the blood, binds to oxytocin receptors on the myoepithelial cells, causing them to contract, and resulting in increased intra-lumenal (intramammary) pressure and ejection of milk from the alveolar lumen. Oxytocin receptors are associated with the myoepithelial cells, not the smooth muscle of the mammary gland. In mice these receptors increase through-out gestation, but are fairly constant through lactation. (see Soloff, 1982, J. Dairy Sci. 65:326)

Outline : 

Outline Breast milk vs. infant formula Introducing solid foods Feeding infants safely Fruit juice debate Introducing fluid cow milk

Breastfeeding : 

Breastfeeding Benefits to mother and child WIC gives extra food to breastfeeding mothers How can we help new mothers? encouragement education Breastfeeding is BEST during the first year of life.

Formula Feeding : 

Formula Feeding WIC infant formula package less food for moms and their families Mead Johnson formula can size changes one less can per month issued through WIC Enfamil Lipil and Similac Advance addition of two fatty acids: ARA & DHA mixed study results higher costs

Introducing Solid Foods : 

Introducing Solid Foods Supplement - NOT replacement for breast milk or formula. Introduce when developmentally ready sit up with support, hold head steady, draw in lower lip infants reach age 4 to 6 months Timing risks to early and late introduction order of food groups Developmental readiness, NOT age, determines when to introduce solid foods.

Feeding Baby Safely : 

Feeding Baby Safely Guard against choking hazards hot dogs, soft bread, grapes, hard candies Beware these ingredients honey, salt, sugar home cooked beets, carrots, spinach, turnips, collards Prevent food borne illnesses no unpasteurized fruit juices Feeding foods safely is the Number 1 priority.

Homemade Baby Food : 

Homemade Baby Food Homemade baby foods are popular Food safety is critical preparation and storage What are the pros and cons of feeding baby homemade baby foods vs. commercial?

Comparing Costs : 

Comparing Costs What is the cost of convenience? How much is your time worth?

Food Allergies : 

Food Allergies Result in immunologic reactions Caused by common foods eggs, milk, peanut, soy, wheat, fish, tree nuts, shellfish Lead to diarrhea, vomiting, wheezing, anaphylactic shock, abdominal pain, gas, hives, skin rashes Can be avoided (at least in part) slowly introduce new foods delay introduction of common food allergens until at least 1 year of age, longer depending on allergen

Fruit Juice : 

Fruit Juice Too much of a good thing? Nutrient density and displacement of nutrients Diarrhea Dental cavities Know the limits  8 oz diluted 100% fruit juice (4 oz fruit juice and 4 oz water)

Feeding Infants Cow Milk : 

Feeding Infants Cow Milk Not recommended during the first year. Fluid cow milk consumption can lead to: GI bleeding Iron deficiency Displacement of nutrients Other dairy products  at 8 months Yogurt and cheese

Conclusion : 

Conclusion Breastfeeding is best for infants and should be avidly supported by nutrition educators. Developmental readiness determines when to introduce solid foods. Feeding infants safely should be a top priority. App 10-24-02

Which Infant Formula? : 

Which Infant Formula?

Feed Choices : 

Feed Choices

Specialised Formulas : 

Specialised Formulas

COT report on phytoestrogens : 

COT report on phytoestrogens March 2003 ‘the Working Group note the advice by the Department of Health based on 1996 COT advice. This stated that breast and cows’ milk formulae are the preferred sources of nutrition for infants. However, women who have been advised by their doctor or other health professionals to feed their baby soy-based infant formulae should continue to do so. In the light of new data presented in this report, which was unavailable in 1996, the Working Group recommend that the current advice be amended to state that soy based infant formulae to be fed to infants only when clinically indicated. The Working Group note that similar advice has been issued in other countries (e.g. NZ, Australia)

Soya Formula : 

Soya Formula Risks an infant receiving soya based infant formulae as a sole source of nutrition between the ages of 4-6 months will consume approx. 4mg isoflavins/kg bodywt/day Studies show upto 36% of infants given soya formulas for the management of Cows’ Milk Protein Allergy manifest symptoms of soya protein allergy. Recent concerns of an increased peanut allergy in infants fed soya based infant formula give further support to delaying exposure to soya

