Department of Pediatrics

Importance of breast feeding

 Human milk is the best food for babies and provides all
nutrients needed for about first 6 months of life
 It represents not the best source of nutrients, but unique
protection from infections, allergy
 Protection of mothers health, increase energetic nutritional
requirement of the mother can be easily balanced be a
healthy alimentation
 Breast feeding has a long affect in turn affecting the growth
and development, its recommended to breast feed as soon as
possible in the first 1-2 hours after birth
 In the next 6 months the child will be exclusively breast fed
 For population with high risk of infectious diseases breast
feeding is recommended till second year of life
Nutritional importance
and benefits of breast feeding
 Alimentary factor – represents the composition and
quality of human milk nutrient components
 Human milk is superior to another types of commercial
milk
 The composition of human milk is not constant but
changes during feeding according to the time and during
the course of lactation
 The total volume of maternal milk production and infant
milk intake is highly variable depended: 100 ml, 300 ml,
800 ml from frequency and effectiveness of sucking of
baby
Protein component of human milk
 Protein component of human milk differs by quantity and quality
 Human milk protein is may predominant in albumines
 In cow’s milk casein is predominant
 The spectrum of amino-acids differs in human and cow’s milk
 In human predominant cysteine, taurine which are so important
for development of CNS
 Chemical properties and characteristics of human protein don’t
provoke allergy and help digestion
 Cow’s milk provoke gastroenteropathy, allergy and in some cases
intestinal hemorrhage
 Human milk assures all quantity of proteins Infant needs during
the first 6 months of life
Fats in human milk breast
 Milk fat represents around 1-1,5 g/100ml
 The concentration of fat depends on mother’s alimentation
 Breast milk is rich in poly unsaturated acid which are important
for development of nervous system
 Fat is mostly made up from triglycerides, about 98-99%
 For quantity in breast milk is not constant but may change during
the day
 Minimal concentration around 10 and 12 o’clock and the most
energy dense at the end of the feeding
 The total concentration of saturated fat is 42%, unsaturated 57%
 Cow’s milk in compare with human milk has a greater proportion
of saturated fatty acids but unsaturated is absent
Carbohydrates
 Carbohydrates – the main carbohydrate in human milk is
lactose that facilitates activity of intestinal physiological
bacterial flora
 Human milk contains a higher concentration of
carbohydrate, it also has a small quantity of galactose,
fructose and oligosaccharide
 Cow’s milk has a small quantity of carbohydrates and the
lactose is A-Type, in human milk is B-Type
Minerals and vitamins
 Minerals – cow’s milk contains a big quantity of Ca+2, Na+,
P, that increase the renal osmosis, but the urinary system
is not so mature for such big effort
 Vitamins depends on infants needs and on the mother’s
alimentation
 Breast milk always contains the necessary quantity of
vitamins comparing to cow’s milk
Protection and immune factors
of human milk
 Ig-A protects against E.coli, klebsiella, pneumonia, salmonella,
shigella, streptococci, candida, cholera
 Antivirus antibody – cytomegalovirus, herpes
 Lysosome – antibacterial enzymes
 Interferon – antiviral agent
 Antistaphylococus factors
 Bifidus bacteria that stimulate lactic acid bacteria such as bifidus
bacteria in the colon
 Proteases inhibitors
 Ribonuclease – antiviral agent
 Human milk stimulates and develops child proper immune system
 the immunological role of breast milk is more pronounced in the period
after birth and first month of life and the protection effect depends on
the duration of breast feeding
Protection role of human milk
 Reduced incidence of diarrhea and duration of diarrhea
