infant feeding practice dr.lanang
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RSUP Sanglah Denpasar IndonesiaTRANSCRIPT
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INFANT AND YOUNG CHILD FEEDING PRACTICE
DIVISI NUTRISI DAN PENYAKIT METABOLIKBAG/SMF ANAK FK UNUD/RSUP SANGLAH DENPASAR
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Soal:seorang bayi laki,diajak ibunya ke praktek untuk imunisasi, usia 3 bulan, BB 5,5 kg, PB 59 cm, saat ini minum ASI dan sudah diberikan susu formula sejak 2 minggu yang lalu.
1. Status nutrisi: Antropometri: BB/U -2SD s/d -1SD; PB/U -1SD s/d -2SD; BB/PB -
1SD s/d median Klinis baik Diet: ASI + susus formula Status gizi baik + perawakan baik
2. Kebutuhan nutrisi: BB ideal 5,7 kg; usia PB 2-3 bulan Energi= 5,7 x 120 kkal = 684 kkal/hari = 977 ml ASI Protein = 5,7 x 2,5 g = 14,25 g/hari
3. Rute pemberian: Oral
4. Jenis nutrisi: ASI + susu formula dilanjutkan
5. Monitoring: Kontrol sebulan lagi saat imunisasi berikutnya
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Soal:seorang bayi laki,diajak ibunya ke praktek untuk imunisasi, usia 3 bulan, BB 5,5 kg, PB 59 cm, saat ini minum ASI dan sudah diberikan susu formula sejak 2 minggu yang lalu, BBL 3,3 kg, BB 1 bl 4,2 kg, usia 2 bl 5,1 kg.
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Konseling tehnik menyusui yang benar, jelaskan cara/penggunaan ASI simpan dan pertanyakan pemberian susu formula???1. Status nutrisi:
Antropometri: BB/U -2SD s/d -1SD; PB/U -1SD s/d -2SD; BB/PB -1SD s/d median
Klinis baik Diet: ASI + susus formula Status gizi baik + perawakan baik + risiko gagal tumbuh
2. Kebutuhan nutrisi: BB ideal 5,7 kg; usia PB 2-3 bulan Energi= 5,7 x 120 kkal = 684 kkal/hari = 977 ml ASI Protein = 5,7 x 2,5 g = 14,25 g/hari
3. Rute pemberian: Oral
4. Jenis nutrisi: ASI + susu formula dilanjutkan ???
5. Monitoring: Kontrol sebulan lagi saat imunisasi berikutnya
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Optimal infant and young child feeding (rekomendasi WHO, 2002) Early initiation of
breastfeeding (within 1 hour after birth)
Exclusive breastfeeding (0-6 months)
Continuous breastfeeding for 2 years or beyond
Complementary feeding (6-24 months)
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Why breastfeeding ?
Breast
milk
• Perpect nutrient
• Easily digested, efficienly used
• Protect against infectionBreas
tfeedi
ng
• Help bonding and development
• Help delay a new pregnancy
• Protect mother’s health
Cost
• Cost less than artificial feeding
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Early initiation of breastfeeding
Skin-to-skin-contact Mother and baby feel more
calm. Reduced risk of infection Warmth, love, security and
food. Smell of nipple = amniotic Get first milk = colostrum Support growth and bowel
function without allergy substance
More successful of exclusive breastfeeding
Oxytocin release, reduced bleeding
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Colostrum: first 3-5 days of life Low in fat, high in CH,
protein and antibodies. Easily digested, laxative
effect, prevent jaundice. IgA contents protect
mucous membranes in the throat, lungs and intestines: protection against GIT and respiratory tract infection.
Initiating breastfeeding reduced neonatal mortality rates by 22%
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Oligosaccharides: 3-9 sugar units Polysaccharides – oligosaccharides – disaccharides
– monosaccharide. Fiber: those polysaccharides we are not able to
digest. Insoluble Soluble: oligosaccharides, digested by bacteria
(microbiome), into short chain carboxylic acids for enrgy by cells lining of intestines first prebiotic of breast milk.
Prebiotic = functional foods. Oligosaccharides concentration in colostrum more
than 20 g/L, mature milk 12-14 g/L, compare with cow’s milk less than 1 g/L.
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Protein
Breast milk: whey protein dominant Whey protein: rich of α-lactalbumin Easily digested and absorbed
Cow’s milk: casein protein dominant Whey protein: rich of β-lactoglobulin, low
in amino acid tryptophan.
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Positioning and attachment
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Cara bayi mengeluarkan ASI
Tekanan positif ketika rahang naik untuk memfasilitasi gerakan peristaltik
lidah pada puting/payudara
Tekanan negatif dalam rongga mulut ketika
rahang terbuka
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Suckling Hormonal Reflex Arc
Source: Lactation Education Program Nutrition Policy and Education
More prolactin Secreted at night
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Inhibitor in breast milk
If breast remains full of milk, secretion stops
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Marker of Successful Breastfeeding 7% or less weight loss in first few days after
birth Return to birth weight for at least 2 weeks Weight gain per day of 20 to 30 g during first
3 postnatal months Lactation established in mother by 2 to 4
days after birth At least eight breastfeeding events every 24
hours Baby is latching unto breast easily Three to six stools and four to six voids by 5 to
7 days of age
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Damayanti Rusli Sjarif 2009
Complementa
ry foods
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Pemenuhan kebutuhan nutrisi bayi
0 – 6 bulan : ASI Eksklusif
6 bulan : 65 – 80% ASI, sisanya MP-ASI
12 bulan : 65-80% MP-ASI, sisanya ASI
24 bulan : seluruhnya makanan keluarga
28
200550
300
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Breast milk in the second year of life
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Some Considerations in Complementary feedingsToo Early diarrheal disease
& risk of dehydration
decreased breast-milk production
Allergic sensitization?
developmental concerns
Too Late potential
growth failure iron deficiency developmenta
l concerns
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WHEN??