CMO Statement on Soya Based Formula. jan.2004 : 

CMO Statement on Soya Based Formula. jan.2004 Soya based formulas should not be the first choice for the management of infants with proven cows’ milk sensitivity Soya based formulas should only be used in exceptional circumstances Infants with cows’ milk allergy/intolerance who refuse extensively hydrolysed/elemental formula Vegan mothers Galactosaemia Hydrolysed formulas should be used as first choice

Protein breakdown of formula : 

Protein breakdown of formula

Amino Acid Formula : 

Amino Acid Formula Only true ‘allergen free’ formula Hydrolysate intolerance occurs Atopy presenting during exclusive breast feeding (especially when FTT) improves on a.a. formula Multiple food allergy or hydrolysate/breast milk intolerance.

Genetic Predisposition : 

Genetic Predisposition

Beneficial Effects of Breast Feeding : 

Beneficial Effects of Breast Feeding Sarrinen and Kayosaari 95 Greatest protection against atopic disease – exclusive BF 1 -6 months Joint statement of ESPACI and ESPGHAN (Arch. Dis Child. 96) ‘exclusive breast feeding during the first 4 -6 months of life might greatly reduce the incidence of allergic manifestations and is strongly recommended.’

Evidence for use of eHF as allergy prophylaxis : 

Evidence for use of eHF as allergy prophylaxis Oldeaus 97 155 infants with FH allergy No cows milk 9/12, fish/egg/citrus 12/12, weaning 4/12 At weaning – pHF, eHF, CMF Atopic symptoms at 18/12 = 81% (CMF) 66%(pHF), 51%(eHF)

Evidence for use of pHF as allergy prophylaxis : 

Evidence for use of pHF as allergy prophylaxis Chandra 97 288 high risk infants CMF, SF, pHF Cumulative incidence of atopy (eczema, wheeze, rhinitis, otitus media, vomiting, diarrhoea, colic) % culmulative allergy = pHF 7% CMF 36% SF 37% BF 20%

Strategies for Reducing Allergy Development Risk in Babies : 

Strategies for Reducing Allergy Development Risk in Babies

Strategies for Reducing Allergy Development Risk in Babies : 

Strategies for Reducing Allergy Development Risk in Babies

Strategies for Reducing Allergy Development Risk in Babies : 

Strategies for Reducing Allergy Development Risk in Babies

Dietary Guidelines for Allergy Prevention : 

Dietary Guidelines for Allergy Prevention Muraro et al Pediatr Allergy Immunol 2004 Mothers should aim to breast feed exclusively for 6 months (but at least 4 months) If mothers cannot breast feed or choose not to, they should use an extensively hydrolysed formula until 4 months of age. Partially hydrolysed whey formula may have an effect in terms of allergy prevention, although seems less than the effects of eHF.

Allergy Prevention : 

Allergy Prevention Palatability Cost/presribability Ethnic acceptance (pork enzyme) Motivation of mother Conflicting advice from health professionals/relatives/friends Infant ailments attributed to special formula

Benefits of Healthy Gut Flora : 

Benefits of Healthy Gut Flora Infants with a healthy gut flora (i.e. one dominated by beneficial bacteria, such as Bifidobacterium and/or Lactobaccillus) have reduced risk of infection, disease and later development of food allergy. Decreased prevalence of eczema in high risk infants given probiotics/lactobacillus. Certain species of gut bacteria down regulate inflammation

Immunological Factors: Non Breast Milk Sources : 

Immunological Factors: Non Breast Milk Sources LCPs and Nucleotides are added to all standard whey based formulas – important in the development of inflammatory chemicals and development of the infants adaptive immune response. Prebiotics (in the form of oligosaccharides) Promotes the development of microbial flora similar to that of breast-fed infants (namely, one that is bifidobacteria-dominant)