 Protects against respiratory infections, otitis media
 Protect against necrotic enterocolitis in the neonatal
period
 Protect against bacteremia, meningitis, urinary tract
infections
 Reduce risk of inflammatory bowel syndrome and
possible sudden infants death syndrome
Contra indications of Breast Feeding
 For mother
 absolute – HIV infection
 temporary
 severe infections pathology in acute phase
 TBC
 somatic diseases in decompensating phase
 cancer in mother and taking of cytostatic
 the physical disease in mothers – diabetes with intake of oral antidiabetes
 For Baby
 absolute – metabolism disorders (example: galactosemia,
phenylketonuria)
 temporary
 severe affectation of newborn and sucking baby that required assistant
respiratory and parenteral feeding
10 Steps for successful breast feeding
1. Health written policy referring natural alimentation which is to be
communicated frequently
2. Prepare a healthy care personal concerning the need abilities for
performing of breast feeding
3. To inform pregnant woman about benefits of breast feeding
4. To help the mother to initiate the breast feed in the first hour after delivery
5. Its recommended to breast feed exclusively before 6 months
6. To breast feed the baby before 6 months not less than 8 times per 24 h
7. To continue breast feed after 6 months till 1 year
8. Not added different food or water before 6 months
9. To create a care group for natural alimentation and to orientate mothers to
promote natural alimentation
10. To breast feed the baby daily and at night as frequent as baby wants
Unfavorable factors in breast feeding
 Problems of the child
 metabolic disorders
 jaundice
 cleft lip and palate
 baby with low body weight at birth

 Problems of the mother

 emergency after delivery
 TBC
 hepatitis B
 breast cancer, chemotherapy
 cesarean section
 breast problems at the beginning and during lactation
Methods for evaluation
of child adequate nutrition
1. Signs of adequate breast feeding in the first month of life
a) satisfactory state of child between feeding time
b) weight gaining 18-30g per day or 125-210g per week
c) physiological defecation ( bowel movement ) usually after each feeding
d) swallowing heard during sucking
2. Hunger symptoms
a) no increase in weight
b) rare urination (N=6-8/day)
c) changes of stool, constipation or diarrhea
d) baby sucking his fingers
e) Anxious or agitated child
3. Signs indicated in adequate weight gaining of the baby in time
a) < 18 g/day increase in weight
b) sleeps a lot, weak crying
c) reduced urination
d) able to suck continuously
Nutrition efficiency
 General state of baby
 Physical development (weight and height)
 Neurological development
 Morbidity level evaluation (how frequent diarrhea or viral
infection …)
 Laboratory analysis, general blood test, urine analysis
Advantages of breast feeding in baby
 Reduced risk of developing
 Gastrointestinal illness and gastroenteritis in particular
 Middle ear infection
 Respiratory system infection
 Urinary tract infection
 Insulin dependent diabetes
 Allergies
 in preterm baby
 Optimum neurological development
 Reduced risk of necrotizing enterocolitis
Advantages of breast feeding in mother
 Reduced risk of
 Premenopausal breast cancer
 Some forms of uterine cancer
 Social gains
 Ready availability for feeding the baby
 Unique contact between mother and baby
 May help mother to lose weight naturally
Maternal diet during
breastfeeding
*Diet rich in energy, carbohydrate, fat and protein
*Iron, iodine, selenium and vitamins A,E,B12
supplementation
*Less cow milk intake by mothers decrease transmission of
allergens in the breast milk and prevent colic symptoms
*Caffeine, nicotine and alcohol is contraindicated in
breastfeeding mothers, because adverse affects of baby
Difficulty feeding in infants
 Baby is feeding less than 8 times/24h
 Taking any other food or drinks under 6 mo
 Have low weight for age
 Wrong positioning
 The infant is not breastfed during the night