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GI readiness: 3-4 months
Developmental readiness: varies, between 4 and 6 months
Nutritional needs beyond breast milk : not before 6 months, after that varies
Need for variety and texture: within first year, order not
important
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Fluid Needs
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Offer plain, clear water several times per day once infants are eating solids.
Additional fluids needed: • 400 - 600 ml / day in temperate
climates • 800 - 1200 ml / day in hot climates.
Without additional water dehydration becomes a threat.
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Food Consistency
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Increase food consistency and variety as infant gets older.
Infants can eat pureed, mashed and semi-solid food
from 6 months.
By 12 months, family foods suitable.
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Responsive Feeding
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Practice responsive feeding, applying the principles of
psychosocial care.
Remember that: Feeding times are
periods of learning and love - talk to
children during feeding, with eye to eye contact.
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The 1st “Test Feedings”
Iron fortified infant rice cereal as 1st food
Should be a single food (not combination), nutritious, smooth texture and thin consistencyBest to offer after feeding some BM or Formula, except who repeatedly no interest offer before
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Basic guidelines
• AAP : no special order to follow• The key : make sure foods are safe,
nutritious, suitable texture
Sequence of solid foods :
• smooth texture and thin consistency
• increase the texture and consistency gradually
Texture :
• start with a small amount (1-2 tsp)• gradually work up to tbsp or more
Serving amount :
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Basic guidelines• introduce every 4-7 days between
each new foods• watch for signs of an adverse
reactions• before trying mixed foods, try each
of the food individually.• best to offer a new food early in the
day plenty of time to watch for any reaction
Time between
new foods :
• parents should wash their hands, the baby’s hands, any utensils dishes, etc.
• parents shouldn’t share eating utensils with the baby or pre-chew food before giving it to the baby
Food safety :
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Precautions when introducing solid food
Home-prepared beets, carrots, collard greens, spinach and turnips :• high in nitrates
methemoglobinemia• should not be fed babies < 6 monthsHoney :• may contain C.botulinum causing
infant botulism
Cow’s milk :• infant < 1 yr should not get cow’s milk low
in Fe, high in Na, K, Cl and other minerals
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Safety Issues Regarding Feeding Infants:
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Honey and corn syrup, are the only food sources in infants diet of Clostridium botulinum spores, which lead to Botulism. They
should not be fed to infants less than 1 year of age.
Cook eggs and chicken well to avoid salmonella.
Small, hard, round , and sticky solid foods may lead to choking and
aspiration
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AAP: Specific Recommendations
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Home prepared spinach, beets, turnips, carrots, collard greens not recommended due to high nitrate levels Methemoglobinaemia
Canned foods with high salt levels and added sugar are unsuitable for preparation of infant foods
Honey not recommended for infants younger than 12 months Botulism
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Help baby become more independent:
• Give finger foods
• Drink from cup since 6-8 months of age
• Hold his/her own cup or bottle
• Make feeding schedule so that baby will feel hungry and full regularly
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Codex Standard for Infant Formula and Formulas for Special Medical Purposes for Infant (CODEX STAN 72-1981) Infant formula, like no other food, is regulated by its
own law, the Codex Standard for Infant Formula and Formulas for Special Medical Purposes for Infant.(CODEX STAN 72-1981)
The act sets upper and lower limits on important nutrients
It requires that the formula supports normal growth and that contents are clearly labeled.
Manufacturers are required to follow “good manufacturing practice,”
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Codex Standard for Infant Formula and Formulas for Special Medical Purposes for Infant (CODEX STAN 72-1981)
Section A refers to Infant Formula Section B deals with Formulas for Special
Medical Purposes Intended for Infants means a substitute for human milk or infant formula
that complies with Section 2, Description, of the Codex Standard for the Labelling of and Claims for Foods for Special Medical Purposes (CODEX STAN 180-1991) and is specially manufactured to satisfy, by itself, the special nutritional requirements of infants with specific disorders, diseases or medical conditions during the first months of life up to the introduction of appropriate complementary feeding.
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FORMULA FOR SPECIAL MEDICAL PURPOSES INTENDED FOR INFANT AND YOUNG CHILDREN
Formula for premature infant Fortified human milks Premature infant formula Premature-discharged formula
Formula for cow-milk allergy "predigested" formulas Extensively hydrolyzed formulas Amino-acid based formula
Formula for inborn errors of metabolism Phenylalanine free formula (PKU), branc-chain amino acids
free formula (MSUD, MMA), etc Formula for gastrointestinal disorders
Acid Reflux: Thickened Formulas Lactose-free formulas: lactose intolerance, Enteral nutrition
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World Health Organization 2009
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Cleaning
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Sterilizing
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How to prepare a bottle feed (1)
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How to prepare a bottle feed (2)
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