Other Infant Formulas : 

Other Infant Formulas Soya formula – Wysoy, Infasoy Low lactose formula – SMA LF, Omneocomfort (C&G), Enfamil Lactofree. Thickened formula – SMA Staydown, Enfamil AR, Omneocomfort

Achieving Optimal Infant and Young Child Feeding: A Global Responsibility : 

Achieving Optimal Infant and Young Child Feeding: A Global Responsibility

Slide 91: 

Before this year is over, 10.9 million of the world’s children < 5 years of age will die of conditions that would be largely prevented by Optimal Infant and Young Child Feeding . Before this day is over 3,500 children will be lost from such causes.

Slide 92: 

Optimal Infant and Young Child Feeding Gestation Family foods Special Transitional foods Maternal Nutrition and Health Fetal Nutrition and Health B ? ? B 2-7 you C Adapted by Wellstart from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding Complementary feeding (weaning) © Infant and Young Child Nutrition 6 mo

REPRODUCTIVE SUCCESS : 

REPRODUCTIVE SUCCESS Individual Reaching reproductive maturity in optimal mental and physical health, able to have children and participate in any and all of life’s opportunities. Species Continuing to reproduce generation after generation

MAMMALIAN REPRODUCTIVE SUCCESS Five Basic Components : 

MAMMALIAN REPRODUCTIVE SUCCESS Five Basic Components Conception Gestation Parturition Lactation/Breastfeeding Weaning

Slide 95: 

Hypothermia Infections Abuse Starvation Abandonment Accidents B Newborn Adult NEONATAL RISKS TO REPRODUCTIVE SUCCESS

MATERNAL/FETAL AND INFANT IMMUNOGLOBULINS : 

MATERNAL/FETAL AND INFANT IMMUNOGLOBULINS

Maturation of Immune Factors in the Human Infant : 

Maturation of Immune Factors in the Human Infant Factor Secretory IgA Full antibody repertoire Lysozyme Memory T Cells Age of Maturation 4 to 12 months 24 months 1 to 2 years 2 years

Slide 98: 

DIARRHEAL ILLNESS AMONG BREASTFED and FORMULA FED INFANTS Adapted from: Dewey et al (1995): 699-700 % Days ill % Days ill OTITIS MEDIA AMONG BREASTFED and FORMULA FED INFANTS

Slide 99: 

Optimal Infant and Young Child Feeding Gestation Family foods Special Transitional foods Maternal Nutrition and Health Fetal Nutrition and Health B ? ? B ? ? C Adapted by Wellstart from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding Complementary feeding (weaning) © Infant and Young Child Nutrition

Exclusive Breastfeeding : 

Exclusive Breastfeeding All fluid, energy, and nutrients are provided by breastmilk, with the exception of small amounts of medicinal supplements.

Slide 101: 

Optimal Infant and Young Child Feeding Gestation Family foods Special Transitional foods Maternal Nutrition and Health Fetal Nutrition and Health B ? ? B ? C Adapted by Wellstart from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding Complementary feeding (weaning) © Infant and Young Child Nutrition 6 mo

Complementary Feeding:“the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk” PAHO/WHO 2003 : 

Complementary Feeding:“the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk” PAHO/WHO 2003

Weaning : 

Weaning The process of introducing breast milk substitutes and/or complementary foods thereby decreasing lactation stimulation and milk production and eventually ending lactation and breastfeeding.

Weaning: : 

Weaning: When should it begin?