 Short nursing time
 Suckling bottles
 Complementary foods before 6mo of age
Teach the correct positioning for
breast feeding
 Show the mother how to hold the infant
 with infant’s head and body straight
 facing her breast, with infants nose opposite her nipple
 with infant’s body close to her body
 supporting infant’s whole body, not just neck and shoulders
 Signs of good attachment for breast
feeding
 Show the mother how to help the infant to attach
 touch her infant’s lips with her nipple
 wait until her infant’s mouth opening wide
 move her infant quickly to her breast, the infant’s lower lips should be lower to
nipple
 look for signs of good attachment and effective suckling, if the attachment or
the suckling is not good, try again
 Is the infant able to attach? to check attachment look for
 chin touching breast
 mouth wide open
 lower lip turned outward
 after infant’s mouth contact to the areola, the upper part of the areola is visible
more than lower part
 All of these signs should be present if the attachment is good
 Infant’s effectively suckling are slow, deep and sometimes pausing
 Rhyming sucking stimulate milk ejection reflex
Stages of breast milk expression
 Colostrum- high-protein, fat-soluble vitamins, Abs, low fat
and energy milk, produced in the first 3 days after birth
 Transition milk secretion at 4-14 days postpartum- it
decreases Abs, proteins and increases of lactose, fat and
total calories
 Mature milk- different composition: at beginning of feed
higher in lactose (foremilk), later increase in fat and
calories (mind milk)
 Extended lactation (7mo-2yr) more stabile ingredients,
gradually decrease vitamins and minerals
Mothers needs to express milk
 To relief her breasts if they are full or uncomfortable
 If the baby cannot feed because of illness
 If she is going away from here baby for more than an 1, 2 hours
or going back to work
 To help the baby to attach to a full breast
 There are 3 ways to express milk
 By hand, hand pump, electric pump
 Any equipment used for expressing milk must be sterilized
before using and mother’s hands must be washed and carefully
dried
The maintenance of breast feeding
 Continue frequent demand breast feeding until 2 years of age or beyond
scientific research for maintenance breast feed
 Breast feed continues to make an important nutritional contribution beyond
one year of life
 Breast feed children at 12-23 months of age, receives 35-40% of total energy
needs from breast milk high fat content compared to most complementary
food. It also is key source of energy and essential fatty acid
 Breast milk produced a certain amount of macro and micro-nutrient, 70% of
Vitamin A, 40% of Ca+2, 37% of riboflavin intake at 15-18 months of age
 The nutritional impacted of breast feeding is most evident during periods of
illness when the child’s appetite for others foods deceased but breast milk
intake is maintained and providing the nutrients required for recovery from
infections
 Continued frequent breast feeding protects maternal fertility postpartum,
increased birth intervals in population that don’t regularly used other forms of
contraception and decreased the child’s risk of morbidity and mortality in this
advantaged population
The maintenance of breast feeding
 Along the duration of breast feeding decreased risk of childhood chronic
illnesses and obesity and improve cognitive outcomes scientific research in
exclusive breast feeding
 The dates of World Health Assembly, World Health Organization suggested
the good motor development in exclusive breast feeding in 6 months of age

 Low birth weight infants are at higher risk for iron deficiency and for that
they receive medical iron drops beginning at 2-3 months of age
 Infants with normal birth weight of mothers with prenatal iron deficiency
maybe at risk prior 6 months
 Complementary food aren’t likely as effective as medicinal iron drops and
zinc supplements from 1-9mo of age to decrease infection disease.