Slide 105: 

Kidneys GI Tract Psycho- Social Brain Metabolic Organs Immune System Oral Motor Infant Development and Readiness to Begin Weaning Cardio- Vascular

Conditions for which non-optimally fed infants and young children are likely be at an increased risk: : 

Conditions for which non-optimally fed infants and young children are likely be at an increased risk: Diarrhea/gastoenteritis Serious Respiratory Infections Recurrent Ear Infections Obesity Type I Diabetes Allergic disorders Childhood Leukemia and lymphoma SIDS NEC Lowered IQ Chronic GI Tract disorders Mortality between 28 days and 1 year of age

Optimal Infant Feeding and Maternal Health : 

Optimal Infant Feeding and Maternal Health

Premature Weaning Increases Mother’s Risks of: : 

Premature Weaning Increases Mother’s Risks of: 1. Excessive postpartum bleeding, 2. Shortened period of infertility and amenorrhea, 3. Anemia, 4. Osteoporosis, 5. Postpartum depression 6. Obesity, 7. Breast and ovarian CA, 8. Dysfunctional Maternal Behavior

Six Months of Exclusive Breastfeeding is Now the Goal of the: : 

Six Months of Exclusive Breastfeeding is Now the Goal of the: The World Health Organization US Department of Health and Human Services and the USDA WIC Program AAP ACOG AAFP ANA IPA

Slide 110: 

Optimal Infant and Young Child Feeding Gestation Family foods Special Transitional foods Maternal Nutrition and Health Fetal Nutrition and Health B ? ? B ? C Adapted by Wellstart from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding Complementary feeding (weaning) © Infant and Young Child Nutrition 6 mo

Weaning: When should Breastfeeding End? : 

Weaning: When should Breastfeeding End?

Benefits of Extended Breastfeeding : 

Benefits of Extended Breastfeeding Breast milk provides one-third to two thirds of the average total energy intake in the latter part of the first year; is an important source of essential fatty acids.

Benefits of Extended Breastfeeding (cont.) : 

Benefits of Extended Breastfeeding (cont.) provides significant amounts of vitamin A and pro vitamin A carotenoids as well as calcium and riboflavin. Morbidity and mortality rates remain lower in children who are breastfeeding into their second and third year.

Slide 114: 

DIARRHEAL ILLNESS AMONG BREASTFED and FORMULA FED INFANTS Adapted from: Dewey et al (1995): 699-700 % Days ill % Days ill OTITIS MEDIA AMONG BREASTFED and FORMULA FED INFANTS

When illness does occur, children will usually continue to breastfeed in spite of an otherwise diminished appetite. Though not as complete, the infertility effect continues resulting in increasing birth intervals.

Weaning: When should Breastfeeding End? : 

Weaning: When should Breastfeeding End? WHO (1995): “up to two years of age and beyond while receiving nutritionally adequate and safe complementary foods”

American Academy of Pediatrics “There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer” AAP Policy Statement (2005). Pediatrics,115:2; 496-506

Slide 118: 

Optimal Infant and Young Child Feeding Gestation Family foods Special Transitional foods Maternal Nutrition and Health Fetal Nutrition and Health B ? ? B 2-7 you C Adapted by Wellstart from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding Complementary feeding (weaning) © Infant and Young Child Nutrition 6 mo

MATERNAL/FETAL AND INFANT IMMUNOGLOBULINS : 

MATERNAL/FETAL AND INFANT IMMUNOGLOBULINS Breastmilk?

Slide 120: 

Before this year is over, 10.9 million of the world’s children < 5 years of age will die of conditions that would be largely prevented by Optimal Infant and Young Child Feeding . Before this day is over 3,500 children will be lost from such causes.

Is it really possible to promote Optimal Infant and Young Child Feeding in the 21st Century?

b : 

b Yes!!!

Developing Lactation and Maintaining Milk Production Depends On: : 

Developing Lactation and Maintaining Milk Production Depends On: Early and recurrent stimulation of the neuro-endocrine system (lactation reflexes) Frequent and effective removal of milk Lactation is baby driven!

Slide 124: 

Frequent and Effective Milk removal

Slide 125: 

The Ten Steps of the Baby Friendly Hospital Initiative Supported by WHO, UNICEF, USAID, USDA

Slide 127: 

Before this year is over, 10.9 million of the world’s children < 5 years of age will die of conditions that would be largely prevented by Optimal Infant and Young Child Feeding . Before this day is over 3,500 children will be lost from such causes.