 Vitamines deficiency are generally rare in exclusively breast feeding infants
but when the mother’s diet are deficient , their infants may have low intakes
of vitamins ( A, B6, B12), in this situation improving the mothers diet or giving
her supplements in the recommended treatment
 Vit. D deficiency may occur among infants who doesn’t receive much
exposure to sun light , but giving Vit. D drops to infants generally prevent this
The comparative composition of breast milk
compared with cow’s milk and adaption milk

Breast milk Cow’s milk Adaption milk

Proteins 0,9-1,4 3,3-3,5 1,4-1,8

Fat 3,8-4,5 3,3-3,7 3,3-4,2

Carbohydrates 6,8-7,0 4,6-4,8 6,3-7,9

Calories 69-70 66-70 67-75

Factors of immunological protection
in breast milk
 IgA , secretory Ig against salmonella, shigella, clostridia,
streptococcus, H. influenza, campylobacter, candida albicans,
Hp. Antivirus, cytomegalovirus, HIV
 IgG A, M
 Lysosome
 Lactoferrin
 Interferon
 Lymphocytes T, B
 C3, C4
 Nonspecific factors, Anti-staphylococcus
 Ribonuclease
 Biochemical factors, fats, carbohydrates
Babies problems in breast feeding
 Problems in babies
 metabolic disturbances, galactosemia, phenylketonuria they
are contra indicated in breast feed
 congenital anomalies of mouth
 jaundice
 children with small weight at birth, at 34 weeks of birth, 1,6-
1,8 kg
Mothers problems in breast feeding
 Problems in mothers
 postpartum emergency
 acute cardiac and vascular insufficiency
 renal & liver failure
 acute pulmonary failure
 TB
 herpes viral infection , when elements of virus are present on the
chest only
 after vaccination of hepatitis B
 HIV
 breast cancer
 caesarian section (after 4-6 hours)
 medical drugs
 some problems with breast , maybe physiologic mastitis , infections
 Hypogalactia
 Hypogalactia- insufficiency release of breast milk, lactation failure
 Prolactin-triggering reflex: suckling infant stimulates release of
prolactin hormones, responsible for milk production, and oxytocin
responsible for milk release. Lactation is sustain by complete
evacuation of milk produced and breastfeeding during the night
 According to deficiency are divided 4 degree: I-deficiency<25%; II-
25-50%; III-50-75%; IV->75%.
 Primary hypogalactia causes by long-term hormone therapy in
pregnancy, mothers infantilism
 Secondary hypogalactia causes by rare nurse the baby, mothers
genital diseases, poor emptying of the breast, nipples problems.
Prevention of lactation failure
 Antenatal check up of the breast
 Antenatal preparation of the mother for breastfeeding
 Feeding as early as possible after delivery
 Remedlial measures for anatomical defects in the breasts
 Adequate attention to mother diet and sufficient rest
 Avoid unnecessary use of drugs
 Family members, friends, and nursery staff must provide
support for lactating women
 Cow’s milk based formulas
 Comprise 80% of present day formulas feed during first 6 months of life,
such formulas are composed of reconstituted cow’s milk or a mixture of
cow’s milk and electrolytes depleted cow’s milk or casein protein
 The fat use in infant formulas is a mixture of soya, coconut, corn, oils or
sun flower oils
 Cow’s milk based formulas are equivalent the human milk in that they
promote subsequent growth during 6 months of life
 The complete cow’s milk based infants formulas are used as substitute
for breast milk for infants whose mothers cannot breast feed, a
supplement for breast feed infants or as complementary feeding if
breast feeding alone doesn’t result in normal growth or other signs of
malnutrition are present
Whole cow’s milk
 Usually introduced into the diet of many infants after 6
months of age
 By 12 months of age infants usually tolerate whole cow’s
milk very well, as a part of a mixed diet the major reason
support the recommendation not to provide whole cow’s
milk before 1 year
 Cow’s milk increased risks of milk protein allergy,
gastrointestinal blood loss, iron deficiency anemia and
poor nutritional status of the infant
 Some studies suggested that the use of 2% of fats cow’s
milk as part of mixed diet during last half of infancy can be
satisfactory for child
 Soya based formulas
 The soya proteins formulas are used if cow’s milk based formula intolerance in protein
hypersensitivity or lactose intolerance, these formulas nutritionally high and save
alternatives to cow’s milk based formula
 The frequency of soya formula used increased from 3% of newborns to 10% of formula
feed infants between 2-12 months of age
 Soya protein contain methionine, carnitine and taurine to improve its nutritional quality
 Soya formula are lactose free, some also sucrose or corn free. Oligosaccharides interfere
with absorption of minerals.