Slide 129: 

Optimal Infant and Young Child Feeding Gestation Family foods Special Transitional foods Maternal Nutrition and Health Fetal Nutrition and Health B ? ? B 2-7 you C Adapted by Wellstart from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding Complementary feeding (weaning) © Infant and Young Child Nutrition 6 mo

Slide 130: 

Babies are born to be breastfed. It’s too important not to!

There is always more to come!Thank you : 

There is always more to come!Thank you

Thank You! : 

Thank You!

Jump to a Healthy Start : 

Jump to a Healthy Start

Overview of session: : 

Overview of session: Benefits of breastfeeding Role of childcare providers in support Healthy nutrition habits for infants, toddlers and preschoolers Role of childcare providers in support Child Care Champions

Breastfeeding benefits: : 

Breastfeeding benefits: Excellent nutrition source DHA and ARA—developmental aids Provides more bioavailable source of iron Immunological advantages—diarrhea, URI’s, ear infections Promotes bonding

Breastfeeding benefits: : 

Breastfeeding benefits: Breastfeeding may help in obesity prevention, through effects on protein intake, insulin secretion, fat cell development and fat deposition (Dewey, Harder) Breastfeeding promotes self-regulation of appetite Breastfeeding moms may have less restrictive feeding practices (Taveras et al) Prolonged breastfeeding may additionally reduce obesity

Breastfeeding and obesity: : 

Breastfeeding and obesity: Breastfed infants leaner at 12 months than formula fed infants (Dewey et al) Infants exclusively breastfed for 3-5 mon. were 35% less likely to be obese at time of school entrance (Von Kries et al) In Native American children, breastfeeding may decrease development of Type 2 DM More on your role later…

Getting off to the right start: infants : 

Getting off to the right start: infants Calorie needs are highest in infancy; met w/milk Respect hunger and satiety cues Delay introduction of complimentary foods (juice, cereal) till 6 months Juice—≤4 oz/day of 100% juice; work towards mashed whole fruit after 6-9 months; juice in a cup, not in bottle Cereal: 1 T/2 oz breastmilk or formula; 1-2 times a day; not in bottle Milk: whole for 1st 2 years; 24 oz a day by 12 months

Baby and table foods: : 

Baby and table foods: Evaluate infant’s readiness for solids Begin with vegetables, then fruits, then meats No more than 1 new food every 3-5 days 1 tsp at first, then move up to 2 and beyond; maximum of 5 T. of any one item after age of 12 months, 1 tablespoon/year of age of any one food is a serving --ex. 1.5 tablespoon carrots, 1.5 T chicken, 1.5 T green beans for 18 mon old

Table foods: : 

Table foods: Mashed up and appropriate consistency for baby’s age, abilities and #teeth Sit at family table, no TV Respect satiety cues Know parent’s and child’s jobs (Satter): “It is the parent’s responsibility to provide a variety of healthy foods. It is the child’s responsibility to decide whether they are going to eat and how much to eat.”

Model the right plate: : 

Model the right plate: Make it colorful—eat the rainbow www.5aday.com 2/3 vegetables, fruit, whole grains, beans 1/3 protein source

Eating out: : 

Eating out: Eat at home as often as possible Teach children about correct portion sizes, “Mighty Kids” meals too big for anyone! Avoid supersizing yourself—model Avoid “all you can eat” buffets

Eating and behavior: : 

Eating and behavior: Being a good role model is #1 Do not use food as a reward or withhold treats as a punishment—these elevate the position of food in the child’s mind Instead, reward with time spent with caregiver Do not refer to certain foods as good or bad Do not over-regulate child’s eating

Child’s self-regulation:Park et al, 1994 : 

Child’s self-regulation:Park et al, 1994

Caregivers as interactive partners: : 

Caregivers as interactive partners: Caregivers transmit messages and values about eating and food by their interaction with their children By your words and actions, children will learn what foods are healthy “Junk” foods—mixed message if you say they’re junk food but then eat them Caregivers’ attempts to lose weight, preoccupation with food or body may lead to same in child (Thelen, Stice et al, Francis et al)

Caregivers as direct instructors: : 

Caregivers as direct instructors: Show children how to choose healthy foods in grocery store, at restaurant Reinforce children for making healthy choices If you overeat or exhibit “out of control” eating, they may, too (Cutting et al)

Caregivers as providers of opportunities: : 

Caregivers as providers of opportunities: Limiting intake of and/or access to foods of lower nutritional value Providing healthy food choices Children have natural preference for sugar, salt and fat Caregivers may respond with controlling feeding strategies—either to restrict or to pressure child to eat

Parents as direct instructors, cont: : 

Parents as direct instructors, cont: This promotes further problems Disordered eating Enticement of the “forbidden” Overweight in child may result, esp. girls Too much food presented decreases child’s ability to self-regulate, encourages overeating (Birch, Rolls et al) Appropriate portion size is important

Picky eaters: : 

Picky eaters: Research demonstrates that it takes 10-15 times of offering a new food before an infant or toddler makes a decision Try, try and try again Make new food the 1st food toddler tries Eat it yourself, talk positively about it Allow preschoolers to help choose and prepare new foods

Toddler and preschooler eating habits: : 

Toddler and preschooler eating habits: Growth rate slows after 12 months, so they do not need as many calories to grow 100-120 cals/kg of body weight in 1st year ~100 cals/kg of body weight from 2-3 yrs 90 cals/kg of body weight from 4-6 years They don’t need as many calories as they did when they were infants Make the calories they do need healthy

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Toddler/preschooler diet: : 

Toddler/preschooler diet: One tablespoon/year of age is a serving of any one food item Switch to lowfat or skim milk at age 2 3 meals and 2 snacks a day Same diet as is recommended for adults is recommended for kids 2 and older (<30% of calories from fat, <10% from sat. fat) www.mypyramid.gov

Eating habits of young children: What do we know?J Amer Diet Assn 1/04; Vol. 104 Number 1 : 

Eating habits of young children: What do we know?J Amer Diet Assn 1/04; Vol. 104 Number 1 Gerber-sponsored “Feeding Infants and Toddlers” Study or FITS 30% of infants have solid food introduced before the recommended 4-6 months of age 31% of toddlers ages 12-24 months have a mean energy intake exceeding their estimated mean energy requirement Intake of “adult” high energy density/low nutritional value foods is prevalent among toddlers

FITS Highlights, cont: : 

FITS Highlights, cont: 18-33% of 7-24 month olds consume no servings of vegetables, and 23-33% consume no fruits French fries are the most commonly consumed vegetable beginning at 15 months of age

FITS Highlights, cont: : 

FITS Highlights, cont: ~50% of 7-8 month olds consume some type of dessert, sweet or sweetened beverage Infants and toddlers in WIC are more likely to consume 100% fruit juice (vs. whole fruit), desserts, sweets and fruit drinks than their non-WIC peers

Eating habits of young children: Why do we care? : 

Eating habits of young children: Why do we care? Rapid infant weight gain is associated with increased risk of being overweight at age 4 (Guo) Mothers of overweight young children are unlikely to view their child as such (Baughcum et al) Restrictive parental feeding practices are associated with increased child eating and weight status (Birch, Fisher)

Most children do not “outgrow” extra weight: : 

Most children do not “outgrow” extra weight: Children who are at-risk for overweight or overweight at any time during the preschool years are more than 5 times more likely than their peers to be overweight 12 year olds (Nader et al) >75% of overweight and obese 10-15 year olds will become obese adults (Whitaker et al)

Childhood obesity affects more than looks: : 

Childhood obesity affects more than looks: Many medical complications --cardiovascular --endocrine --pulmonary --orthopedic --liver

Childhood obesity complications, cont: : 

Childhood obesity complications, cont: Psychosocial complications most common --poor self-esteem --decreased quality of life --depression --teasing and bullying Children prefer normal weight peers to be their friends more often, even at age 5

Role of early child care professionals: : 