 Fat mixture of vegetable oils in soy formula is similar to that used in cow’s milk formula
 Allergy disorders in a later life and clinical intolerance to soya milk protein or cow’s milk
occurs in equal frequency. Soy formula are recommended in vegetarian families
choosing not to serve animal protein formulas and in management in galactosemia .
 Safe for the normal child soya based formula has been associated with protein
enteropathy in patients with cystic fibrosis and with neonatal rickettsia in premature
infants
Premature infants formulas
 Breast milk is gold standard in premature feeding versus
premature infant formula, but immaturity of digestion,
metabolism and secretion ,high growth rates are indicated it
 Glucose polymers and lactose comprises (1:1) decrease the
osmolarity of formula to 211-260mOsm/l and NEC risk
 Medium chain triglycerides are 40-50% of the fat calories,
do not require pancreatic lipase or bile salts for digestion
 Protein is 60/40 whey/casein ratio and prevent elevation of
plasma phenylalanine and tyrosine levels.
 Vitamins and minerals are incorporated at high
concentration and limited volume intake
Therapeutic formulas
 Therapeutic formula using in cow milk and soy protein
hypersensitivity, variety gastrointestinal or liver diseases;
 Casein hydrolyzed (Alimentum, Pregestemil, Nutramigen)
formulas are acceptable but significantly higher cost. These
formulas are also lactose free, some contains Dextrose
 Amino acid-based infant formulas Neocate and Elecare are
indicated for infants with severe protein hypersensitivity and
persistence of symptoms on other formulas. It also are extremely
expensive.
 Low-lactose formula- Lactofree, Isomil, Prosobee, NAN- lactose
free can be used in lactose intolerance
Baby complementary food
 Infant dry cereal are used as a concentrated source of calories (373kcal/100g),
vitamins, minerals to supplement the diet of infants those need for this nutrient are
not meet by human milk formula or other milks
 Possible allergies or food intolerance that may develop from adding new foods to diet
manifest by skin rashes, vomiting, diarrhea, or wheezing
 The single rice cereal are recommended as first food at 6 mo of age an unlikely
allergen, traditionally introduced on a small spoon. Choking or gag reflex during the
food intake indicate that child is not ready for transition to solid foods

 The high protein cereals offers the advantages in addition to variety pureed of fruits,
or vegetables. Cheese, vegetal oil, butter are introduced at 6-7mo of age.
 Fruit and vegetables juices provide 4% of total caloric intake and giving with a cup
rather than a bottle. Infants have greater absorption and tolerance to juices containing
fructose in combination with sucrose and glucose (apple and pear), volume increases
from 5-10ml at 6mo to50-70ml at 1yr.
 Mashed 20-30g of meat, fish, poultry, boiling eggs are introduced at 7-8mo
 Foods with high allergic potential should be avoided during early infancy include fish,
peanuts, eggs , chocolate, citrus fruit, corn products, wheat, chicken and food additive
Food diversifying
 The food of transition period- complementary produces,
destined for suckling baby physiological satisfaction
 The food from family meal- there are complementary
produces, given to infant and which are in fact produces,
consumed by all family
 Introduction of semisolids and solids food need
“maturation” of a lot of systems: neuro-muscular
coordination (chewing reflex), digestion and absorption,
maturating of renal concentrations function.
Age of complementary food
 Early introducing imposes follow risks: complementary
food substituting a part of breast milk decreasing of milk
production and energy consumption by the infant.
 Possible contamination of produces and liquids
increasing the risk of diarrhea, food allergy and
malnutrition
 The mothers become earlier fertile- decreasing of breast
milk production reduces period of ovulation suppressing.
 Late introducing of complementary foods lead to energy
and nutritive deficiencies and growing retardation.
Complementary aliments
 Produces by vegetal origin - Cereal produces (wheat, buckwheat,
rye, oat, rice) constitute the basic aliments practically of children.
65-75% from their content is reverting to glucides, 6-12% - proteins
and 1-5% - fats.