Role of early child care professionals: Child Care Champions Best Practices CO Physical Activity and Nutrition/ CO Dept. of Health document 7 “Best Practices” for prevention of childhood overweight Goals which are attainable, realistic and proven to be effective

#1: Model healthy eating behaviors : 

#1: Model healthy eating behaviors When you eat the same foods as the children you serve, you are saying, “Do as I do” rather than “Do as I say” Sit with children at meals, eat same food Try new foods with children Start with “adventurous” eaters to model trying new foods to picky peers Avoid negative facial expressions, body language or words re: food served

#2: Integrate nutrition/PA into curricula : 

#2: Integrate nutrition/PA into curricula Provides repeated exposures to topics “Normalizes” healthy eating and PA Emphasizes their importance daily New PAT curriculum, High Five, Low Fat, preK school wellness resource guide, Movement Exploration Other ideas listed in CC Champions

#3: Practice division of responsibility (Satter) : 

#3: Practice division of responsibility (Satter) Caregiver’s job=what to offer child to eat Child’s job=how much, what and whether to eat Caregiver provides regularly scheduled meals and snacks at appropriate intervals Allow children to help in preparation, table setting, serving and clean up if possible Offer a variety of healthy foods repeatedly Avoid verbal or nonverbal prompts to eat

#4: Provide the best start for infant feeding: : 

#4: Provide the best start for infant feeding: Breastfeeding, developmentally appropriate 1st foods offered at the right time, recognition of hunger and satiety Promote breastfeeding to all parents

How can you help? : 

How can you help? Be welcoming to breastfeeding moms For 1st 6 months, offer only breastmilk to breastfed infants unless mom wishes otherwise Provide private place to nurse for moms before they leave their infant and when they return Provide adequate and safe storage space for breastmilk (COPAN resource kit)

Appropriate 1st foods: : 

Appropriate 1st foods: In addition to delaying solids till 6 months… Avoid added sugars (desserts, cookies, cakes, fruit drinks, pop) and do not add sugar, molasses, honey, syrup to baby food, cereal, milk or water Do not allow “grazing” from plate, cup or bottle

#5: Become partners in prevention : 

#5: Become partners in prevention Partner with the parent to avoid giving children mixed messages about eating and physical activity Communicate feeding policies to parent Alert parent to feeding problems quickly and enlist their ideas Use resources/newsletter to educate parents on common feeding issues

#6: Promote physical activity and free play : 

#6: Promote physical activity and free play Young childhood is key time when PA behaviors, preferences are being set Infants should play interactive games and safely explore their environment Toddlers need safe opportunities to learn running, jumping, throwing, kicking; refine skills as preschoolers Toddlers need ≥30 min of structured PA and ≥60 min of free play Preschoolers need ≥60 min structured PA and ≥60 min of free play

Physical activity, cont: : 

Physical activity, cont: No TV/screens for children ≤2 years old 1-2 hours/day of educational programs for those >2, preferably movement-promoting Dance or move to music instead of TV Use Hip Hop to Health, Jr, Movement Exploration, other resources

Examples in Child Care Champions: : 

Examples in Child Care Champions: How to provide activity opportunities for infants What counts as structured physical activity? What counts as free play? How to ensure play spaces are safe How to create an indoor activity space

#7: Plan meals w/childrens’ nutrition needs in mind : 

#7: Plan meals w/childrens’ nutrition needs in mind It takes time and planning Use guidance learned during conference Use Child and Adult Care Food Program Guidelines and 2005 Dietary Guidelines Provide written menus to parents Educate parents on balanced meals if they send food Establish positive eating environment

Positive eating environment: : 

Positive eating environment: Children should help with food prep and cleanup as developmentally able Children should sit with caregiver and each other Chairs, table, utensils suitable for children Pleasant social and learning experience with no conflict Food not a reward or punishment Allow sufficient time to eat (>20 min)

Summary: : 

Summary: Young children are establishing eating and activity patterns for life You have an important role to play in promoting breastfeeding as best 1st feeding, promoting and providing opportunities for healthy eating and activity for young children, families

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