 Potatoes - are rich in starch and, because can be preserved long
time as a cereal produces, represents the principal source of
alimentary energy during whole year.
 Legumes and fruits are the principal source of vitamins, minerals,
starch and alimentary fibers, also of other important substances
such as antioxidants and phytosterols.
 Beans - (soya, pea, bean and millet) they contain composed
carbohydrates, such as starch, alimentary fibers, vitamins and
minerals.
Produces by animal origin
 Meat - contains nutritive substances in function of fat
quantity.
 Fish - is also a sourse of protein, giving an important
quantity of essential aminoacids. Fish fats containing
polyunsaturated greasy acids, important for nervous
system development.
 Eggs proteins - contain aminoacids and phospholipids,
indispensable for physical and neuropsychical infant’s
development.
Milk and other milk products
 The cow’s milk can reduce the quantity of produced
breast milk;
 It contains less iron, which has reduced
biodisponibility;
 It can induce gastro-intestinal hemorrhages,
especially in infants until 6 months age;
 It contents too much quantity of proteins and
sodium, quantity which exceeds the breast milk 3 – 4
times.
 The orientative chronology and
quantity of complementary foods
Produces( in gr.) / age in months 6 7 8 9 10-12
Fruit juice 50 50 50 50 50
Mash fruits 50 50 50 50 50
Cheese (white cheese) 40 40 40 40 50
Egg yolk 1/2 1/2 1/2 ½
Mash vegetables 60-80 130 150 160 160
Butter 2 3 4 5 5
Vegetal oil 1-1,5 2 2,5 2,5 3
Porridge of croups 10-60 150 160 180 180
Chopped meat 5-20 20 20 30
Liver 5-20 20 20 30
Bread 3-5 5 10
Pulled bread 3-5 5 10
Biscuits 3-5 5 10
 General principles of suckling baby’s
alimentation diversifying
1. The diversifying will begin only if the suckling baby is healthy.
2. Only one single new aliment will be introduced, at one single meal, in small quantity (20-30
gr), that will be gradually increased in the following days at the same meal, reducing
proportionally the breast milk, so that in 7 - 8 days to substitute completely the breast milk
meal with the new aliment.
3. 2x or more new aliments are not introducing simultaneously, but at intervals minimum 5
days. This is necessary for to adaptate the infant to new produce and for the monitoring of
his tolerance to it. At the smallest signs of intolerance (vomiting or diarrhea) the new
introduced aliment is excluding on the time of 1-2 weeks, until the digestive restoring, after
that its careful reintroducing (in less quantities) will be attempted again.
4. The new complementary aliment will be administered preferable with teaspoon but in no
case through milk bottle. Thus on one hand the skills of alimentation will develop, on the
other hand – we shall sure the infant has received consistent food from the nutritive and
caloric point of view.
5. The consistence of complementary aliments will be gradually changed from good
homogenised meal to puree, minced food, than small pieces.
6. It is not rational to administer two same meals per day. Usually the first complement in day is
administered at the second meal, the first being the milk.
 General principles of suckling baby’s
alimentation diversifying
7. The new complementary aliment is administering before the milk which it substitutes, if the
infant is fed artificially and after applying at breast, if he is breast fed.
8. The choice of new aliment is performing in function of suckling baby’s nutritional state: for
eutrophic suckling – mash vegetables, for this with decreased nutrition – flour gluten-free
porridge, preferable being prepared on adapted milk formula, and in its absence – on diluted,
than integral cow’s milk.
9. All diversifying meals must have caloric value more than milk meals, which are taken out
from alimentation. If the infant benefits by breastfeeding, conformable to WHO
recommendations, the complementary produce is administering after breastfeeding.
10. If suckling baby sistematically refuses new introduced aliment, we renounce temporarily
from its administration, because there is the risk of psychogenic anorexia appearance at
suckling baby.
11. During the infant’s growing we must offer him the possibility to eat alone, to take aliments
with hand for example, but to continue actively feed him and to encourrage him to eat.
12. The diversifying has the goal gradual taking out the breastfeeding meals for to habituate
the suckling baby with aliments similar to adult alimentation.
13. During diversifying the permanent monitoring of infant’s health state is performing.
Classification of formulas for artificial feeding
1. According the degree of adaptation
 nonadaptive (classic )
 partial adaptive
 adaptive (human or maternal)
 special (therapeutic and diets)
2. According the age of indication
 for start (complete formula includes cow formula for premature)
 for diversification (for continue)
3. According to technology of preparing
 with glucose
 acidulate (fermentatives)
4. According to the source of proteins
 cow’s milk
 vegetal milk (soya)
 from meat
5. According to composition
 free / reduced of lactose
 decreased in fats
 increase in fats
 increase in proteins
 increase in minerals and vitamins
Save preparation and storage of
complementary food
Practice good hygiene
a) washing care givers and children hands before food
preparation and eating
b) storing food safely and serving food immediately after
preparation
c) using clean dish to prepare and serve food
d) using clean cups when feeding children
e) avoiding the use of feeding bottles which are difficult to
keep clean
Responsive feeding
Practice responsive feeding applying the principle of psychosocial
care
a) feed infants directly and assist all children when they feed
themselves being sensitive to their hunger
b) feed slowly and encourage children to eat but don’t force them
c) if children refuse many foods, experiment with many food
combination tests, mixture methods of
d) minimized destruction during meals if the child loses interest
easily remember that feeding times are periods of learning and
love
e) talk to children during feeding contact eye to eye
 Nutrient needs
 Protein needs increase after birth from 2.0 to 3.5-4.0 g/kg/day at
12mo. Source: breast milk <6mo of age, later meat, eggs, fish, milk
products- yogurt, cheese
 Fat intake decrease during 1st year from 6.5to 5.0g/kg/day. Source in
complementary foods: vegetable oil, fish, butter
 Carbohydrates more constant in different age- infant, older
children: 12-15g/kg/day. Source: breast milk, >6mo of age fiber-rich
fruits, vegetables, grain group; minimal sugars or sweeteners
 Energy needs: 1st 3mo- 120kcal/kg/day; 3-6mo- 115; 6-9mo- 110;9-
12mo- 100kcal/kg/day.Distribution of calories: 40-50% fats, 7-11%
proteins, remaining calories from carbohydrates
Mixed and artificial feeding
 Mixed feeding is alternative feeding with breast milk and
any other milk or formula in first 4mo of age
 Causes: low release of breast milk, mothers return to
work or school after their baby’s born. When mother are
away baby intake infant formula and is nurse at other
times
 Artificial or bottle-feeding is exclusive feeding with infant
formula in first 4mo of age
Management in bottle-feeding
 Commercially infant formula offer if lactation is low or
not possible to nurse the child when he need
 New formula offer in healthy child, increase gradually in
volume according to digestion and weight gain
 Parents should be discouraged from “formula jumping”
 Is recommended boiling water for 1-5 minutes and
cooling it before mixing formula preparation
 Boiling or microwave preparation is not advised because
hot water may destruction vitamins and minerals
 Bottle feeding techniques
 Holding the infant so that face-to-face contact is
maximized, tilting the bottle so that the nipple is filled
with milk
 Interaction with caregiver and infant can be intimate
during bottle-feeding as with breastfeeding
 Infants should be fed in a semi-upright position; supine
position increased risk of ear infections
 The addition of sugar to the formula or sucrose-
containing fluids in the bottle increases the risk of dental
caries
Bibliography
 Feeding and nutrition of infants and young children.
Guidelines for the WHO Region with emphasis on
the former Soviet counties. WHO Regional
Publications, European Series, No.87. 2002.
 Handbook of pediatric nutrition (3th edition) 2005,
pag. 76 – 103.
 Nelson. Essential of pediatrics (5th editions) 2003,
pag. 131 – 139.